Since you asked...
“I believe the Church teaches that ‘extraordinary means’ need not be used to prolong the life of a gravely ill person. But what are ‘extraordinary means’? Does it differ from case to case? And who decides?”
This month with Msgr. Steve Worsley
Those are great questions! You are definitely onto something both useful and important. As one of my favorite teachers used to say, it’s our ability and our willingness to ask the right questions that helps us find useful answers.
As I consider your questions, two others come to mind: Who made us? Why did God make us? Regardless of whether you recognize these two questions, their answers were foundational to the teachings so beautifully articulated by Pope John Paul II in his encyclical Evangelium Vitae.
For the believer, the answer to the first of these questions is that God made us. Indeed, God made us in his own image and likeness. This is why we hold all human life to be sacred, regardless of age, gender, intelligence, etc. For this reason we never speak, as some do, of a time “when life has no more value.” Rather we believe that human life is always of value as it is a reflection of divine love.
On the other hand, the answer to the second question reminds us that life on this earth is not our eternal destiny. God made us so that we might know, love and serve him in this life and be happy with him forever in the next. Taken together, these two teachings will help us with most of the “end of life” questions we will encounter in bioethics.
Moral theologians such as the Dominican Francisco de Vitoria (1486-1546), have long taught that one is required to employ only those means of preserving one’s life for which the burden is not too great. Pope Pius XII continued this tradition in 1957, when he spoke of the requirement to use “ordinary means” to preserve life and the correspondingly optional nature of “extraordinary means.”
Hence the terms “ordinary” and “extraordinary means” originally developed as technical terms referring to one’s moral obligation. The determination of whether a treatment was ordinary or extraordinary depended on impact of the treatment. Thus, as you asked, the determination is “case specific.” It depends on the benefit a treatment offers to a patient relative to the burden the treatment imposes on the patient, her family and the community.
As this concept gained wider application, confusion arose when people began using the term “ordinary” to refer to what was customary or usual in medical practice rather than its original usage. Consequently they assumed that specific procedures or technologies could be classed as ordinary or extraordinary.
In an effort to reduce confusion, ethicists substituted the word “proportionate” for “ordinary” when referring to means or treatments that were morally obligatory. Similarly they substituted the term “disproportionate” for “extraordinary” when referring to treatments that were morally optional.
Either way, the key moral consideration remained not whether the proposed treatment is customary or commonly employed, but rather the benefit offered and the burden imposed. Following the position outlined by the Sacred Congregation of the Faith in its Declaration on Euthanasia (1980), the United States Conference of Bishops wrote in the Ethical and Religious Directives for Catholic Health Care Services (2001):
“While every person is obliged to use ordinary means to preserve her health, no person should be obliged to submit to a health care procedure that the person has judged, with a free and informed conscience, not to provide a reasonable hope of benefit without imposing excessive risks and burdens on the patient, or excessive expense to family or community.” [32]
Elsewhere in the same document we find, “A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.” [56]
You will notice that it is the patient, who with a free and informed conscience, determines whether a specific treatment is morally required in his particular circumstance.
If you are wondering who decides when the patient lacks the capacity to do so, or whether food and water can ever be considered extraordinary, you will find the same documents helpful. Both are readily accessible on the Internet. Or you can find these and other fabulous resources on the web site of Catholic Health East, sponsor of St. Joseph of the Pines, at www.che.org/ethics/.
Notwithstanding the many developments that have occurred since I first studied medicine, the wisdom of the church continues to be enormously helpful in addressing these and many other ethical questions. Thanks for asking!
Monsignor Worsley is Vice President of Mission & Ethics for St. Joseph Healthcare in New Hampshire. He earned his MD at Duke University and an STL in ethics at the Accademia Alfonsiana in Rome.