Ordinary and Extraordinary Treatments

00:01 Let's look a little closer at life-sustaining treatments because there may be times where there have to be decisions about whether to withhold or withdraw those treatments.

00:10 There are various kinds of life-sustaining treatments if you think about the cardiac system, there could obviously be cardiopulmonary resuscitation.

00:18 There might be a need for vasopressors or inotropes to support the blood pressure, antiarrhythmics take care of an abnormal rhythm, defibrillators and pacemakers that might be implanted in a person.

00:30 For patients with very advanced heart disease, there might be ventricular assist device or ECMO, extracorporeal membrane oxygenation.

00:39 You know, all of these things count as sustaining the life of the cardiac system.

00:46 There may be the need for treatments for the respiratory system.

00:48 Things like mechanical ventilation or noninvasive pulmonary ventilation.

00:53 There might be a need for blood transfusions.

00:56 In the renal system, there could be dialysis, either peritoneal or hemodialysis.

01:01 And then, another life sustaining treatment might be artificial nutrition and hydration.

01:05 All of these might come under the calculus of whether or not they need to be used or should be used for a particular patient.

01:12 One important distinction in the philosophical distinction of treatments like this is ordinary versus extraordinary treatment.

01:20 So, when you think about a treatment, you have to think about its benefits and its burdens.

01:25 That counts for any treatment, not just life-sustaining treatments.

01:28 But you're weighing these benefits and burdens to determine whether or not it's ordinary treatment or extraordinary treatment.

01:36 Part of this calculation of the benefits and burdens also hinges on the probability and the magnitude of the benefit to be achieved or the burdens that might come as a result of the treatment.

01:48 It's also whether the burdens of treatment might reach a point where they become disproportionate either to the benefits that you're hoping will come or the likelihood of success of the treatment.

02:01 So, all of this speaks to whether or not you're going to decide to go forward with the treatment or not go forward with the treatment.

02:08 In classic philosophical debates about this, the distinction is between ordinary and extraordinary where ordinary treatments are obligatory.

02:19 That you're obliged to try to do them.

02:22 You know, this is as, you know, from the patient perspective.

02:25 So, there's a reasonable expectation that it's going to be beneficial without excessive detriment or expense, or pain, or other inconvenience to the patient.

02:38 There isn't a serious risk of harm to the patient.

02:41 So, it's considered an ordinary treatment and therefore, you should try to do it.

02:46 You should follow through on that treatment.

02:49 Whereas extraordinary treatment might be treatments that are considered optional or above and beyond the call of duty.

02:56 You're not obliged to do it. They're, in philosophy, we call supererogatory.

03:02 They're beyond what you're expected to pursue but you could pursue it if you think there's a goal to be achieved.

03:10 So, in these circumstances, extraordinary treatment is where there's no reasonable hope of benefit or the benefit can only be obtained with excessive detriment, expense, pain, other inconvenience, risk of harm to the patient.

03:25 You're really thinking that the burdens outweigh the benefits.

03:28 And therefore, you're not obliged to follow the treatment.

03:31 Now, it's important that the ordinary and extraordinary distinction has nothing to do with technological and sophistication of what you're proposing.

03:41 It's not like a ventilator is extraordinary treatment and it's, you know, antibiotic is ordinary treatment.

03:49 Even an antibiotic could be considered extraordinary treatment if you think the burdens of delivering that antibiotic outweigh the benefits to be achieved.

03:59 So, when it's something that's extraordinary, you might think about withholding or withdrawing that treatment because, again, it's either too burdensome or the benefits aren't achievable. So, that brings us to a discussion of how do patients or family