De Lugo deals with one topic not yet discussed in any great detail but of great interest for his predecessors and contemporaries, the question of mutilation. Agreeing with Aquinas, de Lugo held that, just as a person does not possess full dominion over his own life, 

so he does not possess complete dominion over the parts of his body. THUS, arguing as Aquinas had argued, mutilations of the body are wrong if they are not necessary for the body’s health.

The question at issue here is whether certain mutilations can become obligatory, as being necessary for life or health. De Lugo holds that such a mutilation is obligatory, provided that it can be accomplished without intense pain:

He must permit this cure when

[1] the doctors judge it NECESSARY, and

[2] when it can happen WITHOUT INTENSE PAIN;

NOT IF IT IS ACCOMPANIED BY VERY BITTER PAIN; because A MAN IS NOT BOUND TO EMPLOY EXTRAORDINARY AND DIFFICULT MEANS TO CONSERVE HIS LIFE (media extraordinaria et difficillima ).¹²

Vitoria had insisted, (see the seventh point in summary above), that in most cases one is obliged to use only those means that are regularly (reguariter) and customarily (communiter) employed for the preservation of life. Here de Lugo seems to be making basically the same point, but he chooses to phrase his position in the negative, that one is not obliged to employ extraordinary or out-of-the-ordinary means for the preservation of life. Thus, de Lugo is saying that the difference between not-saving and overt killing is morally important if the means being refused are either difficult to employ or out of the ordinary. He uses, as an example of means difficult to employ, a mutilation causing intense or bitter pain (intenso acerbissimo dolore). Indeed, a means may be out of the ordinary precisely because it is painful to employ.

Nevertheless, it is important to recognize that there may be a number of reasons why a means may be out of the ordinary, other than that it is difficult to employ. Thus de Lugo considers many of the examples of optional means earlier mentioned by Vitoria: the use of choice and costly medicine, or even the drinking of or abstaining from wine.¹³ Indeed, one senses in de Lugo a striking attempt to be most liberal in judging a means to be optional. Any reason that would make a means out of the ordinary suffices for de Lugo as a justification for calling it optional. And he is quite willing to relativize this element of the extraordinary (as Vitoria was with the element of the burdensome) to the particular circumstances of the individual. Thus de Lugo argues that a novice in a religious order is not bound to return to the secular world in order to eat better food to preserve his life, since such food, even though ordinary and common for the secular world, is not ordinary for those in the religious life.

De Lugo holds that the failure to employ available means necessary for preserving one’s life or the failure to avoid a potentially death-dealing natural cause can be morally equivalent to the positive taking of one’s own life. But this is true only where the means are ordinarily employed and not difficult to use, or where the death-dealing natural cause can easily be avoided.

In the previous discussion the opinion of Vitoria argued that a sick person is required to take food to preserve his life, at least if the food can be employed without great difficulty. But Vitoria adds a further qualification: for the taking of food to be obligatory, there must exist “some hope of life.” The implication there is that a person is not obliged to employ means if there is no hope of their being useful in preserving life.

De Lugo is in agreement with Vitoria on this point and employs an example which will be discussed by later moralists and will be seen to have considerable theoretical and practical significance for the present day. De Lugo considers the case of a man facing certain death in a burning building. The man notices that he has water to extinguish part of the fire, but not all of it, and that he can only delay his death by the water’s use. Is the man under an obligation to use the water? De Lugo answers in the negative, “because the obligation of conserving life by ordinary means is not an obligation of using means for such a brief conservation -- which is morally considered nothing at all” (quae moraliter pro nihilo reputatur)

On the other hand, de Lugo holds that if the person could put out the fire completely, he would be obliged to use it. In this latter case, the use of water would be analogous to eating ordinary foods. Certainly the use of water is an ordinary means of putting out a fire (and so saving a life). And, in the example, the means can be easily employed. Thus, de Lugo wished to admit the possibility that an ordinary means need not be obligatory because the benefit to the person is too slight to carry moral weight.

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