Limits to Life-Sustaining Treatment
1. Treat with all "ordinary" measures, but withhold "extraordinary" measures
The distinction between "ordinary" and "extraordinary" measures traces back to medieval times. A classic definition of what constitutes "extraordinary" measures is:
EXTRAORDINARY MEASURES =df "those which cannot be obtained or used without excessive expense, pain, or other inconvenience, or which, if used, would not offer a reasonable hope of benefit" [Gerald Kelly, "Notes: The Duty to Preserve Life," Theological Studies 12 (1951):550-556.]
The fundamental principles behind the distinction were well-stated by Pope Pius XII:
man (and whoever is
entrusted with the task of taking care of his fellowman) has the right
and the duty in the case of serious illness to take the necessary treatment
for the preservation of life and health . . . But normally one is held
to use only ordinary means -- according to circumstances of persons, places,
times, and culture -- that is to say, means that do not involve any grave
burden for oneself or another. A more strict obligation would be too burdensome
for most men. . . . On the other hand, one is not forbidden to take more
than the strictly necessary steps to preserve life and health, as long
as he does not fail in some more serious duty.
Notice the normative nature of the characterization: what expense, pain, etc, is "excessive" or a "grave burden"? Who decides THAT?
Nevertheless, we will see references to "extraordinary" or "heroic" or "optional" measures in some of our discussions. Some state statutes (e.g., the Tennessee "Right-to-a-Natural-Death Act" even contain these terms.) So understanding them and evaluating them will occupy us in this unit.
Not many would question that it is appropriate to refuse extraordinary measures. Nobody would fault (e.g.) the patient who has gone through multiple rounds of chemotherapy plus surgery plus radiotherapy who finally says "enough" and refuses a proposed highly experimental chemotherapy. It would truly be heroic to undertake the treatment.