In the Service of Human Life
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Applied Bioethics in stylized text
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Ordinary Means

Without a doubt, the most challenging and difficult decision that a patient or their caregiver has to make is when to stop taking steps to preserve life. It’s a complex maze of choices that’s made based on the known factors at the time. At best, it’s an educated guess. After all, there’re very few absolutes in the practice of medicine.

When confronted with these challenging moments, the most important thing to do is to go through the decision making process intellectually rather than emotionally. It’s possible to be empathic while still making rational decisions. Emotions are illogical by nature, and to be held captive by them will leave you in the lurch. Inaction of any kind in these critical junctures may even result in prolonged suffering.

Medicine evolves and improves on a daily basis. New and different treatment options are constantly making it to the floors of hospitals, nursing homes, and medical arts buildings. An excellent way to determine the right course of action is to hold each treatment up to a standard of “ordinary means” versus “extraordinary means.”

Bioethical standards demand that all ordinary means in order to preserve life must be attempted. Extraordinary means, however, are not always ethically required.

Ordinary Means
To put it simply, ordinary means are those treatments that are reasonable, practicable, and responsible. They’re backed by extensive medical research and present no outsized financial burden. Their function is not strictly to prolong life, but to correct deficiencies.

Even complex interventions can fall under the standard of ordinary means. Placing a motor vehicle accident patient on life support immediately upon arrival in the ER falls into this category. This decision allows the trauma team to diagnose and begin treating the major injuries. It’s an ordinary means of sustaining life. The intent, whether cognitively acknowledged at the time or not, is to buy the surgeon much needed time to act in order to save a life.

The utilization of ordinary means is always required when treating patients.

Extraordinary Means
Extraordinary means are to those treatments that are experimental, treatments that are a financial or undue physical burden, or those ordinary means that are applied in an extraordinary way.

Experimental treatments could fall under the category of ordinary means or extraordinary means, depending on the situation. There’s a difference between attempting a course of treatment that has been tested, but not proven, and using a terminally ill patient as a test subject unto themselves. In order for an experimental treatment to be considered, there must be at least some clinical data to support the conclusion that it may provide a benefit to the patient. Seldom is it ethical to attempt a treatment on a patient without previous clinical testing, even when using consenting human subjects.

Ordinary means can also be used in an extraordinary way. Think back on to the motor vehicle accident patient. Placing them on a ventilator in an emergent situation was an ordinary way to preserve life. If the patient’s injuries were significant, however, leaving them in a indefinite comatose state, on the ventilator, without hope for improvement or recovery moves this use into the extraordinary means category. What started as ordinary means can end as extraordinary means.

A treatment could also be considered extraordinary if it causes undue suffering for a patient. A patient at an advanced age with late stage four cancer might fit into this classification. While the patient has a negative prognosis, and there may be palliative surgical options to ease the pain of the tumors, the difficulty of enduring those surgeries may make them extraordinary means.

The employment of extraordinary means is never required, even if they’re not inherently unethical. A through ethical and medical review of the particulars of a patient’s cause should be conducted in order to determine ethical treatment.

Very, Very Grey
Without a doubt, it’s difficult to objectively evaluate whether any particular course is ordinary or extraordinary. Real life cases tend to come in all shades of grey. The ethical choice can only be evaluated individually, in each particular case, in light of the medical facts known at the time.