Catholic Moral Guide to Completing the State of Hawai’i POLST (Provider Orders for Life-Sustaining Treatment - Hawai’i)
Prior to reading this, read “A Provider’s Guide to POLST” from by Kōkua Mau. General Comments
POLST can be a means of respecting human life and human dignity — if used properly. Some people mistakenly believe that the only way to respect human life is by prolonging it. This is not Catholic teaching. There are times when respecting life and human dignity calls for no longer interfering with the dying process.
Catholic teaching statements on POLST across the United States have varied, with some dioceses opposed, some in favor, and some cautious. How the Hawaii POLST is employed in a particular situation could be contrary to Catholic Church teaching. Therefore, caution should be exercised in the use of the Hawai’i POLST.
Everyone (18+) needs an Advance Healthcare Directive (AHCD). However, not everyone needs a POLST. Not everyone over a certain age needs a POLST. Not everyone in a nursing home needs a POLST. Only patients with a chronic debilitating disease, seriously ill patients, or terminally ill patients should consider having a POLST. You should not complete a POLST against your will or if you have doubts. A POLST is always optional.
Section A - Cardiopulmonary Resuscitation (CPR)
Catholic teaching permits patients to have a DNR (do not resuscitate) order when they are in very ill health or are very aged and will not benefit from resuscitation efforts. In fact, CPR can cause grave injury, especially to those who are frail due to advanced age or illness. In these cases, CPR may be declined.
Section B - Medical Interventions
Comfort measures are designed to keep patients as comfortable as possible and include medications to control pain and other symptoms. Comfort measures must be provided and are also included in both the second and third options.
Checking the second or third option carries with it the danger of oversimplifying certain situations. It is best to have your agent (Power of Attorney for Healthcare) selected in your AHCD make these decisions if you are unable.
If you decide to complete this section, you must discuss your selection with your physician.
You are morally obligated to select treatment options that provide proportionate benefits in comparison with the anticipated burdens. In accord with Catholic teaching, you may decide against or withdraw treatment where disproportionate burdens include harmful side effects, are highly invasive, or entail significant discomfort or excessive cost, or where the treatment provides little or no benefit. Physician or Advanced Practice Registered Nurse (APRN) licensed in the State of Hawai’i.(or APRN).
In most cases, antibiotics may not be refused. They are often highly effective in treating infection and can be easily administered in pill or liquid form, including intravenously.
Section C - Artificially Administered Nutrition
Catholic teaching is that nutrition and hydration is presumed to be morally required, even by artificial means, that is, through the use of a feeding tube or IV.
Medically-assisted nutrition and hydration may not be not morally required when one of the following conditions is met:
The patient’s body is unable to digest or use nutrition or hydration.
The provision of assisted nutrition and hydration is excessively burdensome or causes
significant physical discomfort to the patient.
Death is imminent because of the patient’s underlying medical condition. In this case,
withholding or withdrawing nutrition and hydration does not result in starvation or dehydration; death is caused by the person’s underlying condition.
You may only select “No artificial nutrition by tube” if one of these three conditions have been met.
Section D - Signatures and Summary of Medical Condition
A physician (or APRN) is to complete the POLST in discussion with the patient.
It is an abusive practice to hand out the POLST form to patients to complete on their own.
In order to properly give consent to or refuse or discontinue a treatment, you must have adequate knowledge about the nature of the treatment and its benefits, risks, side effects, consequences, costs, and alternatives.
You need to discuss your diagnosis and prognosis with your physician (or APRN) in order to make the choices in sections A-C.
Also discuss the POLST with your family, loved ones and AHCD agents before signing it. Section E. Cross out this section. Be sure, instead, that you have appointed an agent and alternate agent in your ADHD.
Final Comments
Make sure that your POLST and your AHCD instructions are in agreement.
In addition to keeping a current copy of your POLST in an obvious location (e.g., on your refrigerator), provide a copy to your agent and your alternate agent.
Read carefully the “Reviewing POLST” and “Modifying and Voiding POLST” sections at the bottom of p. 2. Always provide your agents with a copy of your most current POLST.
For more information on POLST, go to Kokua Mau’s website https://kokuamau.org/polst/