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Helping Catholics deal with life, death.

Booklet goes into second printing of 5,000 just more than a month after its debut

ST. PAUL, Minn. -- A small booklet, written in simple language to help Catholics and others deal with advance medical directives about life-or-death decisions, is going into its second printing of 5,000 just more than a month after its debut.

The first 5,000 copies of In Life and Death We Belong to the Lord: Considering Advance Medical Directives were distributed quickly throughout the nation.

"It's been widly successful," said Janet Krocheski, author of the 21-page, large-type booklet. She directs the St. Paul-Minneapolis archdiocese's Respect Life Office and its Division of Outreach to racial minorities, women, family life, the deaf and other groups.

Krocheski began writing the booklet in October 1991, shortly before the federal Patient Self-Determination Act went into effect in December.

That act requires every medical facility that receives federal funds -- "and that's almost all of them because of Medicare," she said -- to ask people being admitted whether they have an advance medical directive and, if not, whether they would like one. If the patient has a directive, she said, the medical institution must make it part of the patient's medical record.

At the outset of her booklet, Krocheski states that "many of us are afraid that when we reach the end of our lives we will have our deaths needlessly, painfully and expensively prolonged against our will."

She wrote the booklet especially for the elderly who are facing those fears and for their middle-age care-givers.

"Most of the good material that's available -- material which is sound ethically and morally -- is written in terminology that's very difficult for people who don't have a great deal of education to understand," Krocheski told NCR.

As Krocheski worked through 10 drafts, she repeatedly checked with people 75 and older, many poorly educated, to make sure they understood the contents.

The booklet's framework is for Catholics, Krocheski said, but it is recommended to all who share the "Judeo-Christian heritage and concern for the sanctity and dignity of all human life."

The booklet asserts the church's opposition to euthanasia but explains that "refusing or discontinuing useless or unreasonably burdensome medical care is very different from taking our life or allowing someone to kill us."

Intention is "very important," the book says, and Krocheski told NCR that intention was especially important when one was making a life-or-death decision for another. "That is why I suggest that people think about these things ahead of time," she said. Her booklet advises decision-makers to decide for another as they would for themselves.

The booklet advises its readers to weigh burden vs. benefit. "This is basically what the decision-making process boils down to," she said. The booklet states:

"When making a decision to accept or refuse a treatment, we should take into consideration: the type of treatment recommended, how risky or complicated it is, its cost, how painful it will be, its availability, the need to share limited medical resources and how offensive the treatment is to us personally. We should weigh these conditions against the possible benefit we expect to receive from the treatment we are considering."

Among the options it mentions: "When we are faced with severe pain, we may make use of painkilling drugs even if they shorten our life. The use of these drugs is to suppress pain, not to end life." Another option: "When death is certain in spite of our best efforts, it is acceptable to refuse treatment which would only prolong our dying."

In Life and Death We Belong to the Lord deals with such documents as living wills and durable powers of attorney for medical care.

Living wills are care plans, normally not documents for emergency situations, Krocheski said. "Unless you have a living will on your person, or someone is with you who knows exactly what drawer to find it in," ambulance personnel will not search for it before starting life-sustaining measures, she said.

"I'm not particularly opposed to living wills," she said, but "I don't find them very useful. And studies are showing that there isn't any significant difference between the treatment people receive when they have a living will and when they don't."

Living wills must necessarily be vague, Krocheski said, because people cannot anticipate what medical situation will threaten them or what medical technology might be available to treat it.

People who want a living will can obtain samples from a hospital or their state department on aging -- most states have living-will legislation, but provisions differ, she said -- and the American Medical Association "puts out a very good living will, quite detailed." People need to let others know where it is and to provide their physician with a copy for their medical records.

Krocheski said she thinks a healthcare professional would be a more useful assistant than a lawyer or notary to someone filling out a living will, although the writer does need a witness.

She recommended that people consider instead establishing "a durable power of attorney for medical care," a proxy. "And that's simply a matter of assigning the right to make your medical decisions for you to another person" should you be unable to make a decision.

The proxy should be "someone you've talked to, who understands where you are at philosophically," religiously and spiritually, whether that be a family member, a friend or a care-giver. The proxy would say yes or no to a treatment, also taking into consideration the person's disease and total physical condition as well as the technology available, Krocheski said.

Whatever an individual's choice, he or she "should not rely too heavily on the written form," she said. "Absolutely nothing can replace communicating with others about your wishes."

She advised listening as well as talking, especially to children who may express preferences about their care in a crucial situation. Parents do not always die first, she noted, yet often people do not listen to their children because the possibility of their death is so repugnant.

Krocheski recommended that people write down their spirituality and theology, reflections on their life and death. "That could very well be the very last gift we ever give people who care about us," she said.
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Title Annotation:booklet, 'In Life and Death We Belong to the Lord: Considering Advance Medical Directives'
Author:Gibeau, Dawn
Publication:National Catholic Reporter
Date:Feb 5, 1993
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