Most medical decisions, however, fall somewhere in between these boundaries. Reflections on these decisions were articulated in the language of ordinary and extraordinary means.
The expression "quality of life" has been used by the proponents of practices such as abortion, assisted suicide, and euthanasia; indeed "quality of life" has become a rallying slogan for those who favor such practices. There is an understandable tendency in some of these Episcopal statements to avoid any public formulation that might suggest endorsement of that kind of quality - of - life ethic. In the public context, these bishops tend to speak in language that portrays life as an absolute good and to eschew language about the quality of life. Such statements sometimes convey the impression that the distinction between ordinary and extraordinary means can be worked out in fairly objective terms (e.g. benefits of treatment, the proximity of a patient to death). In fact the language of benefit vs. burden ratio or proportionate vs. disproportionate treatment lends itself to images of a mathematical measurement. But this does not retain all the nuances of traditional teaching. While there are objective elements, such as whether or not a treatment is available or will be physiologically useful, the history of the distinction between ordinary and extraordinary means makes it clear that its deployment turns on the prudent judgment of the patient with the help of family and physician. The patient is the one who weighs risks, burdens, and benefits in light of a treatment's probable impact. The distinction depends upon the patient's quality - of - life judgments.
The Pennsylvania bishops' statement on nutrition and hydration illustrates the tendency both to objectify the judgment about ordinary and extraordinary means and to misrepresent traditional teaching. For example, the bishops write that "the patient in the persistent vegetative state is not imminently terminal (provided that there is no other pathology present). The feeding--regardless of whether it be considered as treatment or as care--is serving a life -sustaining purpose. Therefore, it remains an ordinary means of sustaining life and should be continued." The bishops of the Maryland Catholic Conference also wrote that "[a] medical treatment should not be deemed useless, however, because it fails to achieve some goal beyond what should be expected." For them, medically assisted feeding and hydration is useful as long as the patient is capable of absorbing the nutrients delivered by the treatment.
These kinds of statements reflect an erosion of the distinction between ordinary and extraordinary means. There are a number of ways in which the traditional teaching is being lost. First, it should be noted that the distinction between ordinary and extraordinary means traditionally has not been limited only to those patients who were considered to be terminal. In creating such a restriction the bishops are being quite innovative in their interpretation of the distinction. Pope John Paul II seems to limit the distinction's application to those who are close to death; in Evangelium vitae he distinguishes euthanasia from withdrawing aggressive treatment and, in so doing, appears to limit the dis