Catholic Advance Directives and Choosing a Proxy

Most advance directives are a list of treatments the person does not want. Ventilator, no. Feeding tube, no. CPR, no.

The trouble is that real decisions almost never arrive in that form. They arrive as: the pneumonia might be treatable, but she would need a week of ventilation and she may not come off it, and she is frailer than she was in March. No checklist written in advance covers that, and a proxy holding one is left guessing at what the person would have wanted in a situation nobody anticipated.

What helps is naming someone good and telling them enough that they can reason on your behalf. Catholic teaching happens to line up with this, because it defines the surrogate's job in exactly those terms.

Directive 24 requires Catholic institutions to make information about advance directives available, and adds the caveat worth knowing about in advance: the institution "will not honor an advance directive that is contrary to Catholic teaching," and where there is a conflict, "an explanation should be provided as to why the directive cannot be honored."

Directive 25 defines the proxy's duty:

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 the person's intentions and values, or if the person's intentions are unknown, to the person's best interests.

Notably, the phrase requiring surrogate decisions to be "faithful to Catholic moral principles" that appeared in the previous edition was dropped in the seventh edition, approved in November 2025. The duty as now stated is to represent the patient.

Directive 26 requires informed consent that includes information about "any reasonable and morally legitimate alternatives, including no treatment at all," and says patients and surrogates should have access to "pastoral counsel and ethics consultations."

And Directive 57: a competent adult patient's or surrogate's free and informed judgment about using or withdrawing life-sustaining interventions "should always be respected and normally complied with, as long as it is not contrary to Catholic moral teaching."

Within Catholic teaching, a great deal. You may decline treatment that is disproportionate — treatment that offers no reasonable hope of benefit, or that imposes excessive burden or expense. You may state that you do not want resuscitation where it would not benefit you. You may state that you want full pain relief. What you may not do is direct that your death be caused.

If you want the reasoning behind those limits, the companion pages on stopping treatment and on assisted dying set it out with the sources.

The most common mistake is choosing by seniority or by hurt feelings. A proxy needs three things:

• Reachability. A daughter three time zones away who does not answer unknown numbers is a worse choice than a nephew who lives nearby, however close you are to the daughter.
• Nerve. The job is sometimes sitting in a room with a confident consultant and two relatives who disagree, and saying that is not what she wanted. Not everyone can do this, and it is not a character judgment to notice who can.
• Willingness to represent you rather than themselves. Ask directly. A person who says I could never let them stop treatment is telling you something important and kind, and should not be your proxy.

Name a backup. People get sick at the same time, and people travel.

Beyond any form, tell your proxy in your own words:

• What a good day looks like for you now, and what would make life not worth prolonging.
• Whether being at home matters more or less than living longer.
• What you are most afraid of — pain, confusion, being a burden, dying alone.
• What you want at the end, including whether you want a priest called, whether you want anointing and Viaticum, and who you want in the room.
• What you would want them to do if the family split.

Write a short values statement alongside the legal form and give it to the same people. Two pages of your own sentences is worth more to a proxy at three in the morning than a signed checklist.

Directives fail most often because nobody can find them. Give copies to your proxy, your oncology team, your primary care physician, and the hospital where you are treated, and ask that it be scanned into the chart. Ask your proxy to keep a photograph of it on their phone. A document in a safe deposit box is a document that does not exist.

If you change hospitals, do it again. Records do not travel as well as people assume.

Ask for an ethics consultation early rather than at the crisis point. It is free, it is available at every Catholic facility and most others, and it does not overrule anyone — it helps a family and a team work out what is actually being decided. A Catholic chaplain in the same conversation often helps more than either alone, because a great deal of family conflict at the end of life is really an argument about whether stopping means abandoning. It does not, and it helps when someone with standing says so.