[1] Pope Pius XII, Address to the International Congress of Anaesthetists (24 November 1957). Sometimes the distinction between ordinary and extraordinary means is also discussed with regard to proportionate and disproportionate means. Ordinary and extraordinary care is characterized by certain bioethical theories, including the teaching of the Catholic Church. [1] Since euthanasia, including the refusal of ordinary care,[22] is morally unjustifiable according to the principle of double action, whereas the refusal of extraordinary care, that is, letting die, is morally justifiable according to the same principle, it is obvious that the distinction made by the Magisterium[23] between ordinary care and extraordinary care is not arbitrary. [24] We must not, therefore, allow this doctrine to be undermined by confusion between ordinary and extraordinary care. Otherwise, such confusion can lead to the death of millions of our brothers and sisters by euthanasia. A prolonged illness, accident or end-of-life situation can leave patients and their families in financial despair. For a poor family, a relatively simple treatment like a blood transfusion can simply blow their budget. In a developed context, it would generally be unthinkable to consider a blood transfusion as an “exceptional” treatment from a financial point of view. However, if patients in the Philippines need a transfusion, they will have to pay between $10 and $225 per unit of blood, depending on the type of hospital they are staying at (charitable or private).

This can be exorbitant in a country where the daily minimum wage is $10. What is part of ordinary care in developed countries often becomes extraordinary in developing countries. Also called ordinary diligence and due diligence, the standard of care is when a reasonable person would practice in the same or similar circumstances. While human beings can use extraordinary means, they are not morally obligated to do so, because earthly life is not an absolute good for man, and because medical interventions will eventually become ineffective and/or because the costs and burdens of medical interventions are disproportionate to the good of earthly life they are meant to serve. (Catholic Medical Association 2007, 2A) Government-funded health care systems can put pressure on families to force or “encourage” them not to pursue certain treatment options. Stopping such treatments could therefore save the state large sums of money. In other countries, such as the Philippines, where adequate government-funded coverage is lacking, patients and families must pay for medical services. This is where the opposite scenario can occur – the hospital or referring physicians may overencourage a patient or family to pursue a treatment option that is not as convenient. This is a very sad situation, especially in a Catholic country like the Philippines, where the hospital and attending physicians may be motivated by financial gain rather than just the well-being of patients. 4For more information on how corruption affects health service delivery, see Vian (2008). Also Olarte and Chua (2005).

[12] Murder, available in legal-dictionary.thefreedictionary.com/murder (last visit on October 14, 2019), euthanasia can thus be practiced by act or omission. An “act” could involve administering a lethal injection to a patient, and an “omission” would mean that vital medical care is not provided with the intent and outcome of the patient`s death. Excerpt from “Threats to the sanctity of human life,” Catholic Journal, 11.11.2019, www.catholicjournal.us/2019/11/11/threats-to-the-sanctity-of-human-life/. Reproduced by Healthcare Advocacy and Leadership Organizations (HALO) with permission of the author. In some Asian countries, the poor are often denied access to health care. In the Philippines, we have understood thousands of Catholic doctors, Catholic nurses, even Catholic administrators, but no Catholics, as a “universal” health care system accessible to all. It is a scandal that weighs heavily on heavy emotional and financial burdens on many families who have to pay the health costs of sick relatives. The Church teaches the principles of ordinary and extraordinary care, only the former being morally obligatory. Exceptional care associated with excessive burden or cost can be eliminated. Many families and health professionals are uncertain about these principles and their application in practice. It would be useful to disseminate the teaching of the Catholic Church on ordinary and extraordinary care, especially in poor countries, in order to avoid unnecessary or unnecessary treatment, especially in critical or end-of-life situations. MICHAEL VACCA is a devotee of the Sacred Heart of Jesus and Saint Thérèse of Lisieux.

He graduated from Hillsdale College with a B.A. in English and Political Science, holds a Juris Doctor from Ave Maria Law School, and is a licensed attorney in Michigan. He is currently Director of Ministry, Bioethics and Member Experience of the Christ Medicus CURO Foundation. He worked for the Pontifical Council for the Family in Rome, where he advised the Church on pro-life and pro-family issues and promoted Catholic social teaching worldwide. Michael is Editor-in-Chief of the International Centre for Law, Life, Faith and the Family, which produces and provides www.icolf.org resources on these topics. He is a founding member of Sidewalk Advocates for Life and currently a board member of the Casa Vitae Foundation. He is the author and co-author of several articles on bioethics and law, including: Michael Vacca, A Reexamination of Conscience Protections in Healthcare, 62 MEDICINA E MORALE 78 (2013); Jane Adolphe & Michael Vacca, Best Practices: Laws to Protect Human Life and Family Around the Globe, 2 AVE MARIE INT`L. J. 1 (2012); Michael Vacca, lecture on a human rights violation: how heterologous assisted reproduction harms children and violates international human rights law, 7 AVE MARIE INT`L L.

J. 53 (2018); Michael Vacca, The Natural Law as a Guardian of the Human Person, 4 BAKU ST. UNIV. L. REV. 149 (2018); and Michael Vacca, Education and Religious Freedom in the Toledo Guiding Principles: A Comparative Analysis Between the Holy See and the United States 36 ARIZONA JOURNAL OF INTERNATIONAL AND COMPARATIVE LAW 2 (2019). He is also co-editor of two published books, ST. PAUL, NATURAL LAW AND CONTEMPORARY LEGAL THEORY (2012) AND EQUALITY AND NON-DISCRIMINATION CATHOLIC ROOTS, CURRENT CHALLENGES (2019). More than anything, Michael is grateful to know the love of Jesus Christ and his beautiful and holy wife, Sarah. Many of Manila`s state-of-the-art hospitals offer the latest top-notch healthcare, but due to the high cost, not all can afford it.

In its comprehensive report “The Philippines Health System Review”, the Asia-Pacific Observatory on Health Systems and Policy confirmed that there are “significant inequalities in access to health care and outcomes across socio-economic groups”, with one of the main reasons for inequality being “the high cost of accessing and using health care” (APOHSP 2011, xvii). Most Filipinos support the care of their loved ones out of pocket. While acknowledging some progress in health reforms, the Observatory concludes that “for many Filipinos, health services remain inadequate” (APOHSP 2011, 122) and that “reforms are needed in all areas of the Philippine health system for the country to achieve universal health coverage” (APOHSP 2011, 123). Ordinary means of subsistence were also defined as “what is reasonable”, taking into account “reasonable/proportionate expectation of benefit/success; joint due diligence; and not unduly demanding. According to this view, the elements of exceptional need are “what is unreasonable”, characterized by “a certain impossibility; excessive effort; degree of pain; extraordinarily expensive; and causes acute fear or disgust. [4] For more details, exceptional means are “medical acts that no longer correspond to the patient`s real situation, either because they are now disproportionate to the expected results, or because they are unduly burdensome for the patient and his family”. [3] In contrast, ordinary remedies are “available treatments that are objectively proportionate to the prospects for improvement”. [4] However, various factors help determine what is ordinary and what is extraordinary. These factors include: “the nature of the treatment to be applied, its degree of complexity or risk, its costs and the possibilities of exploiting it, and the comparison of these elements with the desired result, taking into account the patient`s condition and his physical and moral resources”.

[5] [6] “Usual care (including artificial feeding and hydration), palliative treatment, especially good pain management, should always be offered in a dialogue with the patient who keeps him informed.” Pontifical Academy for Life, Respect for the Dignity of the Dying, § 6 (9 December 2000).