PROVIDENCE, R.I. - Thomas Kelly embraces life, having survived two bouts with cancer. But when the end comes, the retired nurse is leaving nothing to chance.
Appalled by seeing swollen hospital patients on feeding tubes and respirators during his career, Kelly, 78, signed a legal document with the encouragement of his Roman Catholic priest. It permits his wife to stop those treatments once death is imminent - but not any sooner.
Catholics around the country are turning to their churches for similar fill-in-the-blank documents that turn Catholic teachings into legally binding agreements about how they want to die. Many signers cite Terry Schiavo, whose case sparked a 15-year legal battle that grew beyond her family all the way to the White House over whether she should be allowed to die.
In a persistent vegetative state, her husband ordered her feeding tube removed against her parents' vehement opposition, and she died in 2005. Some, including the Vatican, likened her death to murder.
"I don't think I have any right as a Catholic to say when my life should end," Kelly said. "I don't think I have a right to take my own life, a right to take anyone else's life, and I certainly don't want anyone taking my own life."
Troubled by the Schiavo case, Kelly attended a seminar organized by the Rev. Christopher Mahar, associate pastor of Our Lady of Mercy parish in East Greenwich to help guide his parishioners following Schiavo's case.
Mahar said he intended to hand out a legal form the diocese produced about a decade ago, but stopped when he realized it was more permissive than more recent guidance from the Vatican about when feeding tubes should be removed.
"To remove it would be considered passive euthanasia," said the priest, who is now working to draft a new document. "I guess what the church is trying to do is keep up with the times."
Known as a durable power of attorney, the document will eventually become the centerpiece of an information packet about death that Catholic leaders in Rhode Island could one day hand out in hospitals, hospices or local churches.
The form allows the signer to designate a medical decision-maker in case the signer becomes incapable. That person would be constrained by church teachings, including prohibitions against mercy killing.
Dioceses in South Dakota, Florida, Michigan and Washington states already distribute similar packets, some with legal paperwork that people can easily complete and sign. The Vatican's top health official recently backed the use of living wills, a similar legal document, in Italy.
The National Catholic Bioethics Center, which advises many Catholic institutions, also revised its own durable power of attorney after the Schiavo case. It has shipped thousands of the forms from its Philadelphia headquarters, and demand peaked when the Schiavo case headed to court.
"They were going out in extraordinary numbers then," said Edward Furton, an ethicist who works at the center.
While all the documents work off the same core church teachings, they sometimes reach different conclusions, particularly on when and how feeding tubes can be removed.
In general, the Catholic Church teaches that believers are morally required to seek ordinary care, or medical treatment that offers a reasonable hope of benefit and isn't overly burdensome.
Anything else is usually termed extraordinary treatment and considered optional.
Applying centuries-old guidelines in an age of respirators and feeding tubes has challenged church authorities.
Before Schiavo died, Pope John Paul II said that feeding tubes should be considered mandatory care for vegetative patients, even if hope for a full recovery wanes. Theologians say exceptions can be made when patients can't digest food or water or when the tube itself causes other serious medical conditions.
Deciding when the benefits outweigh the burdens has never been an exact science, said the Rev. Kevin O'Rourke, a Catholic priest who studies bioethics at the Stritch School of Medicine, part of Loyola University Chicago.
He helped author a power-of-attorney document in the early 1990s in which patients can authorize their decision-makers to stop artificial feeding. O'Rourke said people who insist on indefinitely feeding vegetative patients are selectively emphasizing abstract guidance from the Vatican that is supposed to be applied on a case-by-case basis.