Toward the clarification of ideas: medical futility, persistent/obstinate therapy and extra/ordinary means

Despite reluctance of a part of medical society to accept the moral and/or legal permission to euthanasia, there is seemingly a common agreement on the need to resolve the problem of excessive therapy. Several ethical concepts are used to justify decisions to withhold/withdraw such treatment. Three of them are of particular value. The ordinary-extraordinary means distinction has a long tradition deeply-rooted in the Catholic medical ethics. During the last decades the concept of futile (or pointless) treatment has reached popularity within bioethical discourse. Also, slightly less common in use, the term 'obstinate therapy' and the relative concept seems to provide interesting insights into ethical debate. What is however to be emphasized is the ambiguity of meanings attached to these terms/concepts which prompt many bioethicists to reject these terms in favor of other concepts. In the present study a PubMed literature database review is done in order to recognize and then to classify the different ways of interpretation of the three concepts related to withholding/withdrawing excessive treatment. Retrieved interpretations of these concepts are evaluated in the light of an integrated model of moral justification. The undertaken analyses permit reaching the conclusion that the concepts which are the subject matter of this article can be properly defined and used only within the context of the so called holistic ethics and as an example of such i.e., a holistic approach to bioethics, the life's programs approach to bioethics is given.