Abstract
The distinction between ordinary and extraordinary treatment has a long history. Since it was first proposed and discussed in the medieval period, it has formed part of medical ethics, even as that discourse, and the landscape it comments on, has radically changed and developed. In this essay we briefly canvas the history of the debate on ordinary/extraordinary treatment and consider its relevance for professional medical practice in the present context.
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Notes
- 1.
Of course, the same might be said of healthcare professionals – they are moral agents and may act rightly or wrongly. The difference is that, as professionals, they are subject to their profession’s norms and disciplinary procedures. They can be held morally accountable in ways that patients, or ordinary moral actors, cannot.
- 2.
A thorough historical account of the evolution of the distinction between ordinary and extraordinary means can be found in Cronin (1989).
- 3.
Although it is implied there is no explicit mention of “ordinary means” in the English translation of the Declaration. There is only mention of extraordinary means.
- 4.
- 5.
- 6.
This has often been the basis on which futility has been criticized; that what looks to be a biomedical fact – this treatment is futile – is, in fact, a value laden judgment and, rather than being based on the biomedical facts alone, it involves broader issues regarding the value of (a particular) life, or the patient’s state of (ill) health, for example. In response to such comments one can either eliminate futility from the lexicon of medical practice or more clearly acknowledge and engage with the broader value laden – or evaluative – nature of the concept. Given that the notion has not (yet) been successfully excised from professional practice or the literature the latter response seems to be the only option, at least for the present moment.
- 7.
Pellegrino (2000) makes the point that “[c]hanges in medical technology since then do not change the moral impetus of the traditional language.” (p. 88).
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Kearns, A.J., Emmerich, N., Gordijn, B. (2020). The Distinction between Ordinary and Extraordinary Treatment: Can It Be Maintained?. In: Emmerich, N., Mallia, P., Gordijn, B., Pistoia, F. (eds) Contemporary European Perspectives on the Ethics of End of Life Care. Philosophy and Medicine, vol 136. Springer, Cham. https://doi.org/10.1007/978-3-030-40033-0_14
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