Active and Passive Euthanasia: An Impertinent Distinction

Is Euthanasia Wrong?
Thomas D. Sullivan: “Active and Passive
Euthanasia: An Impertinent Distinction ”
Sullivan’s Project
• Sullivan argues that Rachels misinterprets the AMA doctrine,
and that, when read correctly, the doctrine does not lead to
the problems that Rachels contends.
American Medical Association Doctrine:
The intentional termination of the life of one human being by
another—mercy killing—is contrary to that for which the
medical profession stands and is contrary to the policy of the
American Medical Association.
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. The advice and judgment of the
physician should be freely available to the patient and/or his
immediate family.
• The AMA doctrine forbids “active euthanasia”, and permits
“passive euthanasia”.
Recall Rachels’ Arguments:
• Rachels presents three arguments against the policy:
i. The AMA policy is cruel.
 Case 1: Throat Cancer Patient: The AMA policy
seems to require that such a patient endure a slow,
painful death rather than allowing a lethal injection for
terminally-ill patients.
Recall Rachels’ Arguments:
ii. The AMA policy leads to life-and-death decisions based
on irrelevant grounds.
 Case 2: Down’s Syndrome Baby: The AMA policy,
strictly interpreted, seems to allow newborn Down’s
syndrome babies to die from intestinal blockages,
though this is not the reason that parents think it best
to let the babies die.
Recall Rachels’ Arguments:
iii. The distinction made by the AMA policy is based on a
false assumption that killing is worse than letting die.
 Smith & Jones Thought Experiment: If killing were
worse than letting die, we should say that Jones’
behavior was less reprehensible than Smith’s. But we
do not want to say this, so this basis for
the AMA doctrine is untenable.
Points of Agreement
Sullivan agrees with Rachels that:
1) Letting a Down’s syndrome baby die from starvation and
dehydration is cruel.
 “It is cruel to stand by and watch a Down’s syndrome
baby die an agonizing death when a simple operation
would remove the intestinal obstruction, but to offer
the excuse that in failing to operate we didn’t do
anything to bring about the death is an example of
moral evasiveness comparable to the excuse Jones
would offer for his action of “merely” letting his cousin
die.” (197)
Points of Agreement
Sullivan agrees with Rachels that:
2) There is no extra-moral badness that necessarily comes
along with killing that wouldn’t come along with letting
 “[I]t is true that if someone is trying to bring about the
death of another human being, then it makes little
difference from a moral point of view if his purpose is
achieved by action or by malevolent omission, as in
the cases of Jones and Smith.” (197)
Sullivan’s Criticisms of Rachels
Sullivan argues, contrary to Rachels’ contention, that AMA
policy is not based on an untenable moral distinction
between killing and letting die.
• According to the AMA policy (charitably interpreted)
intentionally killing a patient is wrong.
► Intentionally killing a patient “can be done by acting to bring
about [his] death or by refusing ordinary means to keep
[him] alive in order to bring about the same goal.” (197)
Sullivan’s Criticisms of Rachels
• What the AMA policy permits is refraining from employing
extraordinary means to prolong life (under some conditions).
► The AMA policy makes no mention of ordinary means.
► Recall last class, slide 5: The North Carolina legal
definition of “extraordinary means” includes “any procedure
or intervention which in the judgment of the attending
physician would serve only to postpone artificially the
moment of death.”
► Sullivan refers to a definition of “extraordinary means” from
Paul Ramsey’s book, The Patient as Person:
“Extra-ordinary means of preserving life are all those
medicines, treatments, and operations which cannot be
obtained without excessive expense, pain, or other
inconvenience, or which, if used, would not offer a
reasonable hope of benefit.” (197)
Sullivan’s Criticisms of Rachels
• There is a legitimate distinction to be made between
intentionally killing someone and refraining from taking
extraordinary means to save the person.
► One can refrain from taking extraordinary means to save
someone without at the same time intentionally killing him.
► One can foresee that a certain action will result in the
patient’s death without thereby intending the patient’s
Sullivan’s Criticisms of Rachels
If I drive downtown, I can foresee that I’ll wear down my
tires a little, but I don’t drive downtown with the intention of
wearing down my tires.
Sullivan’s Criticisms of Rachels
If I forego my exercises for a few days, I can foresee that
my physical condition will deteriorate a little, but I don’t omit
my exercise with a view to running myself
Sullivan’s Criticisms of Rachels
If you have to hire someone to fill a job, and you hire Mrs.
Green, who is better qualified, rather than Mr. Brown, you
can foresee that you will hurt Mr. Brown. But you needn’t
hire Mrs. Green with the intention of hurting Mr. Brown.
• “[I]t is not the case that all foreseeable consequences and
side effects of our conduct are necessarily intended. And it is
because the physician’s withdrawal of certain extra-ordinary
means can be otherwise motivated than by a desire to bring
about the predictable death of the patient that such action
cannot categorically be rules out as wrong.” (198)
► It may still be the case that the patient will make a
miraculous recovery, and this doesn’t go against the
physician’s intentions.
Ordinary and Extraordinary Means
Refusing ordinary means is another matter: what would be
the point of refusing assistance which would offer a
reasonable hope of benefit without excessive pain or
• The AMA position rules out not only direct actions to bring
about death (such as lethal injection), but also malevolent
omissions, such as not providing ordinary care for a newborn
• Rachels ignores the difference between ordinary and
extraordinary means: performing surgery on the newborn or
saving the drowning boy are certainly not extraordinary
measures to take.
• Since the AMA doctrine does not allow for letting Down’s
syndrome babies to die from intestinal blockage, it is neither
cruel nor does it lead to life and death decisions being made
on irrelevant grounds.
• The AMA doctrine does not rest on some distinction between
“active” and “passive” euthanasia.
• The AMA doctrine does not rest on some distinction between
action and omission.
• Rather, the AMA doctrine is simply a prohibition against
intentional killing, whether by action or omission.
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