Medical Obligation

Is a person obligated to accept medical treatment even if it is necessary to save their life?

Suppose, for example, a person has a heart attack. He is still coherent and his doctors tell him he must have emergency heart surgery or he will die. Can he refuse the treatment even though there is a high probability he will survive with the treatment?

In other words, is he committing some kind of sin by allowing himself to die?

There would be other factors to consider?

Is he an otherwise healthy 40 year old man? Is the issue with his heart affecting how he is thinking at the moment? Is he worried about how he is going to pay for this? etc.

If the burden of undergoing the treatment is too great, then he may refuse.

From the CCC: 2278 Discontinuing medical procedures that are **burdensome, **dangerous, **extraordinary, **or disproportionate to the expected outcome can be legitimate; it is the refusal of “over-zealous” treatment. Here one does not will to cause death; one’s inability to impede it is merely accepted. The decisions should be made by the patient if he is competent and able or, if not, by those legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected.

Every adult has a conscience to decide if they want medical care. Death is a natural part of life.

He just doesn’t want to go through with it and is content to just pass on.

There are two levels of care for the human body: ordinary and extraordinary care. Every person is obligated to give his body ordinary care, and those who are caring for a person who is comatose or unconscious has an obligation to give ordinary care to that person.

Ordinary care is, essentially, food, water, basic medication, etc. It is morally wrong to deny a person ordinary care. (This is one reason it is immoral to remove a person’s feeding tube even if they are “brain dead.”

Extraordinary care consists of any major surgery, very expensive medications or expensive treatments. Under normal circumstances, no one has a moral obligation to apply extraordinary care to himself or others.

Thus, it is not immoral for a person, say, to deny chemotherapy for cancer. It is an expensive, extraordinary means of life preservation, and that person could reasonably make the decision to just let the cancer progress.

OK. Something like a triple bypass would certainly be considered “major surgery” but nonetheless such surgery is practically routine these days, and patients who have such surgery have a high likelihood of recovery.

So even thought the patients could in all likelihood live, can he still say “thanks but no thanks. Just let me die.”?

Note my words “under normal circumstances”.

When a major surgery is easy to do, not terribly expensive, and has a very reasonable chance of success, the obligation to undergo that surgery can change.

In 200 years there might be a complicated and difficult process that can be used to infallibly cure cancer. By then, it might be cheap and accessible. That would then fall under “ordinary care” in a sense, because the means to obtain the treatment are no longer extraordinary.

Extraordinary in this case does not mean what it means in everyday life. It is a specific term meaning above the ordinary, and here ordinary means *what we are obligated to provide. *And ordinary here means provision of food, water, and general physical care like bathing, etc. IOW, we are obliged to make sure our neighbors don’t go hungry when they are sick, and we are obliged to provide the other forms of care mentioned also.

The fact that our circumstances are such that hundreds of bypass operations occur every day doesn’t mean that that becomes “ordinary” in the area of Catholic thinking.

ETA: yes, if a person feels the operation would pose a burden, he has the right to refuse it. For example, a man might realoze that his elderly parents would give their all to pay for the operation because he has very little money, so he would think that the operation would be too much of a burden and refuse the treatment.

No, these treatments would remain “ordinary” under Catholic thinking. Also, burdens are not limited to financial burdens, so a man refuse everyday but “extraordinary” (in the Catholic sense) care because the care for him during or after the treatment might be too much for his family.

Your first sentence puzzles me. They would remain ordinary? Perhaps you meant “extraordinary.”

I did not so much mean to say that the treatment itself is considered extraordinary, but since the means and circumstances around an easily obtainable treatment become, in a sense, ordinary, there is, with the right circumstances, an obligation to take the treatment unless there is a serious reason to refuse it.

Yikes! Thanks so much for picking that up!!!

I did not so much mean to say that the treatment itself is considered extraordinary, but since the means and circumstances around an easily obtainable treatment become, in a sense, ordinary, there is, with the right circumstances, an obligation to take the treatment unless there is a serious reason to refuse it.

Yes, I see what you are saying, but you were also positing an imaginary future scenario, and I didn’t want people to be left with the idea that only the financial was burdensome. There are other burdens.

It’s a very tricky situation which boils down to prudential judgements and so the Church does not posit an absolute obligation to accept “extra-ordinary” care. One cannot under normal circumstances voluntarily reject ordinary care any more than one can refuse to give it.

Good points. This is rocky ground, and, as you say, much of it is up to prudential judgement.

My intention was not to say that financial burdens are what define a treatment as ordinary or extraordinary.

Rather, the whole context of the situation, including finances, the family situation, the dispositions of the person suffering the affliction and the situation the family will be left in if that person dies, all of these and more are important factors in these decisions.

Referring to some future hypothetical then-routine cancer treatment,

The technological transition referred to is not unlike the transition that has already occurred in gastric feeding tubes for unconscious patients. Such a technology would not have been recognized as ordinary feeding several hundred years ago. Even now it bears little resemblance to normal feeding (giving the person food which he chews and swallows). It is more similar to intravenous feeding, the only difference being the point of deposit of the nutrition and the degree of pre-processing of the “food”. It is hard to see how gastric tube feeding can be considered “ordinary” while intravenous feeding is not. I know that intravenous feeding has not been specifically addressed yet in this thread, but I am trying to anticipate what the argument might be.

I agree with everything you say, but want to clarify something regarding ‘ordinary care’. My grandfather had about 2/3 of his stomach removed in the late 80s. In 2005, he had a stroke, which shut down the remaining third of his stomach. In speaking with the priest and Catholic medical staff, we removed him from ordinary care because of an inevitable chain of events (over the course of several days), as noted below:

-Food would be provided intravenously, but his system could not digest it.
-His acid reflux would aspirate the undigested fluids into his lungs, causing pneumonia.
-The pneumonia would be fatal, so the feeding tube was removed.
-Because starvation was inevitable, the hydration tube was removed.
-Because death by dehydration was inevitable, his breathing tube was removed.

I just wanted to make this point because it is not a hard black-or-white when it comes to ordinary care - the effect of the care on the patient’s condition is taken into account. I will again state that what you presented is the common application of ordinary care, but cases do exist where this standard doesn’t apply.

This is certainly a good example of an extreme situation in which even ordinary care would be insufficient to save the patient’s life.

Certainly, almost nothing in this area is black and white, because various situation have different contexts, and thus different solutions/obligations.

This is why prudential judgement is so important. Guidelines can only get you so far.

Precisely! And that’s the important of Catholic hospitals - you have staffs, boards, and priests who are all aware of and sensitive to Catholic teachings about health care. I’m so thankful my grandfather was at the hospital he was, and we could see to it that he was always treated with the dignity afforded all humans solely by our creation from God.

You are absolutely correct and this is an important point–that if the feeding and/or hydration do not help the patient or even harm the patient, then they are not required. Most patients who die slowly have a shutting down process and at some point they no longer can take in food or water.

It is my understanding that the difference is that the patient digests the food given via gastric tube, but is fed intravenously when unable to digest. IOW, withdrawal of a gastric tube when the patient is able to digest would be depriving the patient of food. But if the patient cannot digest, then the reason he is not getting food is that his body is in a state which cannot accept it–the whole eating-part of the body is broken and *that *is why he is not eating.

I think this is an interesting thread. I personally think that if the treatment is too much probably is not a sin buy it may depend on this circumstances. I had this situation with my great grandfather who was diagnosed with cancer at around 72. My great grandfather refused any treatment for his cancer, nothing at all. Doctors and family tried to convinced him to no avail. The doctor told him with no treatment he wasn’t going to last more than six months and his answer was that at his age he had lived long enough and let nature run its course. He never went back to a doctor until the day he died
…which was 23 years after being diagnosed!. So he ended up dying at 96 from untreated cancer. I doubt that my great grandfather was sinning when he refused treatment but he always had a very positive attitude
So in the end it may really depend on circumstances.

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