Academic journal article Theological Studies

Ordinary and Extraordinary Means and the Quality of Life

Academic journal article Theological Studies

Ordinary and Extraordinary Means and the Quality of Life

Article excerpt

CATHOLIC 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.

HISTORY OF THE DISTINCTION

Since the 16th century Roman Catholics have reflected on the extent of one's obligation to preserve life.(1) These reflections were partly influenced by developments in medicine during the Renaissance. This was the age in which A. Vesalius published his De human) corporis fabrica (1542), from which the study of anatomy as we know it emerged, Harvey (1578-1657) advanced his theory of circulation, and Thomas Sydenham (1624-1689) published Observationes medicae (1676), a systematic description of diseases that brought to medicine Bacon's discipline of scientific observation. Against this backdrop of advances in medicine such as the development of surgery, moralists from Francisco de Vitoria (1486-1546) to Juan Cardinal de Lugo, S.J. (1583-1660) explored the positive obligation of Christians to preserve life. Unlike the "perfect" obligation not to take innocent human life intentionally, the "positive" obligation was often ambiguous and open ended. While it was clear that a Christian was not obligated to do everything to preserve life, it was unclear to what extent one was obligated to preserve life. Decisions about pursuing life-prolonging treatments were set within certain boundaries. On the one hand, one could not intentionally take innocent human life, including one's own; but, on the other hand, one need not maintain life at all costs. To do everything to maintain life at all costs could be nothing short of idolatry as Pius XII stated in 1958; it is to put human life before all else including God. Most medical decisions, however, fall somewhere in between these boundaries. Reflections on these decisions were articulated in the language of ordinary and extraordinary means.

In his doctoral dissertation first published in 1958 that examined the obligation to conserve human life, Daniel A. Cronin, now Archbishop of Hartford, repeated the conviction that the human person lacks perfect dominion over his or her own life. …

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