Introduction to EthicsLecture 22

Active & Passive Euthanasia

By David Kelsey

Rachels’ conclusion

• James Rachels wants to argue that the following principle is false:– It is permissible, at least in some cases, to withhold treatment and allow a patient to

die, but it is never permissible to take any direct action designed to kill the patient.

• This is endorsed by the American Medical Association:– The intentional termination of the life of one human being by another…is contrary to

that for which the medical profession stands and is contrary to the policy of the AMA…The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family…

Why Passive Euthanasia can be worse than Active Euthanasia

• In some cases being allowed to die can be a slow and painful death whereas being given a lethal injection is relatively quick and painless.

• For example: – say someone is dying of incurable throat cancer.– The pain can no longer be satisfactorily alleviated.– He asks the doctor for an end to his life.– The doctor agrees to withhold treatment.– But if one simply withholds treatment it may take the patient longer to die. Thus, the

patient may suffer more than if a direct action is taken and a lethal injection given.

• Rachels thinks this situation actually recommends active euthanasia.– Because once the decision has been made not to prolong his agony passive

euthanasia brings about greater suffering.

A second example

• A second example:– There are cases where an infant is born with Down’s syndrome and yet it requires

some surgery in order to live. For example, to clear an intestinal obstruction.– In some cases the parents will decide not to operate and let the infant die.– In such cases, the doctors and nurses try to keep the baby from suffering while natural

forces sap its life away.

• Rachels’ point:– if the decision has been made to let it die then a lethal injection is preferred for letting

the infant die prolongs the infants suffering.

A second argument

• Rachels makes a second argument about the reasons given:– Consider again the case of an infant born with Down’s syndrome.

– In cases where if there is no operation and the infant dies, the reason why such an operation is not performed is that the infant has down’s syndrome. It is thought to be better that a child born with such a condition die.

– But if the life of such an infant is worth preserving what does it matter if the infant has an intestinal tract that is blocked and so needs a simple operation to preserve its life?

– And if the life of such an infant is not worth preserving what does it matter if it has an intestinal obstruction?

– So in such cases what’s relevant to deciding whether to perform the surgery or not is simply whether the life of such an infant is worth preserving…

Killing and Letting Die

• Rachels considers whether killing is worse than letting die. Rachels presents 2 cases exactly alike except for this one difference:

• 1. Smith will gain a large inheritance if anything should happen to his 6 year old cousin.

– One evening while the child is taking his bath Smith sneaks in and drowns him. Smith then arranges things to look like an accident.

• 2. Jones will gain a large inheritance if anything should happen to his 6 year old cousin.

– One evening while the child is taking his bath Jones sneaks in with the plan of drowning the child. However, just as Jones enters, the child slips and hits his head, falling face down in the water.

– Jones is standing there ready to push the child’s head under the water if necessary but the child ends up drowning all by himself accidentally…

Rachels on Smith and Jones

• Rachels wants to argue that there is no moral difference between the cases.– For Rachels, Smith and Jones are equally bad.– This is because both men acted from the same motive, personal gain.– And both men had the death of the child in view when they acted.

• Thus, “the bare difference between killing and letting die does not, in itself, make a moral difference.” So “If a doctor lets a patient die, for humane reasons, he is in the same moral position as if he had given the patient a lethal injection for humane reasons.” (865)

• So in conclusion Rachels claims that there is no moral difference between active and passive euthanasia.

An objection

• Rachels considers an objection:– If killing wasn’t worse than letting die we would hear about cases of one person letting

another die as much as we hear about cases of one person killing another.– But we clearly don’t.– So killing must be worse than letting die.

• Rachels response:– It is clear that most cases of killing are worse than cases of letting someone die.– We hear and see cases of killing all the time.– But what we fail to take into account are the other factors involved in the killing, for

example the murderer’s motive, the action the murderer took to kill, the circumstances of the death, etc.

One more objection

• Rachels considers another objection:– Active euthanasia is worse than passive euthanasia because in passive euthanasia

the doctor does not do anything to bring about the patient’s death. In active euthanasia, however, the doctor does do something to bring about the patient’s death for he kills him.

– So the doctor who performs active euthanasia causes the patients death, but in passive euthanasia when treatment is withheld the cause of death is the ailment from which the patient suffers.

• Rachels in response:– The doctor doesn’t do nothing to bring about the patient’s death. He lets the patient

die. He withholds treatment…– And although in active euthanasia the doctor is the cause of the patient’s death it is

considered bad to be the cause of someone’s death because death is a great evil.– Yet in cases of active euthanasia death is the preferred course of action and so not an

evil...