Advance Directives


Missouri Right to Life urges all persons to prepare and execute durable powers of attorney for health care and advance directives that incorporate pro-life principles.


All human life is sacred, and each human life is a gift. No one can legitimately presume to terminate this sacred gift, even in the face of pain and suffering. As a practical matter, in this era of medical knowledge, no pain is uncontrollable; pain can be rendered tolerable with proper medical attention. It is not a reason to end life before a person’s natural end. Human suffering may be turned into an opportunity to learn humility and acceptance, and for those who are religious, to use prayer to prepare to meet one’s Creator.

The term, “living wills,” is one of the most misunderstood phrases in the English language. Everyone thinks it refers to a document that says, “When things get bad enough for me, stop treatment and let me die.” Unfortunately, very few people agree on when things become “bad enough” for the “living will” to kick in. Even if the document spells it out, health care professionals often think they know what a “living will” provides without reading it, so conditions and stipulations in a patient’s “living will” often are ignored by those who are supposed to abide by them.

Missouri law does not provide for “living wills,” but for “declarations concerning death-prolonging procedures,” “advance directives,” and “durable powers of attorney for health care.”

The first type of document, “declarations concerning death-prolonging procedures,” becomes effective only when the declarant’s condition is terminal and the declarant does not have the capacity to make health-care decisions. Sec. 459.025, RSMo. It is designed to allow a patient to forgo “death prolonging procedures,” which are defined as “any medical procedure or intervention which, when applied to a patient, would serve only to prolong artificially the dying process and where, in the judgment of the attending physician pursuant to usual and customary medical standards, death will occur within a short time whether or not such procedure or intervention is utilized. Death-prolonging procedure shall not include the administration of medication or the performance of medical procedure deemed necessary to provide comfort, care or to alleviate pain nor the performance of any procedure to provide nutrition or hydration.” Sec. 459.010(3), RSMo.

Missouri Right to Life finds nothing objectionable in such declarations, for they allow for a natural death without shortening life. They are rarely used, however, because many people are told that they do not allow for the exercise of control in enough circumstances.

“Advance directives” are more like the documents that most people think of when the terms “living will” comes up, and they are commonly provided as part of estate planning packages offered by lawyers.. The Missouri Bar and other organizations sponsor certain forms for living wills. Often, the basic principle that appears to govern such documents is that if a person is unconscious for a long enough period of time so that doctors and/or relatives give up hope of recovery, that is the time to end treatment. Furthermore, they address tube feeding and hydration by tube as types of treatment that may be ended along with any other treatment, thus directing death to be caused by dehydration and/or

Advance directives satisfy the requirement of Missouri law that a person may be deprived of medical care and treatment that would keep the person alive when unconscious only if there is clear and convincing evidence that the person stated in advance his or her wishes so to be deprived. Cruzan

  1. Harmon, 760 S.W.2d 408 (Mo. 1988). A properly-signed advance directive can provide such clear and convincing evidence.

Not all advance directives are unethical. An ethical advance directive may be drawn for a person who respects the nature of life as a gift and refuses the presumption of thinking that the gift can be terminated at will when pain becomes too much or life has become “useless.”

The use of advance directives is futile if health care professionals do not pay attention to them, as happens all too often. As a practical matter, it is important to find a person who will advocate for a patient with the health care system. Such a person is most often an “attorney in fact” in legal parlance or a “health care agent” in ordinary language. In Missouri, the legal document that appoints this agent is a durable power of attorney for health care. See sections 404.800-.872, RSMo. This document may contain a reference to the advance directive or it can overlap the advance directive by including some of the same conditions. It is recommended that both an advance directive and a durable power of attorney for health care be used to provide for one’s future care based on ethical, pro-life principles.

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