Health Care Ethics

(Bioethics)

Module #15 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson Title: The Human Organism Part 2 Materials:

Learning Targets:
At the end of the module, students will be able to:
1. Explain the difference between the “ordinary” and
“extraordinary” care;
2. Outline the arguments for personhood criteria and state how
they could be uses in withdrawing care determination; and,
3. Understand the purpose of advance directives..
Pen, paper, index card, book, and class List
References:
Ethics of Health Care: A Guide for Clinical
Practice Fourth Edition, Raymond S. Edge, J.
Randall Groves

A. LESSON PREVIEW/REVIEW

Brain Teaser: Find the 4 words that describe biological life and 4 words that describe biographical life.

E S E C N E I R E P X E E A E I C X Y

K H F C D O B E B E R P X E F S V N L

G H J K L W M R B C X S P T Q E H G D

F D S A E H E A R T B E A T I I L P P

Q D G H Y A D D F U I P R O L R T A E

F K N V T E U X D E X R G X F O B B R

M E M H A B C H U I P O I U A M Q D S

J E I S X O A D Z Q N W D R P E L I M

Y N M J J K T N X S A G E F L M D H S

G N B O J L I V I N T H K L Y A Q W X

E D U C R T O I O N Q Z X Y W O K G D

F L L I V I N G T H I N G S D G S L V

L E E W S F A V N M K Y Y G F I L O P

O I T E L I M I N A T I O N N M I L E

B. MAIN LESSON

Ordinary and Extraordinary Care

Every person with decisional capacity has the right to refuse any treatment, regardless of the nature of the treatment or
consequences of the refusal. The surrogate decision-making has the power to act on this right for the patient, as long as
there is reason to believe that the surrogate is making decisions based on the patient’s wishes, values, or interests.

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 Health Care Ethics
(Bioethics)

Module #15 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

That said, some people and groups believe that some refusals of treatment are acceptable and not others. They argue
that it is morally worse to refuse “ordinary treatment” rather than “extraordinary treatment.” This was based on the idea
that people have a general obligation to act to sustain their own lives. A certain degree of pain and suffering is normal. To
refuse to do the basic minimum to sustain one’s life is morally wrong because it undermines life itself, much like suicide.

Lately, insurance providers have used the ordinary/extraordinary distinction to determine which treatments they need to
cover, and which do not constitute “basic care.”

The key to both arguments is the focus on categorizing types of treatment. The error (on their own terms) comes when it
is not acknowledged that what is ordinary for one patient may be extraordinary for another. Legally no distinction between
treatment in categories is recognized about the right to refuse treatment. However, some see a moral difference and
refusal of ordinary treatment may be a sign that a surrogate is not acting in good faith.
Ordinary and extraordinary treatments are generally categorized as follows:

Ordinary Treatment
1. Low risk of harm.
2. Simple, relatively low tech.
3. Routine.
4. Good chance for benefit to the patient.
5. Relatively inexpensive.
6. Available to most people who need it.
7. Causes little pain or distress.

Extraordinary Treatment
1. High Risk
2. Complex, relatively high tech.
3. Innovative, experimental, unusual.
4. Relatively small chance for benefit to the patient.
5. Relatively expensive.
6. Available to few (may involve distributive justice issues).
7. Usually, a source of pain or distress.

Any treatment is extraordinary if the burdens outweigh the benefits, or it offers no hope of benefit for the patient. (Purtilo,
R. Ethical Dimensions in the Health Professions (Saunders, 1999) p220.) But who defines benefit and burden? And what
meets the criteria of hope?

Personhood
 One who could be said to have interests
 One who has cognitive awareness
 One who is capable of relationships
 One who has a sense of futurity

Advanced Directives

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 Health Care Ethics
(Bioethics)

Module #15 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

o 1990 Patient Self-Determination Act (PSDA)

 Federal law regarding advanced directives
 To make people aware of their rights
o Joint Commission
 Developed standards for the documentation of patients’ wishes regarding advanced directives
o No uniformity in laws on living wills and surrogate decision makers
o Many authorities recommend use of durable power of attorney over a living will.

Living will is a type of advance directive. It is a written, legal document. It describes the treatments you would want if you
were terminally ill or permanently unconscious. These could be medical treatments or treatments that will help you live
longer. A living won’t let you select someone to make decisions for you.

A durable power of attorney (DPA) for health care is another kind of advance directive. A DPA states that you have
chosen to make health care decisions for you. It becomes active any time you are unconscious or unable to make medical
decisions (and may be called Medical Power of Attorney, or MPOA). A DPA is generally more useful than a living will. But
a DPA may not be a good choice if you don’t have another person you trust to make these decisions for you.

Supreme Court
 Upheld concept that competent individuals could refuse life-sustaining treatment
 Made no legal distinction between tube feeding and other life-sustaining measures

CHECK FOR UNDERSTANDING

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.

1. In December 1989, this case became the first right-to-die cases to be heard by the Supreme Court in the United States.
A. Baby doe case
B. Nancy Cruzan case
C. Karen Anne Quinlan case
D. None of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

2. Philosophers such as Joseph Fletcher and Joel Feinberg have attempted to define characteristics that a being must
possess in order to be considered the bearer of rights. Among the suggested criteria are as follows EXCEPT.
A. One who has cognitive awareness
B. One who could be said to have interests
C. One who has a sense of futurity
D. One who is incapable of relationships
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

3. Procedure, medicine or treatment given to a patient offered no reasonable hope of benefit is an example of _____
care?
A. Extraordinary
B. Advanced
C. Ordinary

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 Health Care Ethics
(Bioethics)

Module #15 Student Activity Sheet

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

D. Exceptional
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

4. This is a federal law regarding advance directives that tell patients upon admission their rights under the state of law?
A. Living will statement
B. Patient Self-Determination Act (PSDA)
C. Durable power of attorney
D. None of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

5. A 50-year-old woman is dying of cancer. She has only a few days to live. She has severe anemia due to the cancer.
Even though blood transfusion is the usual treatment for severe anemia, the decision is made not to give. What care does
this case involve?
A. Advanced care
B. Ordinary care
C. Extraordinary care
D. None of the above
Answer: ________
Rationale:________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

C. LESSON WRAP-UP

AL Activity: Muddiest Point

In today’s session, what was least clear to you?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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