Extraordinary means and the intentional termination of life

Physicians and their professional organizations often distinguish between ordinary and extra-ordinary means of treatment. The moral relevance of this distinction, which has recently been defended by the philosopher Bonnie Steinbock (The Intentional Termination of Life. Ethics Sci. Med. 6, 59, 1979.). is challenged. It is argued that neither this nor the “overlapping distinction” between intention and foresight is morally significant. If deliberate cessation of ordinary treatment, resulting in the foreseen death of the patient, is the intentional termination of life—so is the deliberate cessation of extraordinary treatment.

Two interrelated arguments are advanced in support of the claim that the distinction between ordinary and extraordinary means of life-support has no moral significance. The first is based on Steinbeck's own criterion for the intentional termination of life (“if one acts intentionally, foreseeing that a particular result will occur, one can be said to have brought about the result intentionally”), the second suggests that the distinction between ordinary and extraordinary means is a distinction not between different means but between lives judged worthy of prolongation and those not: it is a quality-of-life criterion. This explains why the concept of extraordinary means is “flexible”, why “what might be considered ‘extraordinary’ in one situation might be ordinary in another”.

But if we do not admit that quality-of-life considerations rather than “means” are at issue, then we cannot give an adequate answer as to why it may. for example, be morally permissible to switch off the respirator when it sustains an irreversibly comatose patient but not when it sustains a patient with a respiratory disease. It is argued that when the physician intentionally flicks the switch to turn off the respirator, foreseeing the death of the patient, then he has brought about the death intentionally and it does not matter whether we call the respirator in the first case an “extraordinary” and in the second case an “ordinary” means. The deliberate cessation of life-prolonging treatment is the intentional termination of life—either passive euthanasis or. if the patient against his doctor's advice, refuses further treatment. passive suicide.