Of proxies and POLSTs: The good and the bad in end-of-life planning

Fr. Tadeusz Pacholczyk

Planning for end-of-life situations is important. We should put in place an advance directive before our health takes a serious turn for the worse and we are no longer able to indicate our own wishes or make our own decisions. Advance directives can be of two types: living wills and health care agents.

The best approach is to choose a health care agent (a.k.a. a “proxy” or a “durable power of attorney for health care”). Our agent then makes decisions on our behalf when we become incapacitated. We should designate in writing who our health care proxy will be. The National Catholic Bioethics Center (www.ncbcenter.org) and many individual state Catholic conferences offer helpful forms that can be used to designate our proxy. Copies of our completed health care proxy designation forms should be shared with our proxy, our doctors, nurse practitioners, hospice personnel, family members and other relevant parties.

In addition to choosing a health care proxy, some individuals may also decide to write up a living will in which they state their wishes regarding end-of-life care. Living wills raise concerns, however, because these documents attempt to describe our wishes about various medical situations before those situations actually arise, and may end up limiting choices in unreasonable ways. Given the breathtaking pace of medical advances, a person’s decisions today about what care to receive or refuse may not make sense at a later timepoint. In the final analysis, it is impossible and unrealistic to try to cover every medical situation in a living will, and it is preferable to have a proxy, a person we trust, who can interact with the hospital and the health care team, weigh options in real time, and make appropriate decisions for us as we need it.

A new type of living will known as a “POLST” form — a tool for advance planning — also raises concerns. The POLST form (which stands for Physician Orders for Life Sustaining Treatment) is a document that establishes actionable medical orders for a patient’s healthcare. The form is typically filled out with the help of trained “facilitators” — usually not physicians — who ask questions about patients’ health care wishes, and check boxes on the form that correspond to their answers. The facilitators receive training that can lead them to paint a rather biased picture of treatment options for patients, emphasizing potential negative side effects while side-stepping potential benefits or positive outcomes.

POLST forms thus raise several significant moral concerns:

1. The approach encouraged by the use of POLST forms may end up skewed toward options of non-treatment and may encourage premature withdrawal of treatments from patients who can still benefit from them.

2. Filling out a POLST form may preclude a proxy from exercising his or her power to protect the rights of the patient, since the form sets in motion actual medical orders that a medical professional must follow. As a set of standing medical orders, the POLST approach is inflexible. Many POLST forms begin with language like this: “First follow these orders, then contact physician or health care provider.” Straightforwardly following orders created outside of a particular situation may be ill-advised, improper and even harmful to the patient.

3. In some states, the signature of the patient (or his or her proxy) is not required on the POLST. After the form has been filled out, it is typically forwarded to a physician (or in some states to a nurse practitioner or a physician’s assistant) who is expected to sign the form. Thus, in some states, a POLST form could conceivably be placed into a patient’s medical record without the patient’s knowledge or informed consent. In a recent article about POLST forms in the Journal of Palliative Medicine, approximately 95 percent of the POLST forms sampled from Wisconsin were not signed by patients or by their surrogates. Fortunately, in some other states like Louisiana, the patient’s signature or the signature of the proxy is mandatory for the form to go into effect.

The implementation of a POLST form can thus be used to manipulate patients when they are sick and vulnerable, and can even lead to mandated orders for non-treatment in a way that constitutes euthanasia. The POLST template represents a fundamentally flawed approach to end-of-life planning, relying at its core on potentially inappropriate medical orders and dubious approaches to obtaining patient consent.

Notwithstanding the pressure that may be brought to bear on a patient, no one is required to agree to the implementation of a POLST form. Patients are free to decline to answer POLST questions from a facilitator, and should not hesitate to let it be known that they instead plan to rely on their proxy for end-of-life decision making, and intend to discuss their healthcare options uniquely with their attending physician.

 

COMING UP: New Catholic school leaders rise to the challenge

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There’s never been a more exciting time than now to be a student at one of Denver’s Catholic schools.

With robust curriculums that form the whole person and a variety of educational models to choose from, Catholic schools are a great option for parents seeking more for their children’s education.

Even more exciting are the various education professionals who are stepping into leadership roles beginning this new school year. These are individuals are who are passionate about Catholic education and even more passionate about partnering with parents, the primary educators of their children, to help lead their kids to an encounter with Jesus Christ.

The nine new leaders featured below bring a wealth of experience to their new roles, and they are each excited to rise to the challenge of making Denver’s Catholic schools the absolute best they can be at helping to form students into authentic disciples of Jesus Christ.

Andrew Beach
Our Lady of Lourdes (South Campus)

Andrew Beach credits much of his call to the teaching vocation to his parents, who are both teachers themselves. Beach studied economics and philosophy at University of Colorado Boulder and then went on to pursue a master’s degree in theology from the Augustine Institute. “From the second I heard about Lourdes and all that us going on here in terms of its classical education and strong Catholic identity and culture, I knew it was the school where I wanted to teach,” Beach said. As a result of the school’s expansion, Beach is now the Head of School for Lourdes’ South Campus. In his new role, he hopes to assist in guiding Lourdes toward academic excellence, but more importantly, he hopes to foster an authentic and strong Catholic identity within the schools.

Robert Bernardin
St. Bernadette

When St. Bernadette announced they were pausing their operations last year, Robert Bernardin saw it as an opportunity. Having previously worked at Annunciation Catholic School, an Expeditionary Learning (EL) school, Bernardin became very excited when St. Bernadette decided to re-launch as an EL school, joining Annunciation and St. Rose of Lima as the only Catholic EL schools in the nation. “I was immediately drawn to St. Bernadette because I believe deeply in the power of EL to elevate Catholic schools,” Bernardin said. Bernardin believes that Catholic education is transformative, and as principal of the re-launched St. Bernadette, he is “keen to expand our view of what is possible in Catholic schools, to serve as a model of what Catholic schools can be and inspire others to follow our lead.”

Kellie Carroll
Bishop Machebeuf High School

For Kellie Carroll, being at Bishop Machebeuf High School is a bit of a homecoming for her. She’s been in education for 20 years, starting at St. Pius X in Aurora and then moving on to teach for several public schools before finding her way back to the Archdiocese of Denver. However, she was also educated in Catholic schools growing up and graduated from Mullen High School. “This is a system that certainly raised me and had a profoundly positive impact on both my academic and faith formation,” Carroll said. As the interim principal at Bishop Machebeuf High School, Carroll hopes to help prepare students for life outside of the school walls. “I firmly believe a solid formation in the faith and a rigorous academic setting will prepare them for the adventure and challenges life will bring,” she said.

Gretchen DeWolfe
St. Thomas More

Gretchen DeWolfe has taught 5th grade at St. Thomas More Catholic School for the last five years and will now be entering her sixth year as the school’s new principal. “In my new role as principal, it is my duty to support parents, the primary educators, in forming their children through encounters with Christ, which will in turn deepen that beautiful and essential relationship,” DeWolfe said. Being in Catholic education is more than simply a job for DeWolfe — it is a calling. “My heart has always been in Catholic schools … It is an amazing gift to be able to teach and live the Catholic faith on a daily basis,” she said. “[This] is what I have chosen to dedicate my life to — teaching and living the truths that Jesus taught us.”

Dana Ellis
St. Louis (Louisville)

Dana Ellis worked in Jefferson County Public Schools for over 30 years, 18 of which were as a principal, and then went on to work in Boulder Valley Public Schools for several more years until she retired. After “walking around in the desert” for a couple of years, Ellis now finds herself as the new principal of St. Louis Catholic School in Louisville. As she embarks on this new foray into Catholic education, Ellis is confident that God will continue to lead St. Louis down the path it needs to go in order to continue forming authentic disciples of Jesus Christ. “I do know that God will lead the way, but I don’t know what that way is going to be yet,” Ellis said.

Eric Hoffer
Christ the King

Before starting his career in Catholic education, Eric Hoffer had plans to complete a degree in political science and attend law school. “However, God had other plans in place for me,” Hoffer said. He converted to Catholicism while in college, and after graduation, volunteered with the Brothers of the Sacred Heart, where he “fell in love with education and my faith.” He’s had a 16-year career in various roles in education thus far, and recently completed his graduate degree in Educational Leadership at the University of Notre Dame. He feels fortunate to lead Christ the King Catholic School as principal. “If I am able to help each of our students understand that they are beloved children of God and that he has a beautiful plan for their lives, then I will have made a valuable contribution to our archdiocese,” Hoffer said.

Steve Vaughn
St. Therese

Steve Vaughn began his career as a teacher teaching 4th, 5th and 6th grade at a few different Catholic schools in Wisconsin and Nebraska. Over the last 10 years, he’s been a teacher and assistant principal at a Denver charter school, but he’s now answering a call from the Lord to return to Catholic education. “Having worked in both Catholic and public schools, I can say that Catholic schools truly provide an education for the whole child,” Vaughn said. Speaking for his new role as principal at St. Therese, Vaughn shared, “Our goal at St. Therese is to create saints! It’s an honor and blessing to be tasked with fulfilling this mission at my school. This is exciting, challenging work, but there’s no other work I’d rather be doing.”

Tamara Whitehouse
Our Lady of Lourdes (North Campus)

Tamara Whitehouse has worked in both public and Catholic schools for over 20 years. More recently, she has also served as an instructor for the Denver Catholic Biblical School. Her transition from public schools to Catholic schools came after taking time to stay at home with her children when they were young. “We discerned God’s call to send our children to Catholic schools, and then my own deepening faith and desire to instill a love for God in young people led me to follow after them when I returned to work,” Whitehouse said. As she begins her new role as the Head of School for Lourdes’ North Campus, Whitehouse hopes to “support families in the formation of their children to know, love and serve God, and this contribute to the renewal of Catholic culture that is so desperately needed today.

Father Stefan Zarnay
St. Mary’s (Littleton)

Born in the Slovak Republic and ordained a priest just last year, Father Stefan Zarnay is part of the Disciples of Jesus Christ, the religoous order that oversees St. Mary’s Catholic Parish in Littleton. He met them when he was studying for his Masters Degree at the John Paul II Pontifical Institute in Rome, Italy. He has previously served as Chaplain of the Stella Maris — La Gavia Catholic School in Madrid. In addition to being the interim principal of St. Mary’s, he is also the school’s chaplain and the parish’s new parochial vicar.

Ann Zeches
St. Catherine of Siena

For Ann Zeches, education is a second career. Prior to becoming a mom, Zeches was the assistant general manager of a resort. It was when her children were in school that the seed for Zeches’ career in Catholic education was planted. “What I thought teaching entailed, and the reality are two different things,” Zeches said. “Education is the toughest job I have ever experienced, but the one with incredible rewards. Education has become my passion.” In her new role as principal at St. Catherine of Siena, her goal is simple: “I am forming students to know the ‘truth’ of our faith and how to infuse it into their lives. Ultimately, then, they will be well-educated disciples of Christ longing to meet our Lord in heaven while making their community a place filled with the Spirit.”