Ethics - Encouraging Conversations on Health Care Decisions

March-April 2020


Nathanial Blanton Hibner

April 16, 2020, is National Healthcare Decisions Day, an event that "exists to inspire, educate and empower the public and providers about the importance of advance care planning."1 As leaders in the Catholic health care ministry, we, too, are encouraged to promote conversations about one's health care decisions. In part three of the Ethical and Religious Directives for Catholic Health Care Services, Directive 24 states our requirement to "make available to patients information about their rights, under the laws of their state, to make an advance directive for their medical treatment.2 To follow this directive is to ensure that patients' decisions are honored and that their inherent dignity is upheld when their decision-making capacity has been lost.

Even though the importance for one's planning is known, the facts show that most people still do not take the time to fill out the necessary forms. According to a study by the U.S. Agency for Healthcare Research and Quality, less than 50 percent of patients with a severe or terminal illness had an advanced directive in their medical chart. Of those, only 12% had discussed the writing of their document with a physician. This led to the majority of physicians, 65 percent to 76 percent, unaware that their patients even had an advanced care document.3

How can we help to change these statistics? Several organizations share our mission of promoting conversations about health care decisions. As mentioned in the beginning of this text, National Health Care Decisions Day is not only an event but an organization with resources to educate people about advanced care planning. You can visit their website at https://nationalhealthcare-decisi.squarespace.com.

Another resource is designed to focus on positive attributes to one's end-of-life experience. Jim Towey, who developed the resource, labeled them the Five Wishes. In this process, the person is encouraged to discuss their spiritual needs, speaking about prayer, forgiveness and reconciliation. The program has become popular in Catholic nursing homes and diocesan workshops on end-of-life as well as in hospice and palliative care departments. You can learn more at his website, fivewishes.org.

A third group promoting advanced care planning is The Conversation Project. This organization is "dedicated to helping people talk about their wishes for end-of-life care." Their website provides countless resources, such as starter kits with example documents that include fill-in-the-blank guided questions, a series of scales that will help one home in on what is truly important for their care, and answers to common legal and ethical questions. All of this can be downloaded for free at theconversationproject.org.

Finally, CHA also has created excellent resources on these topics. Available for download through our website or ordered in the online store, these three brochures, in both English and Spanish, discuss a variety of topics regarding end-of-life planning.

  • "Palliative Care and Hospice: Care Even When We Cannot Cure"
  • "Advance Directives: Expressing Your Health Care Wishes"
  • "Teachings of the Catholic Church: Caring for People at the End of Life"

These three brochures highlight the Catholic views regarding end-of-life care, treatment and planning. They are excellent documents to be shared with patients, families and parishioners. They can be found on website at chausa.org.

We will all face a time when our journey here on Earth is at an end. It is a time of great unknown and will be different for each of us. As our Catholic faith has taught us, we should prepare ourselves. Having conversations with loved ones about our hopes for transition into the next life is not only to protect ourselves but also gives comfort and strength to the decision makers. Preparing advance care documents helps to guide those who may have to decide for us. Would it not be better for them to feel confident in their decisions?

NATHANIEL BLANTON HIBNER, PhD, is director, ethics, for the Catholic Health Association, St. Louis.

  1. "About Us," National Healthcare Decisions Day, https://nationalhealthcare-decisi.squarespace.com/about#about-us.
  2. Ethical and Religious Directives for Catholic Health Care Services, United States Conference of Catholic Bishops, Fifth Edition, http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-Catholic-Health-Care-Services-fifth-edition-2009.pdf.
  3. Barbara L. Kass-Bartelmas and Ronda G. Hughes, "Advance Care Planning: Preferences for Care at the End of Life," Journal of Pain & Palliative Care Pharmacotherapy 18, no. 1 (2004): 87-109.

Ethics-Encouraging Conversations on Health Care Decisions

Copyright © 2020 by the Catholic Health Association of the United States

For reprint permission, contact Betty Crosby or call (314) 253-3490.