Compassion & Choices, the nation's largest and oldest nonprofit organization working to improve care and expand choice at the end of life, today marked National Healthcare Decisions Day, releasing new language every American may consider to strengthen their advance directive. The new addendum, My Directive Regarding Health Care Institutions Refusing to Honor my Health Care Choices, is designed to protect patients in the event that they are an inpatient in an institution that will not honor their advance directive due to religious, moral or ethics policies. Individuals might find themselves in such an institution due to an unplanned emergency or because circumstances provide them no other choice.
The addendum addresses potential problems arising from the United States Council of Catholic Bishops' instructions to Catholic providers to disregard health care choices that conflict with Catholic moral teaching. Most recently, the Bishops instructed 624 Roman Catholic-affiliated hospitals, 499 nursing homes and 48 Catholic Health Maintenance Organizations that artificial feeding of permanently unconscious patients is almost always morally obligatory, regardless of advance directive instructions or family wishes.
Adding the language in this addendum:
•clarifies admission to a religiously-affiliated facility does not imply consent to particular care mandated by the institution's religious policies, and
•directs a transfer if the facility declines to follow the wishes outlined in an advance directive.
This addendum is available now on the end-of-life planning page of Compassion & Choices' website: http://www.compassionandchoices.org/g2g
The right to make health care decisions is hollow unless those decisions actually determine the care received. National Healthcare Decisions Day is intended "to encourage patients to express their wishes regarding health care, and providers and facilities to respect those wishes, whatever they may be." It is troubling to think that over 20% of America's health care providers operate under ethical and religious policies that may prevent them from honoring the wishes expressed in advance directives. I suggest that people making an advance directive consider including this addendum, because you just cannot know whether a religiously-affiliated institution will carry out specific end-of-life choices.
The addendum, developed in consultation with experts in hospice and palliative care and elderlaw attorneys, is as follows:
My Directive Regarding Health Care Institutions Refusing to Honor my Health Care Choices
I understand that circumstances beyond my control may cause me to be admitted to a health care institution whose policy is to decline to follow advance directive instructions that conflict with certain religious or moral teaching.
If I am an inpatient in such a religious-affiliated health care institution when this advance directive comes into effect, I direct that my consent to admission shall not constitute implied consent to procedures or courses of treatment mandated by ethical, religious or other policies of the institution, if those procedures or courses of treatment conflict with this advance directive.
Furthermore, I direct that if the health care institution in which I am a patient declines to follow my wishes as set out in this advance directive, I be transferred in a timely manner to a hospital, nursing home, or other institution which will agree to honor the instructions set forth in this advance directive.
I hereby incorporate this provision into my durable power of attorney for health care, living will, and any other previously executed advance directive for health care decisions.
On National Healthcare Decisions Day I encourage Americans - of all ages - to talk with their doctor and loved ones and document their wishes in an advance directive.
People may also want to strengthen their advance directive by addressing the unknown question of whether a religiously-affiliated institution will honor those wishes.
For more information about end-of-life planning, visit Compassion & Choices Good to Go resource page: http://www.compassionandchoices.org/g2g.