It is written for all Maryland Catholics, for those with immediate need for guidance on end-of-life questions, and for those individuals and families who look to the day when they will be presented with such questions. It is also written for clergy and religious who minister to those who are sick and dying, for the health-care professionals who treat them, and for members of the legal profession who help in the preparation of documents that will ensure their treatment decisions are accommodated.

The Maryland Health Care Decisions Act, first enacted in 1993 and amended several times since, established in law Marylanders’ inherent right to make health-care treatment decisions for themselves. The law also reaffirms already existing prohibitions in Maryland law against mercy killing and euthanasia.

According to the Maryland Attorney General’s office, “The pastoral letter’s prudential advice about the use of advance directives is sound. Further, everything in the Catholic Declaration on Health Care Decision Making is consistent with the Maryland law.”

The Maryland Health Care Decisions Act recognizes three types of advance directives:

• a written appointment of a health care agent to make decisions for a patient (sometimes called a durable power of attorney for health care) and/or written instructions about one’s future health care decisions;
  
• written instructions (commonly called a living will) authorizing the provision, withholding, or withdrawal of life-sustaining procedures if the patient is in a terminal condition and death is imminent, or if the patient is in a persistent vegetative state; and
  
• oral instructions regarding the patient’s care, or the patient’s appointment of an agent, conveyed to a physician in the presence of a witness.

A completed, witnessed, and signed advance directive can be given to one or more hospitals, health-care facilities, or assisted-living facilities at which a person might seek care. It also should be given to a person who is chosen as a health care agent.

It is suggested that people fill out the form, make copies, and sign each as an original in front of two witnesses and a notary. While notarization is not required in Maryland, persons who travel may visit places where a notarized advance-care directive is required.

One decision has to do with the initiation of certain treatments. Some forms of medical intervention are designed to cure diseases; other to relieve symptoms, retard the progress of a disease, or compensate for the failure of a bodily function.

Whether a given treatment is necessary or useful to a particular patient is a medical question requiring the expertise of health-care professionals. When professional medical care is needed, we must consent to the reasonable use of appropriate services so that we do not neglect our own well-being and our spiritual and family obligations. Beyond these normal efforts, we are at liberty to employ or refuse the techniques of modern medicine that may entail excessive difficulty or risk.

Whether a particular treatment may be excessively burdensome to an individual patient is a moral question requiring the faithful application of Church teaching. An ethical judgment may be required as to whether or not the benefits of the proposed treatment justify significant difficulties and suffering that the treatment may bring to a particular patient.

Another decision has to do with the cessation of treatment. We must not stop medically useful interventions because we are tired of living, or feel that we no longer have a contribution to make, or believe we are a burden to others.

Yet it is morally acceptable to interrupt such treatments when they are no longer beneficial or have become disproportionately difficult. That said, it is important to note what Pope John Paul II taught us -- that basic care (including medically assisted nutrition and hydration in the case of a patient who is unable to take food or drink orally) must not be stopped or interrupted.

Our Christian faith reveals the true meaning of human suffering — including the suffering that can occur at the end of life. The Church encourages us to prayerfully dedicate our pain and fear to help others and ourselves — to offer our suffering to God on behalf of others. The Church also encourages those who need and want palliative care at times of serious illness and injury to make use of it.

The U.S. Conference of Catholic Bishops noted in its Ethical and Religious Directives for Catholic Health Care Services (part 5, 2001) that one of the primary purposes of medicine in caring for those who are dying “is the relief of pain and the suffering caused by it. Effective management of pain in all its forms is critical in the appropriate care of the dying.” Pain medication, however, must never be given for the purpose of hastening death.

Modern medicine enables us to live longer, healthier lives — and we are grateful for the life-saving treatments available to so many people. Yet in times of serious illness or imminent death, we are called upon to make prudent choices about the means to sustain life. These can be complex and difficult decisions.

Each human life is precious in God’s eyes. One can easily understand how a person in prolonged pain, with no hope of recovery, might view death as a release from suffering. But no one must ever presume to adopt a course of action or inaction which is intended to cause death, even if the motive is to alleviate suffering. No matter how good the motives might seem, euthanasia is always an immoral attack on human life.

So the decisions people make as earthly life is nearing an end have to do with their intentions as well as their wishes. Since we are stewards, not owners of the life God has given us, we do not have the right to take our own lives by suicide or to take another’s life by euthanasia.

No. The letter makes the point that there is no ready-made answer for each situation. The patient must make critical treatment decisions for himself or herself, with the caring involvement of those who are closest and in consultation with spiritual advisers and medical professionals. Should the patient be unable to make or communicate those decisions, a health care agent whom the patient has named earlier must act for the patient. The new pastoral letter, including the advance directive form, is designed to assist in those deliberations.

The letter will help you to reflect on the values that guide your life. It will help you particularize the care and treatments you want when your earthly life nears its end. It will encourage you to address matters that are sometimes not easy to contemplate, matters that require prayerful and prudent thought.

In summary, Comfort & Consolation and the Catholic Declaration for Health Care Decision Making provide a solid framework for thinking about your future health-care decision making and the discussions you will want to have with your family and a person you may choose to be your health-care agent should you become incapacitated. The documents also provide sound guidance if you are asked to serve as a health-care agent for a family member or friend. The Declaration is a practical expression of our Catholic faith concerning end-of-life issues and it is in accord with Maryland law on advance directives.