Bioethics and Extraordinary Measures

[kevinkuck78]

I really didn’t know how to answer this question, so thought I’d ask it here. Let’s say a person is diagnosed with a terminal illness. A medical treatment is available that could potentially add years to this person’s life. Is such a medical treatment considered an ordinary measure or an extraordinary measure in the realm of Catholic Bioethics? While such treatment would not reverse the disease, it could potentially turn back the clock so to speak. I’m not sure what to tell my friend. I am inclined to state that it is an ordinary measure if for no other reason than to convince my friend to pursue all possible medical treatments, but I’m not sure if that would be entirely accurate. Your thoughts?

 

[Auntie_A]

More details on this treatment are necessary to discern an answer for you: what are the risks? is it affordable? is it accessible? how successful is it? An ordinary measure would include a suitable history of trials of that treatment being somewhat successful in eradicating or subduing the disease. There might be slight risks but nothing that would increase or hasten the progression of the disease. A good health care practitioner or social services person should be able to educate the patient on the risks.

Example: Some of my friends with AIDS were told to try AZT and some other drugs in the early years of the epidemic: many on AZT died sooner than the others. Then the dosage was improved and added to a “cocktail”: One of my friends was reluctant at first: “everyone I know who has taken AZT is dead now…I’m not sure if I want to.” He waited, but then agreed to take it and is now showing some progress. Another friend has tested HIV negative after years of taking the new protocol of these drugs. At first these drugs, roughly dosaged, were an extraordinary measure but now they are becoming more effective in the proper combination. Success plays a part in how “ordinary” a measure this is; but for some people the “cocktail” is also expensive and therefore not easily accessible.

Your friend should receive a thorough explanation of those things in order to make a sound decision in their situation. I understand your wanting to persuade your friend to try.

 

[Dr_Paul]

The number of additional years of life gained by a medical treatment does not need to be the determining factor in assessing whether it is ordinary or extraordinary. Factors that are considered include financial cost both for the patient’s family and society, other associated burdens, pain and suffering associated with the treatment, and risk and likelihood of success.

A procedure costs a million dollars and has only a 5% chance of working but if successful extends a person’s life by 30 years can justifiably be considered extraordinary.

 

[kevinkuck78]

Thank you so much for your responses. So much to think about really. Auntie A, your response was right on the mark as to what the issue is. My friend is indeed HIV positive and has been doing the meds for many years, but is developing the notion that he no longer wants to do medication. He is a middle aged man in his fifties, and to complicate matters, he has now been a widower for three years. I admit I think that reality plays into his thought process a bit. But also for him is the financial consideration. He could easily spend a million dollars on medications for the next 30 years, not to say that they would necessarily extend his life by that but I suppose it is a realistic possibility. I admit I’ve been trying to encourage him to pursue that, but perhaps that is slightly selfish of me since he is such a good friend. It almost sounds like, at least within the framework of ordinary and extraordinary measures, his particular scenario would fall under extraordinary measures. Once again, thank you for your responses to this thread. I just want to be as informed as possible so I can be the best friend possible and give my buddy the support he needs (whatever his eventual decision).

 

[Auntie_A]

Thinking of shelling out money for lifesaving measures over the next 30 years would be overwhelming for me. Thinking of the next few years would be easier. In three or more years, the meds could change and become more affordable. Your friend could sero-convert to H.I.V. negative as some people have also done. One day or moment at a time.

I would want to know more about my friend’s mental health while he is making these decisions. Is he depressed? Anxious? Also his spiritual health. What does he believe about life? His life? His death? If he is ready to give up is it because he is physically exhausted or mentally tired? Is he getting all of the care he can get for his whole person, not just meds? Nutrition? Supplements? Stress-reducing measures? Grief and loss support? Happiness? Some of this you will have to deduce on your own if he does not want to share.

My rule is do not dig any deeper than you are prepared to commit to help him.

I had a patient who just wanted to stay in bed and watch movies. His friends came and went. The ones who were successful at getting him out of bed were the ones who agreed to watch a movie with him, then negotiated with him to at least have lunch outside if they pick up Chinese food or something like that.

Does he have a life plan?

Example: In the next three years, I will write my memoirs and visit Hawaii. If I am still here after that, I will go to school and get a Master’s in History. I will take up piano. I will watch every Great Garbo movie I can find. I will plant a rose garden. I will plan an annual party for all of my friends…Get him to plan something.

Make it both simple and complex: I will have dinner with a few friends versus a big blow out party, depending on how I feel at the time. If I can’t learn the piano, I will get someone to come play my piano (or bring their portable keyboard). That is called “grading” the activity. But see what kind of plans he will make. If he is too tired to think of ideas, present him with a graded activity. Let him choose.

Good luck to you and him. Have a mass said for him. And rosaries.

 

[kevinkuck78]

You know it’s interesting, I think I expect him to be more depressed than he is. He’s actually one of the most joyous people I know, despite his losses in life. I know he does acupuncture and massage I think for stress and stuff like that. But he seems to take care of other health aspects (I took him to the dentist a couple weeks ago). And he’s also really involved in a grief counseling ministry but more as a leader/mentor to help others down the path he himself has gone. So it doesn’t at all strike me like he has given up or anything. As for more concrete future plans, I think I need to ask that one, because I honestly just don’t know. I really appreciate your response, you brought up some very good questions for me to explore with my friend. I just hope he doesn’t think I’m being too invasive or “meddling.” But I guess he asked my advice on the extraordinary measures aspect, so he opened the door. hehe.

 

[CopticChristian]

I really didn’t know how to answer this question, so thought I’d ask it here. Let’s say a person is diagnosed with a terminal illness. A medical treatment is available that could potentially add years to this person’s life. Is such a medical treatment considered an ordinary measure or an extraordinary measure in the realm of Catholic Bioethics? While such treatment would not reverse the disease, it could potentially turn back the clock so to speak. I’m not sure what to tell my friend. I am inclined to state that it is an ordinary measure if for no other reason than to convince my friend to pursue all possible medical treatments, but I’m not sure if that would be entirely accurate. Your thoughts?

No, it is not extraordinary, it is ordinary.

 

[Auntie_A]

I get it. He takes care of himself and others. He needs you. And he needs subtle meddling. He probably carries the weight of the world on his shoulders. Offer to be his helpful listener. Ask brief direct questions. He has probably thought it all out but has no one to let him be himself with. Good luck.

 

[CopticChristian]

Thank you so much for your responses. So much to think about really. Auntie A, your response was right on the mark as to what the issue is. My friend is indeed HIV positive and has been doing the meds for many years, but is developing the notion that he no longer wants to do medication. He is a middle aged man in his fifties, and to complicate matters, he has now been a widower for three years. But also for him is the financial consideration. He could easily spend a million dollars on medications for the next 30 years, not to say that they would necessarily extend his life by that but I suppose it is a realistic possibility. Once again, thank you for your responses to this thread.

This is what extraordinary measures are according to the Church…

osv.com/OSV4MeNav/WhattheChurchTeaches/WTCTEndofLifeIssues/ExtraordinaryMeansofCare/tabid/491/Default.aspx

Treatment is considered “extraordinary” if it is determined to be futile, meaning that it is either not going to work to keep the person alive or to reverse the course of the disease, or if the burdens of that treatment are disproportionate to the benefits.

In the context of HIV, he is living, and there is no telling what is on the horizon for someone with HIV. The fact that this person has life should be cause to think that there is value in it. In spite of the tragedy of the HIV, having been widowed may be a better place to spend time discussing loss. When someone has a loss their life becomes difficult and that loss is not dealt with all at once, rather over time. This I believe is where you should spend some time in support…the grieving process of loss requires support.

I am inclined to state that it is an ordinary measure if for no other reason than to convince my friend to pursue all possible medical treatments, but I’m not sure if that would be entirely accurate. Your thoughts?

You and I are unable to convince anyone of anything. The only person that can convince your friend is your friend. If you truly thought you had the power to convince anyone of anything would you be willing to bear the burden of knowing that you did. As a Physician I offer education, advice as to this or that and then if possible steer someone to what I believe to be the best decision. In the end it is their decision.

My friend is indeed HIV positive and has been doing the meds for many years, but is developing the notion that he no longer wants to do medication.

Then the best you can do is as him this…How did you come to this decision and what does it mean to you and then listen.

I admit I think that reality plays into his thought process a bit.

No one reads minds. What you think he thinks can only be answered by this…

Tell me what you think?

I admit I’ve been trying to encourage him to pursue that, but perhaps that is slightly selfish of me since he is such a good friend. It almost sounds like, at least within the framework of ordinary and extraordinary measures, his particular scenario would fall under extraordinary measures.

No, this is not extraordinary measures.

I just want to be as informed as possible so I can be the best friend possible and give my buddy the support he needs (whatever his eventual decision).

To be the best friend possible support decisions you may not like, as questions as to what caused those decisions to be made, suggest possible alternatives for discussion and listen.