What is "Extraordinary Care"?
Every so often we hear about someone with a serious illness and the care provided being challenged by family or the medical establishment (Karen Ann Quinlan and Terry Schiavo being two famous cases). Does the Church have any teaching on what constitutes "extraordinary" or "heroic" measures?
We live in a most interesting age as far as our ability to treat illness is concerned. In the past, most diseases that a person or their family could not effectively treat at home with simple measures often resulted in the death of that person. Today many diseases that were once terminal are no longer considered immediate death sentences and among us are many living normal lives that would have not been possible only a short time ago. However, this often comes at a price: one that is financial, social and emotional and strikes at the heart of how we should follow the commandment of Jesus to love one another.
To pose the question in a form that the Catholic Church has used in formulating her teaching: When is treatment for maintaining human life a requirement and when can such efforts (called
in moral theology) be ethically denied? The document that the U.S. Conference of Catholic Bishops, in accord with numerous theologians and ethicists, has released on the subject is the
Ethical and Religious Directives for Catholic Health Care Services
). It states:
A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community (
A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community (
While the guidelines can seem straightforward, the way they can be properly applied changes depending on the specific circumstances. For example, it has been said that an extraordinary means can be things like dialysis and ventilators using machines to keep a person alive. That can be true, but it isn’t always true. Some use of “machines” would not be extraordinary care. A healthy twenty-five-year-old, for example, might need a ventilator for a few days in order to recover from a traumatic accident; in this case the burdens of treatment are proportionate to the benefit provided to the patient.
Surgery is also an “extraordinary” medical intervention but it isn’t always disproportionate. Some newborns are diagnosed with a blocked intestine that would result in death by starvation were it not fora simple, relatively low-risk surgery. In 1982 the famous baby Doe case involved a couple who considered such a surgery disproportionate and chose to let their baby starve to death instead. In this case, the child was deprived a procedure that would have provided proportional care, but its life was considered “not worth living” because of a Down syndrome diagnosis.
On the other hand, some seemingly “ordinary” interventions can actually involve disproportionate care. For example, when a patient is near death it may be painful for him to swallow, they may have a total loss of appetite, and their body may not be able to digest food. In these cases, withholding the ordinary care of food and water is not done to starve the patient to death but to make their inevitable death less painful. That’s why the
Catechism of the Catholic Church
(CCC) says the refusal of “extraordinary care” involves a “refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one's inability to impede it is merely accepted” (
This is a topic that has far too many implications and diverse opinions to adequately cover in a short article. It is recommended that, for particular questions regarding medical ethics and end-of-life decisions, a helpful resource is the National Catholic Bioethics Center website at
When considering any situation such as this either regarding oneself or a loved one, it is best to reflect on the words of Center's Director of Education, Fr. Thaddeus (Tad) Pacholczyk: "We should never choose to bring about our own or another’s death by euthanasia, suicide or other means, but we may properly recognize, on a case by case, detail-dependent basis, that at a certain point in our struggle to stay alive, procedures like dialysis may become unduly burdensome treatments that are no longer obligatory. In these cases, it's always wise to consult clergy or other moral advisors trained in these often-difficult bioethical issues."
...I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
From the Hippocratic Oath
Our FORMED Recommendation for the Week
Audio (75 minutes) -
Aborting America:The Story of Ex-Abortionist and Ex-Atheist Dr. Bernard Nathanson
During October - Respect Life Month - we hear the story of Dr. Bernard Nathanson. He was an American medical doctor from New York who helped to found the National Abortion Rights Action League. He gained national attention by becoming one of the founding members of the National Abortion Rights Action League, now known as NARAL Pro-Choice America. He worked with Betty Friedan and others for the legalization of abortion in the United States. He was also the director of the Center for Reproductive and Sexual Health New York's largest abortion clinic for a time. Nathanson has written that he was responsible for more than 75,000 abortions throughout his pro-choice career.
A self-proclaimed "Jewish atheist", he later became an acclaimed pro-life activist, joining the Catholic Church in 1996 and spoke boldly on behalf of the unborn until his death in 2011. When asked why he converted to Roman Catholicism, he stated that "no religion matches the special role for forgiveness that is afforded by the Catholic Church."
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Sent by Fr. Ed Blanchett on Friday, October 26 at 3:00PM