• Lancet. 1975 Jan 11; 1 (7898): 858885-8.

AbstractEthical problems in medicine usually arise when normal guiding principles appear to be in conflict. In the case of babies with severe spina bifida, or similar abnormalities, two such fundamental principles may be applied with opposing conclusions. The first is that any decision requires an estimate of the balance of suffering and happiness for those concerned in an action, and the other is the assertion that human life is sacred. Resolution of the conflict between these is possible by looking at the problem in a different and less fundamental way, and one such approach is through the concept of ordinary and extraordinary means. While man does not possess power of absolute ownership over life, his duties of stewardship require him to use ordinary means of safeguarding life; he may use, but is not obliged to use, extraordinary means. The distinction between ordinary and extraordinary means may vary with circumstance, and so the application of this principle involves decisions at a third or more practical level. These include an assessment of the child's abnormality, of the effects of this upon the quality of life possible for the child, and of the burdens that will be placed on the family and society. At each level the ethical decisions involve complex choices, and clearly any present policies must be regarded as temporary unavoidable compromises rather than as final solutions.

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