POLST, Conscience and Bishop Clemens von Galen's Sermon on August 3, 1941

August 4, 2012

Feast of St. John Vianney, Patron Saint of Priests

Dear all,

I invite you to read this sermon by Bishop Clemens August Count von Galen delivered exactly seventy-one years and one day ago.  He spoke courageously to Germans who, at that time, were witnessing state-sanctioned mercy killings, explaining clearly their obligations of conscience.

A more subtle type of state-sanctioned mercy killing is rapidly advancing across the USA called the POLST (Physician’s Orders for Life Sustaining Treatment) paradigm.  POLST is known by different acronyms in various states (POLST, MOST, MOLST, POST — some states even have their unique designation such as CA POLST, MN POLST).  Perhaps the mix of names is one of the reasons most people have not yet become aware of this developing tool of the “third path” euthanasia movement.

POLST is changing the definition of what qualifies as physician’s orders.   The result is that good moral physicians are being forced by law to act against their consciences and permit their patients to die because they must follow the orders given by others on these POLST forms.

POLST acts as a DNR because in substance it is a DNR with bells and whistles. POLST is sometimes referred to by the euthanasia movement as an out-of-hospital DNR.  It is a bright colored piece of paper (usually pink) which travels with the patient into every healthcare setting, ending up on the refrigerator or other place of prominence in the home so EMS can quickly find the form before beginning any medical procedures.

POLST was developed by the “third path” wing of the euthanasia movement selling itself as the moral alternative to physician assisted suicide.   The original POLST task force began their work in the late 80s/early 90s in the state of Oregon a few years before Oregon passed the Death with Dignity Act.   The first official POLST form was incorporated into Oregon’s healthcare system in 1995.   Many of the POLST framers were associated with the Oregon Health Science University (OHSU) which has also been a leader in the development of palliative medicine.

Public debate over physician assisted suicide has drawn America’s attention away from the activities of this less visible wing of the euthanasia movement. It has used palliative medicine as its vehicle and established palliative medicine as the standard for end-of-life care, evidenced by the fact that the POLST paradigm is sailing through state legislatures — unopposed.   In the first half of  2010 Colorado and Louisiana adopted versions of POLST statewide, joining twelve other states authorizing the POLST paradigm (CA, HI, ID, MD, NY, NC, OR, TN, UT, VT, WA, WV).    See “Summary of Health Care Decision Statutes Enacted in 2010” by Mills and Sabatino.

The idea behind POLST is simple – complement the living will document by designing a cookie cutter, one-size-fits all form that would have the power of physician’s orders but would not require the bulkiness of execution represented by notarization and witnesses.   To fill out the forms the patients simply check certain boxes which indicate specific treatment they do or do not wish.

Early on the visual advanced by those promoting the POLST form was a patient on a gurney being wheeled into an ambulance while at the same time being offered the POLST form for his signature.   That picture itself should have sent warning signals to those who saw it.  What is deemed appropriate for the use of  POLST has expanded since then.   POLST is replacing the DNR form as the form of record in nursing homes.  POLST is advertised as the tool to guarantee patient-centered care and it is becoming thoroughly integrated into the operations of palliative care teams.  POLST is marketed as a tool to reassess and redocument a patient’s goals as his condition changes.

When the first versions of the healthcare bill were made public it became obvious that the “third path” euthanasia movement intended to incorporate the POLST form into the health care reform act.    Section 1233 of the House version contained the POLST form as a backdrop for end-of-life discussions, billed as being between the physician and patient, but in reality between the patient and a POLST facilitator who might very well not be a physician or  nurse.   In that proposed federal bill the form was called OLST  (Orders for Life Sustaining Treatment).

Sarah Palin quickly called attention to Section 1233, calling it “death panels.”   The euthanasia promoters were quite upset and quickly went into a damage control mode.  They denied the claim of “death panels”, even suggesting the term “life panels” was more appropriate.   In the end OLST was removed from the final version before passage because of the uproar.... but federally-funded OLST end-of-life consulting sessions were scheduled for a quiet return by fiat through changes in the federal rules and regulations to make them part of the annual medicare wellness visits.    Scheduled for implementation in early January, 2011, the proposed new CMS regulations were dropped very suddenly after  Robert Pear of the NY Times revealed their clandestine tactics in a front page story published on Christmas Day, 2010.    Apparently, they have reverted back to their strategy of introducing the POLST paradigm state-by-state.

Much of the information about POLST is misleading.   Advocates of POLST claim that the patient and the physician together fill out the POLST form.   In reality the physician usually has a minimal part in the discussion if at all.  Instead, specially trained POLST facilitators who are generally social workers, chaplains, hospital administrators,  etc.  help with the form filling and then present it to the doctor for his signature.  

The Affordable Care Act of 2010 authorizes large government subsidies for training people who will “aid in decision making.”   In other words, many more POLST facilitators will be trained with federal monies using, for example, the Respecting Choices curriculum developed in LaCrosse, WI.  Working from training modules which include suggested POLST conversations and scripts, the goal is to steer patients into checking boxes which would limit medical treatment.  (Of course these limitations will save considerable costs in our time of economic hardship.)  Will the POLST form be filled out with proper informed consent?   Doubtful.

Efforts have now turned to making sure that all POLST forms are recorded electronically and updated regularly.    Health care professionals with their hand held computers will have access to the POLST form during rounds, but everyone will be legally bound by the checked boxes.

Will it be possible for families, who realize that Grandma and her facilitator made some foolish choices that are now part of her electronic health records, to rescind those orders and reclaim the full range of options for Grandma’s medical care?  The promoters of POLST would deny that option.

Last week the Wisconsin Catholic bishops released a pastoral statement warning against the POLST form.    They emphasize in their statement that there will be conflicts of conscience presented to healthcare professionals and institutions.    They state very clearly:  “Due to the serious and real threats to the dignity of human life that POLST and all similar documents present, we encourage all Catholics to avoid using all such documents, programs, and materials. The POLST form should not be regarded as the standard model for designating treatment preferences.” 

Just as Bishop von Galen spoke out in Germany some seventy years ago, we now have the first statement about POLST conscience problems signed by all five of the bishops in the state of Wisconsin.

We pray for guidance from the Holy Spirit to help us understand that general acceptance of the POLST paradigm brings about a Pandora’s Box of conscience problems.

Elizabeth D. Wickham, PhD (Betty)
Executive Director, LifeTree
The comments and emphases attached to the sermon below are mine.   I have tried to show how his sermon should sharpen our focus on one of today’s problems, the POLST form.    He is quite clear that when circumstances presented by the state threaten human lives moral people must act according to their consciences.
(from von Galen) 
“....there are sacred obligations of conscience from which no one can release us and which we must fulfill even at the price of death itself. At no time, and under no circumstances whatsoever, may a man, except in war and in lawful defence, take the life of an innocent person.”
“Useless Eaters"
Sermon Delivered by Bishop Clemens August Count of Galen
August 3, 1941

[The following is from the book, Cardinal von Galen, by Rev. Heinrich Portmann, translated by R.L. Sedgwick, 1957, pp. 239-246.]

The Third Sermon, preached in the Church of St. Lambert's on August 3rd, 1941, in which the Bishop attacks the Nazi practice of euthanasia and condemns the ‘mercy killings’ taking place in his own diocese.

My Beloved Brethren,

In today's Gospel we read of an unusual event: Our Saviour weeps. Yes, the Son of God sheds tears. Whoever weeps must be either in physical or mental anguish. At that time Jesus was not yet in bodily pain and yet here were tears. What depth of torment He must have felt in His heart and Soul, if He, the bravest of men, was reduced to tears. Why is He weeping? He is lamenting over Jerusalem, the holy city He loved so tenderly, the capital of His race. He is weeping over her inhabitants, over His own compatriots because they cannot foresee the judgment that is to overtake them, the punishment which His divine prescience and justice have pronounced. ‘Ah, if thou too couldst understand, above all in this day that is granted thee, the ways that can bring thee peace!’ Why did the people of Jerusalem not know it? Jesus had given them the reason a short time before. ‘Jerusalem, Jerusalem . . . how often have I been ready to gather thy children together, as a hen gathers her chickens under her wings; and thou didst refuse it! I your God and your King wished it, but you would have none of Me.…’ This is the reason for the tears of Jesus, for the tears of God. …Tears for the misrule, the injustice and man's willful refusal of Him and the resulting evils, which, in His divine omniscience, He foresees and which in His justice He must decree.… It is a fearful thing when man sets his will against the will of God, and it is because of this that Our Lord is lamenting over Jerusalem.

My faithful brethren! In the pastoral letter drawn up by the German Hierarchy on the 26th of June at Fulda and appointed to be read in all the churches of Germany on July 6th, it is expressly stated: ‘According to Catholic doctrine, there are doubtless commandments which are not binding when obedience to them requires too great a sacrifice, but there are sacred obligations of conscience from which no one can release us and which we must fulfil even at the price of death itself. At no time, and under no circumstances whatsoever, may a man, except in war and in lawful defence, take the life of an innocent person.’

When this pastoral was read on July 6th I took the opportunity of adding this exposition:

For the past several months it has been reported that, on instructions from Berlin, patients who have been suffering for a long time from apparently incurable diseases have been forcibly removed from homes and clinics. Their relatives are later informed that the patient has died, that the body has been cremated and that the ashes may be claimed. There is little doubt that these numerous cases of unexpected death in the case of the insane are not natural, but often deliberately caused, and result from the belief that it is lawful to take away life which is unworthy of being lived. (Comment: The POLST form makes it legal to do this to people who have been persuaded that their life is unworthy of being lived)

This ghastly doctrine tries to justify the murder of blameless men and would seek to give legal sanction to the forcible killing of invalids, cripples, the incurable and the incapacitated. I have discovered that the practice here in Westphalia is to compile lists of such patients who are to be removed elsewhere as ‘unproductive citizens,’ and after a period of time put to death. This very week, the first group of these patients has been sent from the clinic of Marienthal, near Münster.

Paragraph 21 of the Code of Penal Law is still valid. It states that anyone who deliberately kills a man by a premeditated act will be executed as a murderer. It is in order to protect the murderers of these poor invalids—members of our own families—against this legal punishment, that the patients who are to be killed are transferred from their domicile to some distant institution. Some sort of disease is then given as the cause of death, but as cremation immediately follows it is impossible for either their families or the regular police to ascertain whether death was from natural causes.

I am assured that at the Ministry of the Interior and at the Ministry of Health, no attempt is made to hide the fact that a great number of the insane have already been deliberately killed and that many more will follow.

Article 139 of the Penal Code expressly lays down that anyone who knows from a reliable source of any plot against the life of a man and who does not inform the proper authorities or the intended victim, will be punished.… (Comment: It would be a crime to keep silent about POLST)

When I was informed of the intention to remove patients from Marienthal for the purpose of putting them to death I addressed the following registered letter on July 29th to the Public Prosecutor, the Tribunal of Münster, as well as to the Head of the Münster Police:

‘I have been informed this week that a considerable number of patients from the provincial clinic of Marienthal are to be transferred as citizens alleged to be "unproductive" to the institution of Richenberg, there to be executed immediately; and that according to general opinion, this has already been carried out in the case of other patients who have been removed in like manner. Since this sort of procedure is not only contrary to moral law, both divine and natural, but is also punishable by death, according to Article 211 of the Penal Code, it is my bounden obligation in accordance with Article 139 of the same Code to inform the authorities thereof. Therefore I demand at once protection for my fellow countrymen who are threatened in this way, and from those who propose to transfer and kill them, and I further demand to be informed of your decision.’

I have received no news up till now of any steps taken by these authorities. On July 26th I had already written and dispatched a strongly worded protest to the Provincial Administration of Westphalia which is responsible for the clinics to which these patients have been entrusted for care and treatment. My efforts were of no avail. The first batch of innocent folk have left Marienthal under sentence of death, and I am informed that no less than eight hundred cases from the institution of Waestein have now gone. And so we must await the news that these wretched defenceless patients will sooner or later lose their lives. Why? Not because they have committed crimes worthy of death, not because they have attacked guardians or nurses as to cause the latter to defend themselves with violence which would be both legitimate and even in certain cases necessary, like killing an armed enemy soldier in a righteous war.

No, these are not the reasons why these unfortunate patients are to be put to death. It is simply because that according to some doctor, or because of the decision of some committee, they have no longer a right to live because they are ‘unproductive citizens’. The opinion is that since they can no longer make money, they are obsolete machines, comparable with some old cow that can no longer give milk or some horse that has gone lame. What is the lot of unproductive machines and cattle? They are destroyed. I have no intention of stretching this comparison further. The case here is not one of machines or cattle which exist to serve men and furnish them with plenty. They may be legitimately done away with when they can no longer fulfil their function. Here we are dealing with human beings, with our neighbours, brothers and sisters, the poor and invalids… unproductive—perhaps! But have they, therefore, lost the right to live? Have you or I the right to exist only because we are ‘productive’? If the principle is established that unproductive human beings may be killed, then God help all those invalids who, in order to produce wealth, have given their all and sacrificed their strength of body. If all unproductive people may thus be violently eliminated, then woe betide our brave soldiers who return home, wounded, maimed or sick.

Once admit the right to kill unproductive persons . . . then none of us can be sure of his life. We shall be at the mercy of any committee that can put a man on the list of unproductives. There will be no police protection, no court to avenge the murder and inflict punishment upon the murderer. Who can have confidence in any doctor? He has but to certify his patients as unproductive and he receives the command to kill.  (Comment: Verify that the patient has a POLST form which orders no food and water, and that patient will surely die.)   If this dreadful doctrine is permitted and practised it is impossible to conjure up the degradation to which it will lead. Suspicion and distrust will be sown within the family itself. A curse on men and on the German people if we break the holy commandment ‘Thou shalt not kill’ which was given us by God on Mount Sinai with thunder and lightning, and which God our Maker imprinted on the human conscience from the beginning of time! Woe to us German people if we not only licence this heinous offence but allow it to be committed with impunity! 

I will now give you a concrete example of what is taking place here. A fifty-five-year-old peasant from a country parish near Münster—I could give you his name—has been cared for in the clinic of Marienthal for some years suffering from some mental derangement. He was not hopelessly mad, in fact he could receive visitors and was always pleased to see his family. About a fortnight ago he had a visit from his wife and a soldier son who was home on leave from the front. The latter was devoted to his sick father. Their parting was sad, for they might not see each other again as the lad might fall in battle. As it happens this son will never set eyes on his father again because he is on the list of the ‘unproductives’. A member of the family who was sent to see the father at Marienthal was refused admission and was informed that the patient had been taken away on the orders of the Council of Ministers of National Defence. His whereabouts was unknown. The family would receive official notification in due course. What will this notice contain? Will it be like all the others, namely that the man is dead and that the ashes of his body will be sent on the receipt of so much money to defray expenses? And so the son who is now risking his life at the front for his German compatriots will never again see his father. These are the true facts and the names of all those concerned are available.

‘Thou shalt not kill.’ God engraved this commandment on the souls of men long before any penal code laid down punishment for murder, long before any court prosecuted and avenged homicide. Cain, who killed his brother Abel, was a murderer long before courts or states came into existence, and plagued by his conscience he confessed, ‘Guilt like mine is too great to find forgiveness . . . and I shall wander over the earth, a fugitive; anyone I meet will slay me.’

Because of His love for us God has engraved these commandments in our hearts and has made them manifest to us. They express the need of our nature created by God. They are the unchangeable and fundamental truths of our social life grounded on reason, well pleasing to God, healthful and sacred. God, Our Father, wishes by these precepts to gather us, His children, about Him as a hen shelters her brood under her wings. If we are obedient to His commands, then we are protected and preserved against the destruction with which we are menaced, just as the chicks beneath the wings of the mother. ‘Jerusalem, Jerusalem …how often have I been ready to gather thy children together, as a hen gathers her chickens under her wings; and thou didst refuse it!’...

‘And as He drew near, and caught sight of the city, He wept over it, and said: "Ah, if thou too couldst understand, above all in this day that is granted thee, the ways that can bring thee peace! As it is, they are hidden from thy sight. The days will come upon thee when thy enemies will fence thee round about, and encircle thee, and press thee hard on every side, and bring down in ruin both thee and thy children that are in thee, not leaving one stone of thee upon another; and all because thou didst not recognize the time of My visiting thee."’

Jesus saw only the walls and towers of the city of Jerusalem with His human eye, but with His divine prescience He saw far beyond and into the inmost heart of the city and its inhabitants. He saw its wicked obstinacy, terrible, sinful and cruel. Man, a transitory creature, was opposing his mean will to the Will of God. That is the reason why Jesus wept for this fearful sin and its inevitable punishment. God is not mocked.

Christians of Münster! Did the Son of God in His omniscience see only Jerusalem and its people? Did He weep only on their behalf? Is God the protector and Father of the Jews only? Is Israel alone in rejecting His divine truth? Are they the only people to throw off the laws of God and plunge headlong to ruin? Did not Jesus, Who sees everything, behold also our German people, our land of Westphalia and the Lower Rhine, and our city of Münster? Has He not also wept for us? For a thousand years He has instructed us and our forbears in the Faith. He has led us by His law. He has nourished us with His grace and has gathered us to Him as the hen does her brood beneath its wings. Has the all-knowing Son of God seen that in our own time He would have to pronounce on us that same dread sentence? ‘Not leaving one stone of thee upon another; and all because thou didst not recognize the time of My visiting thee.’ That would indeed be a terrible sentence.

My dearly Beloved, I trust that it is not too late. It is time that we realized today what alone can bring us peace, what alone can save us and avert the divine wrath. We must openly, and without reserve, admit our Catholicism. We must show by our actions that we will live our lives by obeying God's commandments. Our motto must be: Death rather than sin. By pious prayer and penance we can bring down upon us all, our city and our beloved German land, His grace and forgiveness.

But those who persist in inciting the anger of God, who revile our Faith, who hate His commandments, who associate with those who alienate our young men from their religion, who rob and drive out our monks and nuns, who condemn to death our innocent brothers and sisters, our fellow human beings, we shun absolutely so as to remain undefiled by their blasphemous way of life, which would lay us open to that just punishment which God must and will inflict upon all those who, like the thankless Jerusalem, oppose their wishes to those of God.

O my God, grant to us all now on this very day, before it is too late, a true realization of the things that are for peace. O Sacred Heart of Jesus, oppressed even unto tears by the blindness and sins of men, help us by Thy grace to seek always what is pleasing to Thee and reject what is displeasing, so that we may dwell in Thy Love and find rest in our souls. Amen.


© LifeTree, Inc. 2012


For those of you who have not seen the POLST paradigm, click the image above to view a sample draft of one of the versions of the MOST form sent to LifeTree by the NC Medical Society in June 2006.