Abstract
Despite reluctance of a part of medical society to accept the moral and/or legal permission to euthanasia, there is seemingly a common agreement on the need to resolve the problem of excessive therapy. Several ethical concepts are used to justify decisions to withhold/withdraw such treatment. Three of them are of particular value. The ordinary-extraordinary means distinction has a long tradition deeply-rooted in the Catholic medical ethics. During the last decades the concept of futile (or pointless) treatment has reached popularity within bioethical discourse. Also, slightly less common in use, the term ‘obstinate therapy’ and the relative concept seems to provide interesting insights into ethical debate. What is however to be emphasized is the ambiguity of meanings attached to these terms/concepts which prompt many bioethicists to reject these terms in favor of other concepts. In the present study a PubMed literature database review is done in order to recognize and then to classify the different ways of interpretation of the three concepts related to withholding/withdrawing excessive treatment. Retrieved interpretations of these concepts are evaluated in the light of an integrated model of moral justification. The undertaken analyses permit reaching the conclusion that the concepts which are the subject matter of this article can be properly defined and used only within the context of the so called holistic ethics and as an example of such i.e., a holistic approach to bioethics, the life’s programs approach to bioethics is given.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Atkinson, G. M. (1984). Ethics Commission examines moral distinction in using life supports. Hospital Progress, 65(2), 36–41, 70.
Baker, R., & McCullough, L. (2007). Medical ethics’ appropriation of moral philosophy: The case of sympathetic and unsympathetic physician. Kennedy Institute of Ethics Journal, 17(1), 3–22.
Beauchamp, T. L. (2007). History and theory in ‘applied ethics’. Kennedy Institute of Ethics Journal, 17(1), 55–64.
Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedical ethics (6th ed.). New York: Oxford University Press.
Bole, T. J. (1990). The ordinary-extraordinary distinction reconsidered: A moral context for the proper calculus of benefits and burdens. HEC Forum, 2(4), 219–232.
Bulger, R. J., & Barbato, A. L. (2000). On the Hippocratic sources of western medical practice. The Hastings Center Report, 30(4), S4–S7.
Carnevale, F. A., Alexander, E., Davis, M., Rennick, J., & Troini, R. (2006). Daily living with distress and enrichment: The moral experience of families with ventilator-assisted children at home. Pediatrics, 117(1), e48–e60.
Clark, P. (2006). Tube feedings and persistent vegetative state patients: Ordinary or extraordinary means? Christian Bioethics, 12(1), 43–64.
Curran, W. J. (1976). Bioethics and health ethics: A critical examination of the new terminology. American Journal of Public Health, 66(5), 497–498.
Devlin, M. (1982). Extraordinary means in prolonging life. JAMA 248(17), 2180.
De Vries, R. (2004). How can we help? From ‘sociology in’ to ‘sociology of’ bioethics. Journal of Law, Medicine and Ethics, 32(2), 279–292.
Deegan, G. (2008). Dominic Banez & Francis Vitoria, Univeristas (Summer ed.: 5–7). Available from http://www.cts.org.au/0808/DOMINIC-BANEZ.pdf. Accessed 05 May 2012.
Gillon, R. (1986). Ordinary and extraordinary means. BMJ, 292, 259–261.
Gillon, R. (2003). Ethics needs principles – Four can encompass the rest – And respect for autonomy should be “first among equals”. Journal of Medical Ethics, 29(5), 307–312.
Gostin, L. O. (1997). Deciding life and death in the courtroom. From Quinlan to Cruzan, Glucksberg, and Vacco – A brief history and analysis of constitutional protection of the ‘right to die’. JAMA: The Journal of the American Medical Association, 278(18), 1523–1528.
Henke, D. E. (2004). Artificially assisted hydration and nutrition from Karen Quinalan to Nancy Cruzan to the present: An historical analysis of the decision to provide or withhold/withdraw sustenance from PVS patients in Catholic moral theology and medical practice in the United States. Rome: Pontificia Universitas Lateranensis.
Henke, D. E. (2005). A history of ordinary and extraordinary means. National Catholic Bioethics Quarterly, 5(3), 555–575.
Hunka, S. A. (1993). The right to refuse treatment – An ethical case study. Intensive & Critical Care Nursing, 9(2), 82–87.
Kahn, J. P. (2006). What happens when politics discovers bioethics? The Hastings Center Report, 36(3), 10.
Kaveny, M. C. (2002). Conjoined twins and Catholic moral analysis: Extraordinary means and casuistical consistency. Kennedy Institute of Ethics Journal, 12(2), 115–140.
Kelly, G. (1951). The duty to preserve life. Theological Studies, 12(4), 550.
Kilan, B. (2009). J. Rawls’s idea of an ‘overlapping consensus’ and the complexity of ‘comprehensive doctrines’. Ethical Perspectives, 16(1), 21–60.
Kuhse, H. (1985). Euthanasia again. ‘Letting die’ is not in the patient’s best interests: A case for active euthanasia. The Medical Journal of Australia, 142(11), 60–613.
Lantz, G. (2000). Applied ethics: What kind of ethics and what kind of ethicist? Journal of Applied Philosophy, 17(1), 21–28.
Lopez, J. (2004). How sociology can save bioethics…maybe. Sociology of Health & Illness, 26(7), 875–896.
Niebroj, L. (2008). The origins of bioethics: Advances in resuscitation techniques. Journal of Physiology and Pharmacology, 59(Suppl. 6), 515–522.
Niebroj, L. (2010a). Bioethics of life programs. Katowice: SUM (Article in Polish).
Niebroj, L. (2010b). Bioethics of life programs: Taking seriously moral pluralism in clinical settings. European Journal of Medical Research, 15(Suppl. 2), 98–101.
Niebroj, L. T., Olejniczak, M., & Kruzlak, A. (2007). The issue of autonomy in medical ethics: Philosophy of Karol Wojtyla. Przeglad Lekarski, 64(12), 1045–1048 (Article in Polish).
O’Rourke, K. (1988). Evolution of Church teaching on prolonging life. Health Progress, 69(1), 28–35.
Pius, X. I. I. (1958). The prolongation of life: An address of pope Pius XII to an international congress of anesthesiologists (November 24, 1957). The Pope Speaks, 4(4), 393–398.
Pope, S. J. (2002). Overview of the ethics of Thomas Aquinas. In S. J. Pope (Ed.), The ethics of Aquinas (pp. 30–52). Washington, DC: Georgetown University Press.
Rawls, J. (1993). Political liberalism. New York: Columbia University Press.
Snelling, P. C. (2004). Consequences count: Against absolutism at the end of life. Journal of Advanced Nursing, 46(4), 350–357.
Sousa-Lara, D. (2008). Aquinas on the object of the human act: A reading in light of the texts and commentators. Josephinum Journal of Theology, 25(2), 243–276.
Sullivan, S. M. (2007). The development and the nature of the ordinary/extraordinary means distinction in the Roman Catholic tradition. Bioethics, 21(7), 386–397.
Thiel, M. J. (2011). Human dignity: Intrinsic or relative value? Journal International de Bioéthique, 21(3), 51–62. 88–89.
Thomas, A. (1920). Summa theologica. (2nd and Rev. ed.). Available from http://www.op.org/summa/. Accessed 25 June 2011.
Thomas A. (2003). In R. Regan., & B. Davies (Ed. & Trans), On evil. New York: Oxford University Press.
Vatican Council II. (1965). Declaration on religious freedom Dignitatis Humanae on the right of the person and of communities to social and civil freedom in matters religious promulgated by His Holiness Pope Paul VI on December 7, 1965, Available from http://www.vatican.va/archive/hist_councils/ii_vatican_council/documents/vat-ii_decl_19651207_dignitatis-humanae_en.html. Accessed 25 June 2011.
Waddington, I. (1975). The development of medical ethics – A sociological analysis. Medical History, 19(1), 36–51.
Wenar, L. (2008). John Rawls. In E. N. Zalata (Ed.), Stanford encyclopedia of philosophy. Available from http://www.plato.stanford.edu. Accessed 25 June 2011.
Conflicts of interest: The authors declare no conflicts of interest in relation to this article.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media Dordrecht
About this paper
Cite this paper
Niebroj, L., Bargiel-Matusiewicz, K., Wilczynska, A. (2013). Toward the Clarification of Ideas: Medical Futility, Persistent/Obstinate Therapy and Extra/Ordinary Means. In: Pokorski, M. (eds) Respiratory Regulation - Clinical Advances. Advances in Experimental Medicine and Biology, vol 755. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-4546-9_44
Download citation
DOI: https://doi.org/10.1007/978-94-007-4546-9_44
Published:
Publisher Name: Springer, Dordrecht
Print ISBN: 978-94-007-4545-2
Online ISBN: 978-94-007-4546-9
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)