A HISTORY OF EXTRAORDINARY MEANS Scott M. Sullivan, M.A.
This is the second of a three-part series on ordinary and extraordinary means. The author here begins to examine contributions made to this distinction in the writings of prominent moral theologians.—Ed.
Francisco de Vitoria
The theologian Francisco de Vitoria (d. 1546) exerted a strong influence on later moralists and therefore merits special attention. We get an idea of Vitoria’s thought on the distinction between ordinary and extraordinary means by looking at examples. First, regarding a sick man taking nourishment, Vitoria says revulsion toward food would excuse a man from having to eat:
If the depression of the spirit is so low and there is consternation in the appetitive power that only with the greatest of effort as though by means of a certain torture, can the sick man take food, right away that is reckoned a certain impossibility, and therefore he is excused, at least from mortal sin, especially where there is little hope of life, or none at all.11
Citing the difference between the positive duty to conserve life and the negative precept not to destroy it, Vitoria notes that one is not obligated to seek expensive or extravagant cures:
It is one thing not to protect life and it is another to destroy it: for man is not always held to the first and it is enough that he perform that by which regularly a man can live: if a sick man could not have a drug except by giving over his whole means of subsistence, I do not think he would be bound to do so.2
And the same goes for foods and one’s living environment. A man or woman is not bound to eat only the healthiest things and breathe only the healthiest air:
One is not held to protect his life as much as he can by means of foods. This is clear because one is not held to use foods which are the best, the most delicate and most expensive, even though these foods are the most healthful, indeed this is blameworthy… Likewise, one is not held to live in the most healthful place, therefore neither must he use the most healthful food.3
Vitoria also says that the obligation to conserve one’s life does not bind when the amount or duration of food or medicine exceeds the customary:
If one uses foods which men commonly use and in the quantity which customarily suffices for the conservation of strength, even though from this his life is shortened [this is acceptable]. From this, the corollary follows that one is not held to use medicines to prolong his life even where the danger of death is probable, for example, to take for some years a drug to avoid fevers or anything of this sort.4
Those of us who have an affinity for junk food might be glad to hear that in his commentary on St. Thomas Aquinas, Vitoria goes further and says one can eat “normally” even if one knows for sure he would live longer by eating other, healthier foods:
I say that one is not held to lengthen his life because he is not held to use always the most delicate foods, that is, hens and chickens, even though he has the ability and the doctors say that if he eats in such a manner, he will live twenty years or more, and even if he knew this for certain, we would not be obliged … So I say, thirdly, that it is licit to eat common and regular foods.5
Dominic Soto and Dominic Bañez
Vitoria does not think that the duty to conserve life obliges us to go to extremes regarding food and medicines, and Dominican theologian Dominic Soto (d. 1560) says the same about pain. The example he gives of amputation is one that will be commonly repeated throughout the tradition:.
But really, no one can be forced to bear the tremendous pain in the amputation of a member or in an incision into the body: because no one is held to preserve his life with such torture. Neither is he thought to be a killer of himself. 6
The observation advanced here, it should be noted, was made prior to the invention and common use of anesthesia and other pain-killers.
Confessor to St. Teresa of Avila and a theologian of exceptional authority, called by his fellow Spaniards proeclarissimum jubar (“the brightest light”), Dominic Bañez (d. 1604) seems to be the first to explicitly contrast the terms “ordinary means” (media ordinata) and “extraordinary means” (media extraordinaria). Bañez reiterates that one is bound only to common food, medicines, and a reasonable amount of pain in order to conserve life:
He is not bound absolutely speaking. The reason is that, although a man is held to conserve his own life, he is not bound to extraordinary means but to common food and clothing, to common medicines, to a certain common and ordinary pain: not, however, to a certain extraordinary and horrible pain, nor to expenses which are extraordinary in proportion to the status of this man. So that if, for example, it were certain that a common citizen would gain health if he spent three thousand ducats for a certain medicine, he would not be held to spend them.7
Although much will depend on whether a person is wealthy or poor, financial considerations have long been a standard consideration in estimating what constitutes extraordinary means.
The renowned Jesuit theologian Leonard Lessius (d. 1623), a student of Francisco Suarez, and one who consulted with the likes of St. Robert Bellarmine, makes an important point concerning extreme psychological factors, much like Vitoria’s observation on revulsion toward food. Such is the case of women highly conscious of chastity:
Women, especially virgins, are not bound to accept from men medical treatment of this type in the more secret parts…The reason is because no one is held to accept a cure which he abhors no less than the disease itself or death. 8
Cardinal de Lugo
The great Cardinal John de Lugo (d. 1660), whom St. Alphonsus Ligouri ranked immediately after Aquinas, and whom Benedict XIV called “a light of the Church,” wrote extensively on this issue. In line with his predecessors, he held that a man should do what is recommended by his physician, unless it requires enduring extreme pain:
He must permit this cure when the doctors judge it necessary, and when it can happen without intense pain; not, it if is accompanied by very bitter pain; because a man is not bound to employ extraordinary and difficult means to conserve his life.9
Some measure of even considerable pain must be endured, for de Lugo cautions that to omit what is normally done to preserve life is morally indistinguishable from suicide:
Because the one who neglects the ordinary means seems to neglect his life and therefore to act negligently in the administration of it, and he who does not employ the ordinary means which nature has provided for the ordinary conservation of life is considered morally to will his death. 10
So for de Lugo there is also a difference between the blameworthy neglect of one’s life and having to care for it by the use of extraordinary means. Interestingly, de Lugo explicitly says what others only imply, that although human life is valuable, it is not so valuable that it necessitates conservation by any means possible:
The “bonum” [good] of his life is not of such great moment, however, that its conservation must be effected with extraordinary diligence: it is one thing not to neglect it and rashly throw it away, to which a man is bound: it is another however, to seek after it and retain it by exquisite means as it is escaping away from him, to which he is not held. 11
Arguably extending to the comfort of those who suffer the smog of our cities, de Lugo says that we are not obliged to seek out the most healthful places to live. So, too, just as one is not required to lengthen one’s life by the use of certain foods or wines, neither is one required to abstain from the same in order to live longer:
Whence, much less is a man bound to effect a lengthening of his life by choice and delicate foods, for just as one is not held to abstain from wine in order to live longer, so neither is he bound to drink wine for the same purpose: because just as a man is not bound to seek a more healthful and wholesome locality and air in order to prolong his life, so neither is he held to eat better or more healthful food. 12
Scott M. Sullivan, M.A.
The Center for Thomistic Studies
University of St. Thomas
1 Francisco de Vitoria, Reletio de Temperantia, I, quoted in Daniel A. Cronin, Conserving Human Life (Braintree, MA: Pope John XXIII Medical-Moral Research and Education Center, 1989), 35.
2 Ibid., 36.
4 Ibid., 36–37.
5 Ibid., 37.
6 Dominic Soto, O.P., Theologia Moralis, Tract. De Justitia et Jure, Lib. V, Q. 2, a.1, quoted in Cronin, Conserving Human Life, 38.
7 Dominic Bañez, Scholastica Commentaria in partem Angelici Doctoris S. Thomae II-II, Q. 65 a.1, quoted in Cronin, 42.
8 Leonard Lessius, De Justitia de Jure, Lib. II, Cap. 9, dub. 14, n. 26, quoted in Cronin, 45.
9 De Lugo, De Justitia et Jure Disp. 10, Sect. I, n. 21, quoted in Cronin, 48.