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Medical decisions by power of attorney

Advanced Alzheimer’s disease, brain damage or coma from a traffic accident are among challenges that could render a person mentally or physically unable to express any wishes concerning medical care.

And that’s where allowing someone else to make medical decisions through a power of attorney, or POA, comes into play, said Bill Lindsay, an attorney whose specialties include trusts and estates, and a member of St. Leo the Great Parish in Omaha.

"We can’t be guaranteed for the rest of our lives to be capable of making decisions for ourselves," he said.

Those decisions can include deciding to use, refuse or withdraw life-sustaining treatments, Lindsay said.

Under a power of attorney, people appoint an "attorney in fact," someone who can be trusted to carry out their wishes regarding medical care – often a close family member. And a backup should be named in case the first person is unavailable, he said.

For Catholics, medical decisions, particularly involving extraordinary means of extending life, require careful consideration based on moral and medical factors, Lindsay said.

Decisions about health care should be made in close consultation with medical professionals, he said, comparing an intervention’s expected benefits with the possible burdens.

And people can include a "do not resuscitate," or DNR, order, in a document setting up a power of attorney, Lindsay said, indicating that the person does not want to allow extraordinary means of prolonging life.

Provisions about the sacraments also can be included in a POA, he said.

"One other obligation which I think supersedes health care is that most people I talk to want to receive the anointing of the sick and the Eucharist," Lindsay said.

And for Catholics, medical decisions must respect the church’s teachings regarding the sanctity of life, he said. These principles are summarized in a document titled, "Medical Treatment Decision Making," found on the Nebraska Catholic Conference website, necatholic.org.

Considerations include:

Never directly assisting in ending a patient’s life.

Determining when a treatment offers no reasonable hope of benefit or is excessively burdensome.

Administering pain medicine to terminally ill patients only to relieve pain, not hasten death.

Providing life-sustaining treatment for a pregnant patient whenever such treatment can benefit the child.

Never withholding or withdrawing a medical intervention if it results in neglecting the patient. Normal care must always be administered.

Not feeling an obligation to utilize all possible medical interventions, all possible means of prolonging life. Death need not be avoided at all costs.

Two other interventions should not be confused with extraordinary means – providing nutrition and hydration, Lindsay said.

According to Catholic teaching, nutrition and hydration, even if given through artificial means, is considered basic care, and in most cases should not be denied or withdrawn, unless death is imminent.

"There’s a point in the dying process where there’s no benefit and the body can no longer assimilate it," Lindsay said. "The medical rule is, ‘first do no harm.’"

POWER OF ATTORNEY

Working with an attorney to develop a POA is recommended, but people can construct their own, as long as it conforms to state legal requirements. A template called "Catholic Declaration on Health Care Decision Making" is available on the Nebraska Catholic Conference website, necatholic.org.

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