Don't Rely on Just Written Instructions -- Appoint a Health Care Agent
by Christopher Dodson
Executive Director, North Dakota Catholic Conference
September 2005

Do you have someone who cares about you? Would you want that person to make health care decisions for you it you were unable to? If you answered “yes” to these questions, you probably should fill out a health care directive and appoint that person as your health care agent.

The Terri Schiavo case, changes in North Dakota’s law, and some speeches in the last year of Pope John Paul II’s life have resulted in many questions about advance directives, living wills, Catholic teaching on end-of-life care, and the law. During the next few months, information answering many of these questions will come from a variety of sources, including the state’s dioceses and the North Dakota Catholic Conference. For now, I want to explain and emphasize this one point – if you have someone who cares about you, you should have a health care directive that appoints the person as your agent. You should not have just a document that only states your wishes.

An explanation of terms is in order. A person can have a document that states in writing what the person wants done if he or she cannot communicate. This type of document is most often called a “living will,” but has also been known as a “health care directive.” If the document only states what you would like done, but does not also name a person to make decisions for you, this the type of document you do not want.

Why, in most cases, would you not want just a living will?

To begin with, a living will asks you to predict your future medical condition and future medical treatment options. This is practically impossible. No two people are ever in identical physical conditions since everybody is unique. Moreover, medical treatment and care options are always changing and can vary from place to place. These two facts should particularly concern Catholics since the morality of medical acts typically depends upon the circumstances unique to that patient and the options available at that place and time.

Second, by relying on just a living will, you are asking a health care provider to interpret what you wrote at another place and time. The problems inherent here are compounded by the fact that the physician may apply a medical interpretation to something that you wrote with a layperson’s understanding – or, maybe worse, your lawyer wrote with a legal viewpoint.

So, the next time you go to the hospital or a medical clinic and someone asks, “Do you have a living will?” tell him or her that you do not, but that you want to appoint a “health care agent.”

A document that appoints someone to make decisions for you has been called a “durable power of attorney for health care.” Sometimes it is called a “proxy,” or “surrogate” document. North Dakota law now calls all types of advance directives a “health care directive” and the person appointed a “health care agent.”

Why would you want to appoint a health care agent?

Well, your agent, presumably, is someone you trust. In addition, under the law, the agent has to do as you would have wanted, in accordance with your wishes and moral and religious beliefs. If the agent does not know what you would want, he or she must act in your best interests. Most important, the agent can make a decision based on your actual condition and the treatment and care options actually available.

You can, of course, include in your health care directive some specific instructions for your health care agent. It is probably best, however, to leave your agent some discretion for interpreting those instructions – just as you would if you could speak for yourself. You can also include in your health care directive principles to help your agent, such as, “I want all decisions concerning my care to be in accordance with the teachings of the Catholic Church” and “If I should become irreversibly and terminally ill, I request to be fully informed of my condition so that I can prepare myself spiritually for death and witness to my belief in Christ’s redemption.”

No one has to have a health care directive. If you have one, however, make sure that it appoints a health care agent to make decisions for you. If you have a living will – one that does not appoint an agent – give serious consideration to revoking it and executing a health care directive that appoints a health care agent. So long as there is someone out there who cares about you, there is no excuse not to.