Over 30 years ago ALL developed the Loving Will as an alternative to the living wills frequently promoted by the culture of death. In 2024, realizing that the changes in our culture posed even greater threats to the sick or those nearing the end of their lives, we updated it with the help of lawyers and euthanasia experts and changed its name. ALL’s Pro-Life Healthcare Directive with Durable Power of Attorney ensures life-affirming medical treatment and care, including food, water, and oxygen. It instructs your family, friends, and healthcare providers to do nothing intentionally—by act or omission—to cause your death. The downloadable document includes a wealth of information to help you make an informed decision before signing and is available—free of charge—at ALL.org/shop. Unable to download? Call 540-659-4171 to request your copy.
What is ALL’s Pro-Life Healthcare Directive (PLHD)?
ALL’s Pro-Life Healthcare Directive is a life-affirming form of an advance directive. This document tells your doctor and other healthcare personnel how to take care of you if you become so sick or injured that you cannot communicate your wishes or give informed consent regarding your medical treatment and care. In short, it instructs healthcare personnel to do nothing intentionally, by act or omission, to cause your death.
To use this document (pgs 8–9), you need only sign it in the presence of two witnesses and acknowledge it in the presence of a notary public. Any responsible adult person who is a disinterested third party may be a witness. Your notary or your attorney should be able to help you locate your witnesses.
The PLHD also includes ALL’s Durable Power of Attorney for Healthcare (pgs 10–11). This document allows you to appoint a trusted relative or friend who can make healthcare decisions for you if you are incapacitated. This person will advocate for you and make sure that your doctors correctly interpret your healthcare wishes. The DPAHC must be witnessed and notarized as well.
How is the PLHD different from other, dangerous types of advance directives?
The popular perception about advance directives—that they allow a person to refuse unwanted medical treatment that unnecessarily prolongs life—seems harmless. The problem is that these documents, as they are interpreted in most states, allow not only the refusal or withdrawal of “extraordinary” medical treatment but any type of medical treatment and even basic care like food and water—whether or not death is near. (Oxygen, food, and water, regardless of how they are provided to a patient, are not medical treatment but are basic necessities for life and basic care. They also provide comfort to many patients.)
These documents may allow legal, involuntary euthanasia—an act or omission intended to cause death, even against the patient’s will.
Advance directives are usually written to take effect when you cannot express your informed consent for medical treatment. Typically, they instruct medical personnel to withhold or withdraw medical treatment if you are in a “terminal” condition or “permanently unconscious.” State laws and court decisions are not only defining medical treatment to include the provision of food and water, but they are also defining terminal to include many patients who are neither dying nor near death.
For example, if you have been unable to respond to visual, auditory, and tactile stimuli for a prolonged period and if you were being given food and water through a feeding tube, your doctor may remove your feeding tube because your advance directive says that you do not want medical treatment. Even if that wasn’t what you meant when you signed the document, a medical professional can interpret most advance directives as rejection of basic care.
A living will, for instance, tells doctors to stop medical treatment in certain circumstances. Living wills can grant others unlimited authority to stop your medical treatment and care, even when death is not near. This could result in death by starvation and dehydration and/or suffocation.
“Do not resuscitate” and “do not intubate” orders are also types of advance directives. A DNR tells healthcare personnel not to try CPR or other lifesaving treatments if you experience cardiac arrest or stop breathing. You can extend this order to emergency services as well with a “durable do not resuscitate” document. A DNI means you don’t want to be placed on a ventilator or life support machine if you are unable to breathe on your own. If you have any of these advance directives, you may not receive lifesaving treatment, even in nonterminal situations. Doctors may interpret these documents to mean you don’t want other types of care, such as antibiotics, blood transfusions, and intravenous lines. You may also receive less attention from doctors and nurses at the hospital.
In addition, your doctor may recommend the Physician Orders for Life-Sustaining Treatment (a document that goes by many different names and acronyms). The POLST is promoted as a way to give your doctor instructions about your desired care when you are seriously ill or injured. In reality, the language in these documents is particularly deceptive. Your doctor or a named facilitator will ask questions about your healthcare preferences. These questions often manipulate patient answers. Your responses may unknowingly allow doctors to interpret the document as a refusal of life-sustaining or lifesaving care. Agreeing to “comfort care,” for instance, may result in your doctor withholding food or water from you and administering pain medication to mask your discomfort caused by starvation and dehydration.
Most alarming, doctors may choose to follow misinterpreted POLST documents that contradict your expressed wishes for care, even when you are capable of making healthcare decisions or have the potential to recover with proper treatment. A POLST may also override decisions of your attorney-in-fact.
Organ and tissue donation forms are additional types of advance directives. If you have signed one of these documents, medical personnel may prematurely declare your death based on controversial “brain death” tests. To preserve your life, you should never permit a hospital to harvest your organs.
A durable power of attorney for healthcare document authorizes someone else, called your attorney-in-fact, to act on your behalf when you are unable to communicate your informed consent because of illness or injury. These documents are also called medical power of attorney or medical power of healthcare agent. You use a DPAHC to name a trusted relative or friend to carry out the wishes you express in your PLHD.
Using a DPAHC without an accompanying PLHD, however, may not protect your life. If your attorney-in-fact misinterprets, misremembers, or doesn’t agree with your wishes, he or she may not advocate for the care you want.
In contrast, the PLHD ensures necessary medical treatment and comfort care, including oxygen, food, and water. It provides for life-affirming healthcare and protects you from an unnatural death by the act or omission of a medical professional. This document also protects you from any accidental or intentional miscommunication by your attorney-in-fact. The PLHD declares that your decision-maker cannot order food or water to be withheld or withdrawn from you as long as your body can assimilate them, nor can this person act contrary to your PLHD in any other way.
The PLHD alone, without an executed DPAHC, is of value in achieving your wishes. The DPAHC, without an executed PLHD, gives you a healthcare advocate but may not guarantee life-affirming treatment. Together, these two documents offer the protection you need when you are too sick or injured to advocate for yourself.
Why would I need a PLHD?
Two reasons: 1) the practice of withholding treatment and care (including food and water) is common in medicine today, and 2) a 1991 federal law and laws in every state increase the chances that you may feel pressured to sign a type of advance directive that will not protect your life.
The federal law, the Patient Self-Determination Act, was passed by Congress and went into effect on December 1, 1991. It says that facilities receiving federal Medicaid or Medicare funds (and that means nearly all hospitals) must give adult patients, at the time of admission, written information on the advance directives that are legally available. In practice, this federal requirement can make people think they must have an advance directive. They may then feel pressured to sign a living will or durable power of attorney for healthcare that could have the effect of stopping their medical care and treatment—even medical care and treatment that could save their lives!
In February 2024, Catholics United on Brain Death and Organ Donation penned a Call to Action in which they expressed their concern about the increasing number of doctors and hospitals that have employed lax definitions of brain death, thus putting people in jeopardy of being killed by organ removal and of the donation of organs against their will. Its document states:
At a minimum, Catholics should know that: 1) vital organ donation, while a noble and generous act in principal, becomes immoral in practice when there is no moral certainty of death; 2) while there is disagreement among Catholics about whether whole BD represents true death, all Catholics agree partial BD does not; 3) the current medical guidelines for BD cannot provide moral certainty of death because they only test for partial BD; and 4) the average person cannot expect to be dead at the time of organ harvesting because the majority of organ procurements rely on inadequate BD criteria.
Signing a document that protects you if you are unable to communicate is always in your best interest.
You say that it is common to withhold medical treatment, and even food and water, from patients today. That’s because more people request this, right?
Not always. The term “medical treatment” is often interpreted to include giving someone food and water through a tube. Sometimes the wording of an advance directive is so vague that a patient may not realize that, by signing it, he or she may be requesting starvation and dehydration in certain circumstances because healthcare providers are convinced that food and water are medical treatment, not comfort care. When the patient can’t communicate, healthcare professionals can make assumptions that are not at all what the patient had in mind.
In addition, some medical personnel may assume that by signing an advance directive, the patient automatically indicates that he or she does not want to be given even minimal comfort care in certain circumstances. Thus, these personnel will not even consult with family members in these cases.
Can’t it be said, though, that if a person is really sick or injured, stopping his or her food and water lets that person die a “natural” death?
No. Denying food and water to a sick or injured person no more “allows” a person to die a natural death than starving a healthy person locked in a room. Making someone die of dehydration or starvation is not a natural death.
Besides food and water, what other types of beneficial care or treatment might be withheld if a person has an advance directive?
To name a couple of examples, it’s possible that antibiotics might not be administered to treat an infection of an Alzheimer’s patient or that insulin might not be given to a comatose diabetic.
If I sign a PLHD, am I asking that all possible means of medical technology be used to keep me alive, even on my deathbed?
No, nothing in the PLHD requires this, and it is doubtful that the document would be interpreted this way.
In your PLHD, you provide a number of basic, but not detailed, guidelines for those who will be making medical decisions for you. It instructs the people who treat you that “medical treatments and care are to be provided when necessary to cure, remedy, or relieve the symptoms” of your condition. The document specifically states that nothing is to be omitted or done “to shorten my life, to hasten my death, or cause my death, either as a means or end in itself, regardless of motivation.” You instruct personnel that you are “not to be denied food, water, or oxygen, as long as [your] body is able to digest and absorb them.”
In the document, you also ask for maximum efforts to relieve pain. If pregnant, you ask that the maximum effort be made to save your life and your child’s life. You forbid evaluation of your “quality of life.” Any ambiguity is to be resolved in favor of preserving your life.
Other than the basic guidelines, the PLHD does not address specific factors. Given the emerging quality-
of-life ethic and growing trend among medical professionals not to treat certain patients because of cost-cutting policies or other similar anti-life policies, the PLHD is based on the presumption that medical personnel will be far more likely to misinterpret a document in favor of undertreatment or even nontreatment rather than overtreatment. That is why we have included the durable power of attorney for healthcare document with the PLHD. Even if medical staff attempt to misinterpret your PLHD, your attorney-in-fact can advocate for the care you want.
Keep in mind that no written document can substitute for a competent, moral physician who is faithful to the Hippocratic ethic and tradition.
Our moral obligation is to use “ordinary” means of medical treatment and care to preserve our lives, while “extraordinary” means are optional. Why doesn’t the PLHD say this?
The PLHD does not use the traditional ethical/moral/religious terms “ordinary” and “extraordinary” means. These words are, now more than ever, subject to interpretation that distorts their proper, traditional meanings. For example, the provision of food and water was once commonly considered ordinary and is now increasingly considered extraordinary. The authors of the PLHD determined that it was simply not possible to define these terms carefully enough to avoid this problem while maintaining a simple, easy-to-use format.
But what if I do or don’t want to receive extraordinary treatment?
The PLHD does not address specific considerations, such as cost or other hardship, that might determine whether a certain medical treatment is extraordinary, that is, gravely burdensome for you to bear or otherwise requiring heroic virtue on your part. However, you can discuss this wish with your physician(s) and your appointed decision-maker (attorney-in-fact) under the durable power of attorney for healthcare in the PLHD. Make sure they understand the proper moral principles for making a decision regarding extraordinary means, taking into account the facts and circumstances of your case. American Life League’s publication Life, Life Support, and Death, included in the PLHD package, defines and describes these principles. Discuss these principles with your attorney-in-fact.
What if there are certain medical treatments that I do or do not want? How does the PLHD help me with these?
As mentioned, the PLHD provides only basic guidelines for your care and treatment. It does not specify treatment instructions because it is simply impossible to foresee everything that could happen to you, along with the available treatment options and how you would want to proceed in each case. Moreover, the moral obligation to be conscientious stewards of our lives requires that these types of decisions be made on the basis of the facts and circumstances existing at the time of treatment.
What if I haven’t signed a living will or any advance directives that could cause me harm? Why should I sign the PLHD now?
Unless there is evidence of the patient’s contrary wishes, the current standard of medical care presumes not to provide medical treatment or comfort care that is unlikely to improve a patient’s “quality of life.” If you want to preserve a presumption for life, you must express your wishes while you are able. In addition, the Patient Self-Determination Act requires most healthcare facilities to tell you about your state’s law regarding medical decision-making and then to find out if you have signed an advance directive. Unless you have an alternative, you may feel pressured to sign something like a living will, which will not protect your life.
The PLHD is a document that will secure life-affirming healthcare when you can’t speak for yourself. With it, you will have peace of mind and will be prepared for any health crisis. Everyone 18 years or older should sign a life protective advance directive such as the PLHD.
How will medical personnel be made aware of my PLHD and/or DPAHC if I can’t communicate?
To ensure that you receive the necessary medical treatment, a copy of the full PLHD should be given to your physician(s) and included in your medical records in and out of the hospital. You should also discuss your wishes with your physician(s). You can share your wishes with a family member or trusted friend as well. Likewise, if you are close to a priest, minister, rabbi, or other clergyman, or if you have an attorney, you should discuss this subject with them. Not every clergyman or attorney understands the problems with most healthcare advance directives and may need educating.
The best way, however, to make sure that your wishes are made known is to also authorize someone to speak for you in the event that you cannot. The DPAHC included in the PLHD specifically allows you to appoint an “attorney-in-fact” who would be given a limited durable power of attorney to make healthcare decisions for you, should you become unable to communicate your informed consent because of illness or injury. Give your attorney-in-fact the original of each sheet in this package. Keep a copy for yourself in a readily accessible place (not, for example, in a lockbox).
How long will my PLHD and DPAHC remain in effect?
These documents last until you revoke them in writing that is both dated and notarized. You should review this package from time to time.
Is the PLHD a legal document like many advance directives?
The PLHD and its accompanying durable power of attorney for healthcare were created in response to state laws authorizing types of advance directives that can jeopardize a person’s life and health, as explained earlier. Since the PLHD document may not be specifically envisioned by these laws and, in important ways, is antithetical to them, it may not be legally recognized and directly enforceable in a court in every state. Properly executed and circulated, it should make your wishes sufficiently clear to alert healthcare providers of a possible risk of malpractice actions, should they act against your wishes.
It is important to emphasize that this PLHD document is not legal advice, and it is always advisable to consult with your attorney on such important matters so that your PLHD can be legally recognized in your state. We cannot afford you that assurance; your attorney can.
Your state’s advance directive law will not prevent you from signing the PLHD and DPAHC. Instead, these laws make it more advisable that you sign these documents.
Am I getting legal advice from ALL?
No. American Life League, Inc., is a nonprofit educational and charitable organization that works to protect all human beings—born and preborn. This package is an effort to help you, if you want to take advantage of it. It is not legal advice. The PLHD and DPAHC may not be specifically authorized by a law or regulation; however, they are indicative of your wishes. It is always advisable to consult with your attorney.