Health Care Directive

In Health Law, we've been working on advanced directives- the things you sign to talk about the medical decisions you want made on your behalf if you become unable to consent to treatments, or lose capacity to give instructions, and we had to draft our own. It was very tough- trying to put Church teachings on end of life care into words- I don't know that I succeeded in mine- I'm not signing it until I think about it some more, but it's really important. (Once I figure out how to draft mine, I will post it)

The first thing I want to say is be very, very, very careful as to how you word these. The second thing I want to say is make sure you ask your lawyer (if you are using one) what he uses to make them up. If he says the firm uses a precedent, you need to be very careful in the instructions you give, and ensure that you read over it and ask LOTS of questions about what it entails. Why? Because many directives do not follow the teachings of the Church regarding end of life care.

When you are coming up with your instructions, take time to think it through. Talk to a priest you trust. Do not let anyone (the lawyer, the home care facility, the hospital) rush you, because it is important. The following are my thoughts on what you should include, but please don't consider this exhaustive advice- it is merely information you need to consider. If you already have an advanced directive (also known as a health care directive) please review it.

As Catholics, we need to ensure that we don't allow our health care directives to permit passive assisted suicide (which is legal in most countries, including Canada and the US). Passive assisted suicide is removing or withholding treatments and allowing someone to die. Those treatments can include basic things like food and water. If that is removed, you starve/dehydrate to death. This is an inhumane practice, but is allowed.

For women, you want to include a clause regarding what you want done if you are pregnant.

When you appoint a proxy (a person who will make decisions in the event you cannot), make sure you choose someone who will make decisions in line with church teachings. If you want, you can explicitly state that they have to make decisions based on Church teachings.

Do you want to donate your tissues for therapeutic purposes? For medical research?

This is not a long list, but just some of the things I am considering for mine. As a final plug, I want to advise everyone to ensure they have a will, power of attorney and a healthcare directive, and advise you to get them drafted by a lawyer to ensure they meet all the legal requirements. Don't think that just because you are young, you don't need one. None of us know when we will be called home to God, and I ask you prepare your affairs so your family (who will be grieving) doesn't have to think about these things.

In the case of all of them, if you don't plan ahead, the courts can make the decisions for you, and that should scare you more than anything else I can say. J Also- please discuss these issues with your family- they NEED to know what your wishes are in advance.

Finally, if you envision you health care directive being needed sooner rather than later (or you have family who might need it) let them know that EMS personal are trained to look on the fridge for a plastic pouch containing the directive. If you've got questions, don't hesitate to ask.

And just when I thought I'd heard it all...

I learned something very scary in Health Law today. Apparently it was common practice, up until about 10 years ago, for medical students to do unauthorized pelvic examinations on anesthetized female patients for learning purposes. The women who were victims of this wouldn't even know that it had been done. Some teaching hospitals still follow this practice, but many have changed their policy- not because the doctors found it to be unethical, but because the students have a problem with it. Good for the students for standing up against this, but what are the professors and practitioners doing the teaching thinking?

The medical rationale is that med students need to learn how to do proper pelvic exams, and that takes practice. Pelvic exams are one of the most private exams women undergo, and few will consent to one by anyone other than their doctor. A pelvic exam conducted by someone who hasn't had a lot of practice can be very painful for the woman involved. Unconscious, anesthetized women are the perfect practice subjects because they are relaxed.

For an in depth discussion of this, see: http://www.cnn.com/2003/HEALTH/03/11/pelvic.exams.ap/

My problem with this practice is the fact that the women (and some men in the case of prostate exams) involved have not had the opportunity to consent to this procedure. We are all autonomous beings with the right (assuming we have capacity) to determine what we want done to our bodies, and to consent to it. As Justice Cardozo famously stated in Schloendoff v. Society of New York Hospital, 211 N.Y. 125(1914), "Every human being of adult years and sound mind has the right to determine what shall be done with his own body."

An unauthorized pelvic exam violates the right of women, and, in my opinion, should constitute a battery, actionable in a civil suit. Some hospitals have included this in their general consent form, but it's not explicitly stated, and is generally just covered by a general clause stating that teaching may occur in the surgical process. I have no problem with these exams if the women explicitly consent to it, but without informing them, they are being violated. I won't go as far as some commentators and call it rape, because I think that is a very different situation, but it is battery.

I guess the bottom line is that before you undergo any surgery where you will be anesthetized, discuss this with your doctor, and make it very clear that you do or do not consent to such an exam. All in all, the best thing you can do is ask as many questions as you can so you know exactly what the doctor intends to do to you.