We have received several inquiries regarding our policy position on Advance directives. To better educate the public on the position of the Texas Bishops on this issue, we've prepared the following article below. You can also find links to more information on this issue below the article. 

We support reform of the current law as follows:

• Including nutrition and hydration as ordinary care, unless they cannot reasonably be expected to prolong life or when they would be excessively burdensome for the patient;
• Providing better and more compassionate communication to the family when there is a disagreement between the physician and family over treatment, including a review of the ethics committee composition;
• Extending the period of time of transfer to beyond the current ten days, but with a firm deadline rather than requiring treatment pending transfer when an ethics committee agrees with the physician that continued medically inappropriate treatments and interventions should be discontinued; and
• Reinforcing and continuing the rights of licensed providers not to provide medically inappropriate treatment.

Our overarching position on this issue is that the patient and his or her family should be the first, but not only concern of legislation impacting end-of-life care. Issues related to the death experience are profoundly important not only to patients, families, and communities, but also to the health care professionals who are involved, and who want to provide the most compassionate care possible. Respect and care for the life and personal dignity of the dying patient is the goal of every individual and institution involved in this process. The instances when this law comes into play are under the circumstances of a patient in the active dying process.

Some have incorrectly characterized our position as allowing euthanasia.  This is not accurate.  Euthanasia involves the deliberate intent to kill a human being.  It is always morally unacceptable and is a serious violation of God’s law.  A dignified natural death occurs without human intervention that would deliberately cause or hasten the patient’s death.  In the cases governed by the Advance Directives statute in Texas, the cause of death is not euthanasia or the direct action or inaction of the physician, but instead the cause of death is the patient’s underlying disease or injury.

The following excerpt from the Ethical and Religious Directives for Catholic Health Care Services #56 and #57, is very helpful. It states, "A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community (56).”

“A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient's judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community (57)." For example, we support reform of the current law, including the inclusion of nutrition and hydration as ordinary care, unless it cannot reasonably be expected to prolong life or when it would exacerbate a major medical condition.

There are times when a patient or a patient’s family does not want to accept that death is imminent and inevitable, but the view of the physician and the hospital ethics committee is that continued medical intervention will artificially delay death with no real benefit to the patient, or even worse, at the cost of further and severe suffering to the patient.  Aggressive medical treatment under these circumstances is neither justifiable nor acceptable from any perspective.

A helpful resource book on this issue, "A Will to Live: Clear Answers on End of Life Issues," by Archbishop Gomez, is available from Basilica Press. In it, he explains that there are times when a medically ordinary method may not always be ethically proportionate in all situations to which it may be theoretically applied. "Refusing to use an ethically disproportionate method is an expression of acceptance of the human condition in the face of death...it is important, then, to know how to distinguish when a given method is proportionate and when it is disproportionate."

Furthermore, Archbishop Gomez explains what should be included in the living will or advance directive of a Catholic.“The document must explicitly exclude any form of euthanasia, as well as reject an abusive and irrational extension of the death process.  It must also insist that the patient receives medical treatments that are proportionate to his or her clinical situation, with no therapeutic cruelty, neglect, or with withdrawal of normal methods of care such as nutrition, hydration, shelter, or warmth” Answer to Question 24, p. 55. emphasis is our own.

This book was used extensively in the preparation of this document.

For more information, you can read our policy paper on this issue here. 

You can also read the article "Does the Catholic Church have doubts about brain death" by Fr. Tadeusz Pacholczyk, Pd.D., Director of Education at the National Catholic Bioethics Center on the Diocese of Corpus Christi's web page here.

Click here to view other resources related to this issue.