County group aids in advanced care planning6 min read

Jenny Snarski
Catholic Herald Staff

When Nancy Deda, a hospice social worker in the Phillips area, was looking for ethical guidance on a specific case in early 2001, she didn’t know where to turn or who to ask. A few inquiries led her to Susan McCarthy, a clinical ethicist at Ministry Health Care. Deda’s experience spurred interest in developing a community bioethics committee.

A committee on bioethics

With McCarthy’s wisdom and compassion and a committed group of individuals’ persistence, the Community Bioethics Committee of Price County was established in 2002. They are one of only a handful of similar community-based committees in the entire United States. Deda, now retired, was the first chair of the committee whose members include local clergy, physicians, medical professionals, social workers and attorneys.

The make-up “worked very well because you do have so many different voices and people that can bring different frames of reference,” Deda said. While many hospitals have formed healthcare ethics committees, most are made up solely of doctors.

Through collaboration of agencies and interested members of the community, the committee’s first major project was a medical power of attorney form. Based on Gunderson Healthcare System’s “Respecting Choices” program and, with both medical and religious input, they met their goal of developing a user-friendly and thought-provoking form.

Acknowledging the difficulties most people have in understanding legal jargon, Deda added, “The Wisconsin form was written by attorneys. Well, attorneys aren’t the one sitting in the hospital with that patient when they’re dying, and you’re having to make choices.”

The forms they created offer an overview of what a Health Care Power of Attorney form does and does not do, how to complete it and what to do afterward so that the parties involved have a clear understanding. It includes basic instructions for care as well as special provisions or limitations – applicable in the case that a person is unable to make medical decisions for themselves.

In addition, the committee developed an adapted version, still meeting the Wisconsin legal requirements, but with even more user-friendly language for persons with limited education or developmental disabilities. Deda said she has used this “really handy” form several times as a social worker.

With education as the primary goal, the committee expanded their efforts and came up with a “Final Affairs Guide” covering a complete array of topics to discuss and worksheets to combine pertinent medical, financial and personal wishes information in one document. These guides were made available throughout the community, in particular with local hospice providers and Veteran’s services. Deda called this effort “one of the biggest ways we’ve gotten education out.”

She hopes others would see the importance of bioethics and the need to form similar community coalitions.

Catholic values for end of life care

Julia Ruff, who became the committee chair in 2014, shared some of the advice they were given by McCarthy: “If you’re doing your education right, you shouldn’t have as many (consultation) scenarios that come up, because people are going to have the information ahead of time.”

Ruff confirmed that the committee’s main focus has been education, although they do offer case consultation services – “ethics regarding end of life and advanced planning is really where the rubber meets the road,” she said.

Advanced planning “saves the family so much pain, and indecision and in-fighting sometimes,” Ruff said. “I tell people when I help them do the advanced care paperwork – this is a gift to your children, to your family.”

A committee member from the beginning, Diocese of Superior priest Fr. Jerry Hagan spoke to the inclusion of Catholic values in the advanced planning process.

He is pleased the medical community has increased their efforts in “pushing advanced care planning; however, their document doesn’t have Catholic values reflected in it.” The Phillips cluster pastor gave his input for a form the committee worked on to include a “values statement.” Through that process he discovered the Wisconsin Catholic Conference had just the resource they were looking for.

But he is concerned that most Catholics don’t know about it.

Published in March 2014, the document was revised in August of that year. The introductory letter, written by the Wisconsin bishops, says their effort was in response to numerous inquiries for a care planning document “that is true to Catholic principles and provides greater clarity for decision makers regarding treatment options.”

The bishops continue, “No one tool can provide certainty, nor replace the vital conversations that must occur between loved ones. However, this addendum, designed for use with the Wisconsin Power of Attorney for Health Care (POAHC) document, can help you communicate your desires in a manner consistent with our Catholic faith.”

Fr. Hagan stated that the Wisconsin Medical Association has been pushing their “Honoring Choices” document, also made public in 2014; “However, their document doesn’t have those Catholic values reflected in it … ‘Honoring Choices’ tends to use a subjectivist view of quality of life.

“You can’t base your healthcare decisions on subjective things – there have to be norms that guide that process,” the priest said.

The Catholic Addendum includes clarification of the use of ordinary versus extraordinary mean to preserve life, as well as proportionate versus disproportionate. This second determination can be summarized as means “that offer a reasonable hope of benefit” and “do not entail an excessive burden or impose excessive expense.” It clarifies further that “medically assisted nutrition and hydration become optional when they cannot reasonably be expected to prolong life, or when they would be excessively burdensome for me, or would cause significant physical discomfort, for example resulting in complications in the use of the means employed.”

Financial burden, the document says, “should only be considered when the administration of this means cannot be expected to prolong my life or lessen significant physical discomfort.”

It also speaks in opposition to deprivation of consciousness without a compelling reason, to suicide and euthanasia, use of comfort measures and medications – even if the therapy may indirectly shorten life.

The addendum includes a request for attendance by a Catholic priest for last rites and a space for other personal inclusions.

This form is available at www.wisconsincatholic.org under the Resources tab. The link is called “Addenda to Power of Attorney for Health Care” and includes various helpful and informative resources. For those living outside of Wisconsin, a website made possible by an Our Sunday Visitor grant and put together by the New York State Catholic Conference, offers available resources searchable by state. This can be found at www.catholicendoflife.org. The site also offers general explanations of terminology and Church teaching.

Fr. Hagan encouraged reflection on death in light of the Christian understanding, and acceptance of it as the natural end of life, but Ruff said she knows a lot of Catholics who are still confused about the moral acceptability of advanced directives.

“Catholics need to know that exists,” Fr. Hagan iterated. He also said each parish priest should have the knowledge and available resources for pastoral consults of a medical nature.

Ruff said she was shocked when, after all the committee’s efforts to come up with a Catholic resource, she found one. “Then I was shocked because I’d never heard of it,” she added.

The Community Bioethics Committee of Price County maintains a public Facebook page at www.facebook.com/pricecobioethics/. Voice messages – checked daily – may be left at 715-339-1994 for further questions or information.