Case Study 8 : PERSONALIZING HEALTH CARE
Challenges
A 15-year old male is admitted with the chief complaint of pain associated with liver cancer. The doctors explain to the patient’s family that since the malignancy already sits at a very advanced stage, no real hope for recovery exists, and that any aggressive treatment (e.g., radiation) would simply be too burdensome for the patient and the family members themselves. The doctors add that such radiation treatment at this point may already count as “extraordinary”, and therefore the obligation to pursue it might not apply.
The patient’s parents reason out that radiation treatment seems to be an “ordinary” procedure, since it is frequently used in many hospitals. They could not understand why the doctors would describe radiation as “extraordinary”.
Question
How would the doctors, knowledgeable in bioethics, explain the term “extraordinary” to the patient’s parents?
Solutions
A distinction needs to be made between “medically” and “ethically” ordinary or extraordinary procedures.
1. In medicine, accepted or standard procedures are considered “ordinary”, while new or untested ones are “extraordinary”. Thus, a procedure that is now extraordinary may later on become ordinary.
2. In ethics, on the other hand, “ordinary” procedures are “all medicines, treatments, and operations which offer a reasonable hope of benefit for the patient and which can be obtained or used without excessive expense, pain, or burden; extraordinary means are all medicines, treatments, and operations which cannot be used or obtained without expense, pain, or other burden” (a definition offered by Pius XII, Prolongation of Life, Nov. 24, 1957).
From the ethical perspective, then, we must look not only at the medicines, devices or procedures themselves, but also at the patient’s condition, plus the social and familial circumstances. Too much burden to the patient, family or society, without giving any reasonable hope of benefit, would make the medical procedure ethically “extraordinary” (this is what the doctors were pointing at), even though from the medical point of view the procedure is actually “ordinary”, that is, regularly performed (this is what the patient’s family thought).
There is no duty to make use of ethically extraordinary means to preserve life, though at times the family may opt to use them for a certain period, given other considerations.
