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

Abstract

This article looks at the late John Paul II's allocution on artificial nutrition and hydration (ANH) and the implications his statement will have on the ordinary-extraordinary care distinction. The purpose of this article is threefold: first, to examine the medical condition of a persistent vegetative state (PVS); second, to examine and analyze the Catholic Church's tradition on the ordinary-extraordinary means distinction; and third, to analyze the ethics behind the pope's recent allocution in regards to PVS patients as a matter of conscience. Rather than providing clarification, I argue that the papal allocution has raised many difficult questions. People in situations where decisions must be made about withdrawal or continued ANH are in need of guidance. Moreover, additional analysis is needed to determine whether the papal allocution is in conflict with the traditional Catholic medical ethics understanding of the ordinary-extraordinary care distinction.

A Life Worth Giving? The Threshold for Permissible Withdrawal of Life Support From Disabled Newborn Infants

“…Surveys of patient preferences also suggest that the vast majority of adults would not want life-sustaining treatment provided if they were in a vegetative state (Emanuel et al 1991). While the 2004 statement by Pope John Paul II maintained that patients in a vegetative state retain a right to certain basic treatments, including artificial nutrition and hydration (Pope John 2004), the Catholic church has long held that the duty to preserve life is relative rather than absolute (Clark 2006). For patients in a vegetative state, mechanical ventilation and intensive care would usually be regarded as extraordinary means and therefore not obligatory (Clark 2006).…”

Catholic Teaching: A Middle Ground and Guide for End-of-Life Care and Decision-Making and an Antidote for Dying Badly in America

“…Ordinary does not refer to medical care that is normal or frequently used; rather, it is used in the context of whether the intervention offers reasonable hope of benefit and is not excessively burdensome. Excessive burdens include something impossible, something requiring great/grave effort or hardship, unbearable/excessive pain, excessive/unreasonable expense, and/or repugnance/severe dread (CHA ND; Cronin 1956, 1958 reprinted 2011; Clark 2006; Henke 2005; Panicola 2001; Sullivan 2007). On the other hand, extraordinary means are morally optional.…”

Fallacy of the last bed dilemma

“…In 1595, Domingo Bañez (1528–1604) was the first to use the terms ‘ordinary’ and ‘extraordinary’ when referring to the obligatory and non-obligatory means of preserving life. 24 The importance of this distinction is essentially ethical and not clinical: the ordinariness of treatments (or means) refers to the mandatory dimension of the action implemented through those means, while the extraordinariness indicates the optionality of the action itself. In other words, the distinction is clinical insofar as it is ethical, but not vice versa.…”

“…This distinction is ‘based on the prudential judgment of the patient or surrogate on whether the means used offered a proportionate hope of benefit without imposing excessive burdens to the overall quality of the patient’s life’. 24 The criterion of proportionality mainly concerns the balance between the hope of benefitting and the burden that certain means may inflict on the patient. Following Jansen and Sulmasy, we may affirm that ‘the proportionality principle instructs the physician to estimate the total intensity or amount of his or her patient’s suffering’.…”