Sign a healthcare proxy today

Sign a healthcare proxy today

On June 1, a new law goes into effect here in New York State called the "Family Health Care Decision-Making Act." It's meant to protect us should we ever become unable to make our own healthcare decisions.

The law will set up a priority list of decision-makers for us that hospitals will have to follow in order to make our medical decisions, including decisions about life-sustaining treatments.

It starts with a spouse; if the spouse is unwilling or unavailable, it moves on to a child, then a parent and so forth. These "family decision-makers" will be required to make decisions based on our previously-expressed wishes and in accord with our religious and moral beliefs.

If those wishes and beliefs are unknown or vague, the decision-maker can use "substituted judgment" - substituting their judgment for ours, doing what they feel is in our best interests.

The law contains some good criteria for determining best interests, including consideration of the dignity and uniqueness of every person, the possibility of preserving life, the restoration of health and the relief of suffering.

In order to discontinue life-sustaining treatments, the law provides that some rigorous standards be met, and even borrows from our Catholic tradition in recognizing that "extraordinary burdens" must be considered in the decision-making process.

The implementation of the new law will be interesting to monitor, to determine how conflicts among family members will be resolved and whether the conscience rights of hospitals will be protected.

It's not a perfect law, but legislation is an imperfect instrument. Only God's laws have no loopholes.

For me, the enactment of this law highlights the value of signing a "healthcare proxy." The proxy is a simple form you can complete now, while you're competent, to designate someone to help make healthcare decisions for you should you ever become incapacitated.

It makes so much more sense to appoint your own decision-maker using a proxy, rather than letting the law appoint one for you under the new Health Care Decisions Act.

A proxy enables your designated "healthcare agent" to make all medical decisions, including life-sustaining treatment decisions. It allows decisions to be made about artificially-provided food and water only if you have specified your wishes about them.

The proxy form allows you to make statements about your treatment preferences: for example, it enables you to specify that you wish to follow the teachings of your Catholic faith.

You can state that you wish to receive all care that is considered morally obligatory, but refuse treatment that would be excessively burdensome and outweigh the benefits. (For good language in writing a healthcare proxy, see the "Catholic Guide to End-of-Life Decisions," available from the National Catholic Bioethics Center at 215-877-2660 or www.ncbcenter.org.)

The key is appointing someone you trust to be your agent: someone who knows you well, respects your faith, is of good moral character and operates well under stress.

Legal since 1990, the proxy is really the preferred advance care directive in our state. "Living wills" are legal, but not very flexible or practical; they require you to put down on paper today your wishes for tomorrow - wishes about an unknown medical condition in an age of rapidly-advancing medical interventions.

The living will is likely to be outdated before the ink dries. A healthcare agent, on the other hand, is a living, breathing implementer of your wishes.

Consider that none of the highest-profile end-of-life cases in this country involved elderly or terminally ill patients: In 1975, Karen Ann Quinlan suffered irreversible brain damage at the age of 21; in 1983, Nancy Cruzan was in a car accident that put her in a "persistent vegetative state" at age 25; in 1990, Terri Schiavo was 26 when she suffered a mysterious cardio-respiratory arrest.

We should prepare now for that illness or injury that may come along wherein we face difficult medical decisions and want to make them responsibly, in accord with our faith.

(Kathleen Gallagher is director of pro-life activities for the New York State Catholic Conference, which advocates for the state's bishops on public policy issues.)

(05/27/10)