Introduction to Ethics
Lecture 22
Active & Passive Euthanasia
By David Kelsey
Rachels’ conclusion
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James Rachels wants to argue that the following principle is false:
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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:
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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
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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.
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For example:
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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.
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Because once the decision has been made not to prolong his agony passive
euthanasia brings about greater suffering.
A second example
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A second example:
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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:
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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
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Rachels makes a second argument about the reasons given:
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Consider again the case of an infant born with Down’s syndrome.
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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.
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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?
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And if the life of such an infant is not worth preserving what does it matter if it has an
intestinal obstruction?
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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
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Rachels considers whether killing is worse than letting die. Rachels presents 2
cases exactly alike except for this one difference:
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1. Smith will gain a large inheritance if anything should happen to his 6 year old
cousin.
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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.
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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
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Rachels wants to argue that there is no moral difference between the cases.
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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.
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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)
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So in conclusion Rachels claims that there is no moral difference between active
and passive euthanasia.
An objection
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Rachels considers an objection:
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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:
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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
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Rachels considers another objection:
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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:
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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...