Actions Seek to Subjugate your Choices to Dogma

This column first appeared in the San Antonio Express-News and other Hearst Newspapers on September 14, 2018.

Dear Mr. Premack: I am 50 and ready to prepare my estate plan and medical directives. I have strong opinions about artificial life support. I do not want any extraordinary or artificial methods used to prolong the process of my death if I have a terminal illness and cannot communicate at the time. I am concerned that my personal choices about this most intimate topic – my own death – could be interfered with if a doctor’s or a hospital system’s religious convictions are different than my own. I am particularly concerned since the Bishops’ declaration instructing Catholic hospital systems to place their dogma above my personal choices. Are there any ways in which I can retain control over my medical care? - SM

Catholic health care systems have been aggressively expanding in the US. It is estimated that one-sixth of the hospital beds available in the US are part of the Catholic system. Some medical insurance policies may financially push policyholders into using the Catholic system as their “in-network” provider. Additionally, the taxpayers pay billions (in 2011, $27 billion and it has just increased from there) to the Catholic system to provide care under programs like Medicare and Medicaid.

The US Conference of Catholic Bishops issued the Sixth Edition of its “Ethical and Religious Directives for Catholic Health Care Services” in June 2018. Specifically, all health care providers that are affiliated with or are part of the Catholic hospital system are bound by the Bishops’ declarations that:

“… a Catholic health care institution … will not honor an advance directive that is contrary to Catholic teaching.” and that “Each person may identify in advance a representative to make health care decisions as his or her surrogate in the event that the person loses the capacity to make health care decisions. Decisions by the designated surrogate should be faithful to Catholic moral principles… “.

For individuals who are faithful Catholics, those requirements should pose no problem. But for individuals from other faiths, for Catholics who disagree, or for those who are secular these declarations are a huge problem. Should an individual’s personal medical choices be subjugated to religious principals which that individual does not hold? From the individual’s perspective their own freedom of religion/conscience could be submerged below the larger institution’s freedom of religion just because the individual seeks medical assistance.

To compound the issue, the Trump Administration has opened a new Conscience and Religious Freedom effort in the Health and Human Services (HHS) Office of Civil Rights (OCR). Director Severino stated that, “No one should be forced to choose between helping sick people and living by one’s deepest moral or religious convictions…” (that is, the doctor’s or hospital’s religious convictions should take priority over the patient’s religious/conscience convictions).

In March 2018 HHS proposed a federal regulation to protect doctors and hospitals from “being coerced into participating in activities that violate their consciences”. If the regulation is adopted, there is a question whether a doctor and hospital could legally refuse to remove life support for a patient with a Directive to Physicians by claiming it would violate the doctor’s/hospital’s religion.

If this issue is important to you, meet with your attorney to update your Medical Power of Attorney to instruct your Agent to keep you away from any hospital system that may refuse to honor your legal wishes due to its own religious dogma. Pre-planning the selection of physician and hospital system is a step to help you retain control, and to see that you will not be denied medical services on religious grounds. Using online forms will not help achieve this goal; you need to meet with your attorney. Additionally, talk to your insurance company to see which hospitals are “in-network” and if necessary, change insurance companies when able to do so.

Paul Premack is a Certified Elder Law Attorney with offices in San Antonio and Seattle, handling Wills and Trusts, Probate, and Business Entity issues. View past legal columns or submit free questions on legal issues via or

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Paul Premack has been a Board Member and has served as President of the Texas Chapter of the National Academy of Elder Law Attorneys (NAELA) and is a Member of the Washington Chapter of NAELA. He is Certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation as accredited by the Texas Board of Legal Specialization and the ABA. He is licensed to practice law in the States of Texas and Washington and handles Estate Planning and Probate in Texas and Washington, including Bexar County and King County Probate, Wills, Living Trusts, Durable and Medical Powers of Attorney, and Elder Law. Premack writes the legal column for the San Antonio Express News which is syndicated in other Hearst Newspapers around the USA.

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