Ordinary and Extraordinary Means and the Quality of Life

Abstract

C ATHOLIC MORALISTS today appear hesitant to speak about "quality of life." A number of Catholic hierarchs and theologians tend to avoid that expression because of public-policy debates surrounding abortion and physician-assisted suicide. In fact the term has been deployed by many hostile to traditional Christianity's views on these moral issues. While it is understandable that in today's political and cultural climate, particularly in the U.S., one might wish to avoid the term, it is important that Roman Catholic bioethicists and moral theologians recognize that quality-of-life judgments have played a central role in the traditional distinction between ordinary and extraordinary means. If we fail to understand the importance of quality-of-life judgments, we run the risk of misunderstanding that distinction and the important moral commitments it implies-all in the interests of winning a political battle.I contend that the distinction between ordinary and extraordinary means cannot be understood without quality-of-life judgments. In assessing the benefits and burdens of treatments, the distinction between ordinary and extraordinary means turns on an assessment of medical treatment relative to the patient. The judgment whether or not to pursue a particular treatment is based in part on a judgment about how a treatment will affect the quality of life for a patient, one's family, and others. Failure to appreciate this underlying framework of the distinction is a failure to understand traditional moral teaching. Such failure is partly due to an oversimplification of language found, for example, in the pro-life agenda and partly due to a modern secular view of medicine. To make my argument I will first review the history of the distinction between extraordinary and ordinary means, then analyze important elements in the distinction, and finally review several current applications of the distinction that have been made by certain sectors of the Roman Catholic episcopacy, with special attention to moral issues related to feeding and hydrating a certain type of patient.

Cryopreserved Embryos: A Catholic Alternative to Embryonic Stem Cell Research and Adoption

“…38 Besides the question of pain, Soto also recognizes the role that emotions of fear and repugnance could play. 39 Soto incorporates the dimension of optional versus obligatory, adding if a procedure or treatment was too painful or burdensome, it would be morally optional. In 1595, Domingo Bañez (1528-1604) was the first to articulate the terms "ordinary" and "extraordinary" as they regard obligatory and non-obligatory means of preserving life.…”

Tube Feedings and Persistent Vegetative State Patients: Ordinary or Extraordinary Means?

“…Such surgery can make a beneficial surgery "morally impossible" to bear (Soto, 1568;Sparks, 1988). Besides the question of pain, Soto also recognizes the role that emotions of fear and repugnance could play (Wildes, 1996). Soto incorporates the dimension of optional versus obligatory, adding if a procedure or treatment was too painful or burdensome, it would be morally optional.…”

“…This statement reinforces the traditional understanding of not treating the physiological aspect of the body separate from the person. Benefits of a treatment can only be determined within the context of a person's life (Wildes, 1996).…”

Conjoined Twins and Catholic Moral Analysis: Extraordinary Means and Casuistical Consistency

“…In some cases, the means themselves can be burdensome, either in a concrete physical sense-e.g., the procedure in question is very painful-or in an more holistic sense that is sensitive to the patient's values-e.g., some eighteenth-century casuists argued that a consecrated virgin need not preserve her life if so doing required her to be treated by a male physician. The tradition also recognizes that a particular means can impose a wide variety of other burdens, ranging from excessive expense, to the emotional repugnance [ 118 ] many people experience at the thought of physical mutilation, to prolonged separation from familiar places and people (Wildes 1996). Significantly, the range of morally cognizable burdens include not only those that fall on the patient, but also those that fall on the family and the community.…”