Sunday, May 16, 2010

An Education Gets Put to Use

This article from the New York Times (not that I would generally recommend reading the NYT) recently arrived in my email inbox from our parish nurse.  She has the responsibility to coordinate our care and outreach to the sick, the homebound, and the grieving.  She had asked that several other priests and I would read the article and then share our thoughts with her.  My response follows below.

When determining what is ordinary and extraordinary, a basic distinction must be made between medically ordinary and morally ordinary means.  In medicine, a means is ordinary when each of the three following criteria is met:

1) The Treatment is scientifically proven. 
2) It is statistically successful.
3) It is reasonably available.

If any one of these criteria is not met, the means is considered extraordinary.

Morally speaking, a means is ordinary when beneficial, useful, and not unreasonably burdensome (physically and psychologically) to the patient.  Some consideration must be given to cost as well.  The data used to make this determination are typically hope for benefit, common use (the treatment is not exotic or experimental), and that they are commensurate with one’s status (financial, physical, and psychological), and that the means is not otherwise unreasonable.  When some treatment is ordinary, one has the moral obligation to make use of it.  In contrast, when a means is morally extraordinary, one has no obligation to make use of it except in circumstances where the patient is unreconciled with God, or when the life or welfare of another person depends upon the life of the patient.  From this, it can be seen that moral decisions about end of life care are often artful.  There are few “lines in the sand” across which one absolutely may not step.  The Church does insist, however, in contrast to the suggestions of the article, that basic nutrition and hydration are never to be considered extraordinary except in those cases where they would hasten death. 

Given the specific case of dementia, I think the NYT treats human suffering a bit too flippantly.  It is one thing to recognize that a person is very near the end of one’s life and to withhold certain basic treatments.  It is another to say that because a person suffers dementia, there is little reason to treat problems of ill health that tend to affect many of the elderly.  When death is immanent, we have great freedom to allow nature to take its course.  It does not seem to me, however, that we have the freedom to make death immanent by refusing to treat a very treatable condition.  To give antibiotics to treat an infection is not likely to be extraordinary even if it would mean great confusion and psychological turmoil for the patient.  The argument of the NYT seems akin to suggesting that the illnesses of those with Downs Syndrome should not be treated because Downs itself is incurable and because of the potential for confusion and psychological discomfort on the part of the patient. 

The NYT seems to give too little credence to the inestimable value of human life.  They presume that suffering is an evil that must be avoided at all costs.  While suffering is an evil, in the Christian context, it holds a redemptive value.  It finds meaning in the Paschal Mystery.  Even the demented are human; they have value and so does their suffering.  As regards palliative care, I agree that there are often times when the treatment of pain and the provision of comfort would be more appropriate.  The aggressive treatment of disease for the person whose death is already immanent makes no sense (though it is not immoral - one is free to pursue extraordinary means if one chooses to do so).  So, while I appreciate the NYT arguments as to the progressive nature of dementia, I find their conclusions as to the moral course of action quite dubious.



  1. "The Church does insist, however, in contrast to the suggestions of the article, that basic nutrition and hydration are never to be considered extraordinary except in those cases where they would hasten death."

    Why would the Church insist on this? You don't explain and your criteria would not necessitate this. (I realize, these aren't "your" criteria, but the criteria you received in an only-okay morals class.) It seems you have forgotten the criteria of what is naturally necessary--what is necessary for human dignity and human rights. Food, water, basic health care (the treatment of infections, viruses, etc...). Hence, bedsores, etc..., would rarely if ever be a consideration which would make life burdensome.

    I would basically refer you to three helpful texts:

    1) The CDF's 'Declaration on Euthanasia':

    2) Paragraph 65 of John Paul II's 'Evangelium Vitæ':

    3) John Paul II's talk on euthanasia and ordinary care from 2004:

  2. Your point is well-taken. Obviously, those things that are naturally necessary must also be provided and should probably be listed among the criteria listed above.

    While I concur with most of your comment, I would remind you that the criteria I list are the same criteria that are named in the Catholic Health Care Ethics Manuel, which is the document from which many (most?) Catholic Health Care institutions derive their decisions concerning the ethical treatment of patients. I believe that the argument concerning natural necessity was inserted as an addendum to the Manuel sometime after the late Holy Father offered clarification of the issue.

    Given that the bulk of the article does not focus on the issues of nutrition or hydration, it seemed unnecessary to elaborate a case as to their importance (likewise, the person for whom this was first written already understood that principle).

    The texts you mention are useful, and as I recall, primary texts assigned used in the "only-okay" class to which you refer.


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