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On January 18, the U.S. Department of Health and Human Services announced the formation of a new Conscience and Religious Freedom Division in the HHS Office for Civil Rights (OCR). Below are excerpts from a press release issued by the HHS.
From the HHS – The Conscience and Religious Freedom Division has been established to restore federal enforcement of our nation’s laws that protect the fundamental and unalienable rights of conscience and religious freedom. OCR is the law enforcement agency within HHS that enforces federal laws protecting civil rights and conscience in health and human services, and the security and privacy of people’s health information.
The creation of the new division will provide HHS with the focus it needs to more vigorously and effectively enforce existing laws protecting the rights of conscience and religious freedom, the first freedom protected in the Bill of Rights.
OCR already has enforcement authority over federal conscience protection statutes, such as the Church, Coats-Snowe, and Weldon Amendments; Section 1553 of the Affordable Care Act (on assisted suicide); and certain federal nondiscrimination laws that prohibit discrimination on the basis of religion in a variety of HHS programs.
OCR Director Severino said, “Laws protecting religious freedom and conscience rights are just empty words on paper if they aren’t enforced. No one should be forced to choose between helping sick people and living by one’s deepest moral or religious convictions, and the new division will help guarantee that victims of unlawful discrimination find justice. For too long, governments big and small have treated conscience claims with hostility instead of protection, but change is coming and it begins here and now.”
To learn more about the new Conscience and Religious Freedom Division or to read the full press release, visit www.hhs.gov/conscience.
From The Catholic Accent — The Diocese of Greensburg will host a series of education and training sessions during March to help priests, parish staffs and diocesan employees respond to the opioid crisis.
The training sessions are a continuation of Bishop Edward C. Malesic’s initiative to provide a pastoral response to the opioid crisis, which he launched last summer with “A Pastoral Letter on the Drug Abuse Crisis: From Death and Despair to Life and Hope” and a series of seven education sessions and prayer services held throughout the diocese last summer.
“The diocese has 78 parishes, each of which can be considered a local resource in this battle to save people’s lives and support their families while this battle is raging,” said Msgr. Larry J. Kulick, vicar general and a member of the Bishop’s Advisory Board on the Opioid Epidemic.
He said the purpose of the sessions is to begin providing priests, deacons, pastoral ministers,
faith formation directors, youth ministers and other parish staff members with basic tools to assist people who are suffering from addiction, support their families and friends, and help individuals find the resources they need.
The sessions are scheduled from 1:30-4 p.m. and will be held:
March 1: St. Mary, Our Lady of Guadalupe Parish, Kittanning
March 8: St. Therese, Little Flower of Jesus Parish, Uniontown
March 15: Our Lady of Grace Parish, Greensburg
March 22: St. Thomas More University Parish, Indiana
The agenda, established in consultation with the Bishop’s Advisory Board on the Opioid Epidemic, will cover:
* Basic skills in recognizing addiction;
* Nonjudgmental language to use when dealing with a person who has an addiction and the person’s family;
* Region specific referral resources for the parish personnel to have on hand when someone asks for assistance;
* Information on assessing the need for support groups of varying kinds in an area; and
* Information about establishing such a group, either as an individual parish or with other parishes in a specific area.
The doors of North Philadelphia’s Sacred Heart Home opened in 1930. The Dominican Sisters of Hawthorne have been offering free medical care and a place to call “home” in every sense of the word to incurable cancer patients ever since.
For the last year, Jim, who suffers from a form of throat cancer, has called Sacred Heart Home his home.
“I should have been dead three years ago,” says Jim. “This is a miracle in my life.”
The miracle he refers to is the work of Sister Mary DePaul, a Dominican Sister of Hawthorne and director of operations, and the nine other nuns and small staff who work at the home. It is their mission to make “guest-patients” feel welcome in an atmosphere of peace and warmth, where love, understanding and compassion prevail – without discrimination as to race, creed or national origin.
“We take those of all faiths, of all backgrounds,” explains Sister Mary DePaul. “(The term) guest-patient has a dual meaning. You want them to feel like guests in your home and we want the nursing care to be as it would if you were to take care of your mother and father.”
The 25-bed facility is for those who need around-the-clock nursing care and do not have the ability to pay for it. The home operates solely on donated funds and does not accept payment from guest-patients or their families, nor are funds accepted from state and federal programs or health insurance providers.
Sister Mary DePaul adds that the majority of guest-patients come from what she calls a broken down society – a lack of family life and struggles with drug and alcohol addictions.
“They shine, especially at the end of their life. It’s a real gift that you can do that for people when they’ve had such a struggle all their life and they just have a little shining at the end. It’s the best reward of all.”
But for Jim, he says he’s the one who has received the gift. For instance, with the help of the sisters, he was recently able to fulfill a lifelong wish on his bucket list: to go to the Philadelphia Museum of Art, conquer the steps and pose at the famous Rocky statue.
“This place has given me a renewed lease on life until God is ready to call me home.”
The Dominican Sisters of Hawthorne were founded by Nathaniel Hawthorne’s daughter, Rose, in 1900. She took those suffering from incurable cancer into her home and her heart, comforted them, restored their spirits and helped them to live out their days in dignity and peace. Today, her mission continues.
The Pennsylvania Senate Health and Human Services Committee voted unanimously to advance Senate Bill 623 on December 12, 2017, kicking off the legislative process. There are many more steps before it could become law. The measure would codify the use of Pennsylvania Orders for Life Sustaining Treatment (POLST) and is designed to clarify provisions regarding Do Not Resuscitate (DNR) orders.
POLST forms have been used in Pennsylvania for years without official legislative authorization. The Pennsylvania Catholic Conference (PCC) and the Pennsylvania Catholic Health Association (PCHA) have been part of a group of stakeholders working to get statutory controls to govern their use.
Fundamentally, SB 623 would bring necessary regulation to POLST; but as proposed, the bill does not go far enough to safeguard human life. PCC and PCHA are asking for amendments that would assure that these documents are only used in appropriate situations. The law should guarantee that a POLST would be used solely for patients with a qualifying health status, diagnosis and prognosis where their doctor would “not be surprised if they died within the next year.”
Amending the bill to clarify that POLST applies just to patients determined to be in the end stages of life would put important protections into the law. With the current practice, many facilities ask all patients admitted to a hospital, a long term nursing home, or other health care facility to sign a POLST, even without consulting a doctor. There has also been an increase in POLST use in healthy patients presenting to primary care physicians for their annual wellness visit. Patients and their families should pay attention to what they are signing and why. Anyone can and should sign a living will; but most patients should not qualify for POLST.
POLST and end-of-life decision making is complex. The PCC and PCHA consulted with Dr. Ferdinando Mirarchi, Principal Investigator of the TRIAD research series and Chief Medical & Scientific Officer of the Institute on HealthCare Directives and the Founder of MIDEOTM (My Informed Decision on VidEO) to learn more. Here is a summary of his answers.
What is POLST?
The term POLST stands for the Physician Orders for Life-Sustaining Treatment or locally, Pennsylvania Orders for Life-Sustaining Treatment. In other states the form might have a different name such as MOLST or Medical Orders for Life-Sustaining Treatment.
POLST is meant to serve as a portable, standing medical order that specifies whether life-sustaining treatment is to be used or withheld for a specific patient in various circumstances.
Who uses a POLST and when?
By its true definition, POLST is not for healthy people or even those with chronic conditions. It is only appropriate for those with terminal illness who are expected to die within a year.
NOTE: PCC and PCHA have concerns because Senate Bill 623 has no such limitation. As written, there are no safeguards to prevent an uninformed young person, or the most at risk, a healthy older person from having a POLST.
Who decides if a POLST is appropriate?
When used properly, a physician in consultation with the patient or designated representative should determine when it is appropriate to have a POLST. Based on moral and ethical principles POLST is only appropriate if there is a diagnosis of advanced chronic, life limiting, or terminal illness. And it is only appropriate if the physician and the patient and/or the family or other representative have first had an in depth conversation about what POLST means. To date, both medical practice and research has shown that physician involvement and in depth conversations have been lacking or absent.
NOTE: Senate Bill 623, nor the companion bill, House Bill 1196, do not require a diagnosis nor impose any condition for appropriateness of POLST. The bills do not require a conversation with a physician or even the review of the patient’s medical records by the signing medical professional.
How is POLST different from a living will or a do-not-resuscitate order?
A POLST is an immediately actionable medical order that is different from a living will. It may or may not contain a Do Not Resuscitate (DNR) order depending on how it is completed.
The orders outlined in this medical document are supposed to be followed by paramedics, nurses, and other physicians even though they may not have been involved in the creation of the initial medical orders.
The POLST form itself is to be honored in a facility such as the hospital and is transportable so it will also be honored in the post-hospital settings such as skilled nursing facilities or in the pre-hospital ambulance settings.
A living will is different from a POLST. A living will is a legal document outlining a patient’s treatment preferences which can be honored when the patient cannot speak for him or herself.
A living will gives instructions and preferences, but should not obligate medical professionals to follow them. Consider how a typical last will and testament for your property is used. Simply creating a will for your estate does not give your family the ability to take your assets. The will has to be triggered and that trigger is your death. At the time of your death, and only then, can the assets be divided up according to the instructions contained in your will. A living will is triggered when your health status prompts questions about your medical treatment. The triggering events are when you are not able to consent for yourself and you have an end stage medical condition or have entered a persistent vegetative state.
A DNR (Do Not Resuscitate) order (inside or outside a hospital setting) is different from a living will and may or may not be contained in a POLST. In Pennsylvania, a DNR order is a medical order that pertains to one specific condition, cardiac arrest. So if a patient agreed to a DNR order, then he or she wishes not to receive CPR in the event of cardiac arrest.
A significant patient safety risk is posed when patients are asked the question of DNR. We know from years of research that patients with DNR orders are at risk to receive less than the expected medical care when not in a cardiac arrest situation. We aggressively try to remind health care providers and patients families that a DNR order is not the same as a do not treat order.
Also, a standard living will and POLST are often misinterpreted as DNR orders regardless of what is documented in those forms.
A Patient to Clinician Video is another form of advance directive that is used increasingly. This new technology allows you to do this on your own or through a trained physician. However, be careful to understand that an un-scripted video can pose just as significant a patient safety risk as a vague living will or POLST. There are definite benefits of video if it is “scripted.” This is to ensure your wishes are not misunderstood by medical providers in your own community or when traveling. There are a multitude of companies that have deployed video directives and an increasing number of other programs in development. As such, if approached to consider this in the physician’s office or prompted via a “Do It Yourself” (DIY) app, consider seeking advice from a physician experienced in this field of medicine and be sure he or she is an expert in Patient Safety & Advance Care Planning.
What questions about POLST should people discuss with their doctor or other health care practitioner?
Unless you have an advanced chronic, life limiting, or terminal illness, your physician should not even be asking you about POLST; however discussing an advance directive such as a living will is appropriate.
See Living Will and Health Care Power of Attorney: What you should know about ADVANCE HEALTH CARE DIRECTIVES from the Bishops of Pennsylvania
If you are of advanced age and your doctor has advised you that you are high risk to die within the current year, then your spouse, children or whomever you have appointed as your health care agent should talk to your doctor. Decide together:
Am I required to have one? What if I refuse?
By law, no one is required to have a POLST form. It is to be a voluntary process. If you refuse a have a form completed and you feel pressured to complete a POLST form, you should ask to speak to the administration of that facility. Be careful of what you sign when you enter a healthcare facility. Many patients who have a POLST created are not aware that it is being created for them. Also, if the facility is not honoring your concerns, then you should report the situation to the Department of Health. Call 1-800-254-5164 and visit www.health.pa.gov to download a complaint form.
End-of-life decision making can be confusing from a secular and medical standpoint, but you may also wonder: what does the Catholic Church teach about POLST and end-of-life decision making?
As Catholics, we believe that we have a responsibility to preserve our life. Suicide and/or assisted suicide are always morally wrong. (Declaration on Euthanasia: Congregation for the Doctrine of the Faith, 1980)
However, we also believe there are some limited qualifications to the obligation to attempt to preserve life, such as the refusal of overzealous treatment, including medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome. (Catechism of the Catholic Church, #2278, 1995) It is morally permissible to sign a POLST if it follows the documented indications for use, and if it is determined that medical treatments would not offer reasonable hope of benefit or are disproportionately burdensome. “Disproportionately burdensome” means the treatments will impose serious risks or excessive pain to the patient, excessive expense on the family or the community, or other extreme burdens.
Death is not to be feared as the end of our existence, rather it is the doorway to our eternal destiny.
A decision to forego a medical treatment should not be made because a person’s life is judged as not meaningful. If you are approached to sign a POLST document, you should not feel compelled to sign it immediately. You should discuss your health status with your family and your doctors and then decide if POLST is appropriate for you to complete. To simply complete such documents without knowledge of how they impact your care and treatment is a significant safety risk to you as well as to your family. The most important step in creating a POLST is having a conversation with your medical provider. Make sure your choices are informed and created appropriately for you as an individual. Take care to outline your end-of-life wishes safely and right.
The Pennsylvania General Assembly is taking a mid-session break and will resume session late in January 2018. 2017 was a very busy year and more issues are on the horizon for 2018. Here is the status of the several high priority bills that are on the legislative agenda of the Pennsylvania Catholic Conference.
Bills That Made It Through
Several bills made it all the way through the legislative process in 2017. One bright spot in the difficult, prolonged budget debate was a $10 million expansion of Educational Improvement Tax Credits (EITC) which will benefit more students in Catholic schools.
The Pennsylvania General Assembly took a strong pro-life stand to ban barbaric dismemberment abortions and abortions when the unborn baby is able to feel pain (20 weeks). Both the Senate and the House passed Senate Bill 3 with overwhelming majorities. Unfortunately, Governor Tom Wolf vetoed the measure and there was no vote to override.
Governor Wolf did however sign House Bill 1139 into law. This law adds fire stations to the list of safe places where a newborn baby may be placed without penalty. Police stations and hospitals are also safe havens. Incubators will be placed in participating locations to hopefully prevent babies being abandoned in dumpsters or public restrooms.
The legislature reauthorized the Children’s Health Insurance Program (CHIP), but not without controversy. An amendment to correct regulations that allow coverage for sex reassignment surgeries for children was taken out of the final bill that went to the governor’s desk. The Pennsylvania Catholic Health Association and PCC will look for ways to address this again without compromising a valuable program that has given thousands of children access to health care.
Legislation to address the statewide opioid crisis was signed into law by Governor Tom Wolf. Senate Bill 446 establishes state-regulated minimum quality standards for the licensure of recovery houses that receive funding or referrals from government agencies. This new law is welcomed by the recovery houses operated by many Catholic Charities agencies within Pennsylvania’s Catholic dioceses.
The governor also signed the “Right to Try” Act into law which will provide terminally ill patients the opportunity to try experimental treatments, such as investigatory drugs, biological products and medical devices. It will allow access to treatments that have not been fully approved by U.S. Food and Drug Administration.
Issues Left To Do
There is much more work left to do in 2018. Legislation to create Education Savings Accounts (ESA) is being considered. Senate Bill 2 would give families that live in the boundaries of a chronically underperforming school a grant in the amount of the average state funding per pupil if they withdraw their students from public school. The money could only be used for tuition and expenses in a participating private school, for tutors, or other education expenses. The money would come out of the local school’s state subsidy; any unused dollars would return to the local school.
Senate Resolution 174 and House Resolution 609 each condemn the practice of selectively aborting babies with Down syndrome. Although resolutions do not have the force of law, they are useful gestures for raising awareness. Another resolution, HR 519, condemns the free availability of pornography because of the public health hazard it causes to children and families across the Commonwealth. It passed the House Health Committee in November and should be taken up on the House floor soon.
The Pennsylvania Catholic Health Association is reviewing legislation that would govern the use of POLST, Physician’s Orders for Life Sustaining Treatment. Senate Bill 623 and House Bill 1196 similarly outline how and when someone would use a POLST in an end-of-life situation. The concern lies in whether or not a qualifying condition must be present for a POLST order to be signed.
Beyond these moral issues, the PCC is tracking legislation that tackles social justice concerns as well. House Bill 1076 would create a land bank of blighted properties and transform them into safe housing for the homeless. With opioid addiction continuing its terrible toll on every community, more legislation will be considered including House Bill 825. This bill provides for a central registry of existing emergency drug and alcohol detoxification beds so health care facilities can better serve people with a substance abuse crisis.
This is by no means an exhaustive list of public policy issues that the Catholic Conference will review and advocate. Sexual orientation non-discrimination, access to health care, threats to religious liberty, and other proposals are all potential issues on the radar. For a list of the PCC’s positions on specific legislative proposals, log on and check out: www.pacatholic.org/legislative-review.
According to figures recently released by the Pennsylvania Department of Health, the number of annual abortions in the state is at the lowest level since being recorded.
In 2016, the number of abortions totaled 30,881, which is about 3 percent less than the previous year. That percentage translates into nearly 1,000 fewer abortions between 2015 and 2016.
The report also indicates that more than 80 percent of abortions in Pennsylvania occurred in the following four counties (with corresponding numbers)
You can find a further breakdown of Pennsylvania’s 2016 abortion statistics by clicking here.
Pro-life legislation, which passed both the House and Senate chambers in 2017, was eventually vetoed by Governor Tom Wolf. Senate Bill 3 would have strengthened Pennsylvania’s Abortion Control Act by banning the cruel and brutal practice of dismemberment abortions and placing a ban on abortions from the 20th week on during a pregnancy.
Visit pacatholic.org to join the Catholic Advocacy Network and add your voice to others speaking in support of the dignity of life.
““Karla”, 36, was recently released from prison, and was referred to Shining Light by Capitol Pavilion, one of our partner agencies. Trying to get back on her feet, and with limited resources, Karla needed basic clothing. Shining Light was able to provide her with several complete outfits, nightwear, shoes and underclothing. She can continue to obtain some additional free clothing over the next six months, as she seeks employment and establishes a household again. Her joy in selecting and “modeling” her “new” clothing touched us all!” – A Shining Light story
Treating all who enter our doors with dignity and respect. That’s the motto the Shining Light Thrift Shop has been operating under in midtown Harrisburg since it opened its doors on September 9, 1992.
Today, the store is an outreach ministry within St. Patrick Cathedral Parish in the Catholic Diocese of Harrisburg. Donations and purchases help to fund the Shining Light, which serves the ongoing needs of over 1,000 economically disadvantaged individuals each year by providing free or low-cost clothing and domestic goods.
Gail Kline is the Shining Light’s store manager and says its mission is simple: “We are here to help people in need.” Over the years Kline recalls the store has helped individuals who have been released from prison, victims of home fires, and those who have lost their job to get back on their feet.
The Shining Light partners with nearly 50 local agencies that refer those in need to the store’s program. Individuals may get nearly $200 worth of clothing and household items over six months if needed. The store also helps those outside of the referral system by offering store discounts from 50 to 90 percent off of store merchandise.
“This is the time of year we count our own blessings and, in turn, bestow those blessings upon those who need it the most. And that’s what the Shining Light does all year long.”
Legislation seeking to address the statewide opioid crisis that had strong support by the Pennsylvania Catholic Conference was recently signed into law by Governor Tom Wolf.
Senate Bill 446, now Act 59 of 2017, will establish state-regulated minimum quality standards for the licensure of recovery houses receiving funding or referrals from the Department of Drug and Alcohol Programs or another state, federal or county agency.
In a statement issued by the bill’s sponsor, Sen. Tom McGarrigle (R-Chester\Delaware) said, “The addiction crisis is affecting communities in every region of Pennsylvania, and access to effective treatment is vital in turning the tide. People entering the recovery process have taken the crucial first step to a better, productive life. Approval of Senate Bill 446 sends the message that we will not let that journey be cut short due to lack of oversight.”
This new law is welcomed by the recovery houses operated by many Catholic Charities agencies within Pennsylvania’s Catholic dioceses. This is one of several important bills being considered by the General Assembly and monitored by the Pennsylvania Catholic Conference to combat the growing epidemic of opioid abuse.
This holiday season, students at Bishop Guilfoyle Catholic High School have teamed up with Catholic Charities of the Diocese of Altoona-Johnstown to help make Christmas bright for seven children within two area families.
Every angel on the tree is marked with information describing a child, their interests and what they would like to receive for Christmas if they could make a wish.
“It’s almost a random selection. You just pick an angel and you go and you just think about how happy it’s going to make that kid by receiving that gift,” said Morgan Kiesewetter.
Kiesewetter is a senior at Bishop Guilfoyle and chairs the Celebration Committee. The committee is responsible for gathering the gifts once all of the wishes displayed on the angels have been collected, wrapping them and as Kiesewetter describes it, “sending them on their way”.
She added that students enjoy making the wishes of the children come true and even though they will not meet the families, she would also like to send this Christmas message: “They’re always in our prayers; we’re always thinking of them. We’re trying to give a little part of us to them.”