Philosophy 220
Euthanasia: Gay-Williams, Rachels and Steinbock
Euthanasia and PhysicianAssisted Suicide
 As the long public debate about the case of Terri
Schaivo revealed, Euthanasia and Physician-Assisted
Suicide are controversial moral issues.
 If progress is going to be made in resolving these
issues, there are some basic questions that need to be
addressed.
 Are euthanasia or suicide (including physician-assisted
suicide ever morally permissible?
 If either is morally permissible, what accounts for this
permissibility. If either is not, why not?
Euthanasia: Some Definitions
 Euthanasia: “…the act or practice of killing or allowing
someone to die on grounds of mercy” (295).
 When we take into account the difference between acting to
bring about someone’s death and merely allowing it, we must
observe a distinction between active euthanasia and passive
euthanasia.
 Typically, passive euthanasia is further subdivided into instance
of withholding treatment and withdrawing treatment.
 Though not a specific feature of the definition, it is also
important to distinguish between those instances when an
agent knowingly and voluntarily consents to either active or
passive euthanasia (voluntary euthanasia), those instances
when not consent has or cannot be given (nonvoluntary
euthanasia), and those instances when consent has been
denied (involuntary euthanasia)
Reviewing the Theories
 Kant insists that the categorical imperative (particularly the humanity
formulation) rules out suicide, and it is generally assumed that he would
render the same verdict with regard to euthanasia. The claim, however, that
respect for the moral humanity of the affected individuals requires a negative
verdict in all cases is controversial, and Kant’s writings don’t do much to clear
up the controversy.
 Consequentialist reasoning requires us to consider the consequences for the
affected parties. When we include consideration of broader social goods, the
specter of a slippery slope problem becomes evident: if we allow euthanasia
or physician assisted suicide in some cases, don’t we risk the expansion of
permissible cases to the point where clear violations of people’s rights would
occur?
 A natural law theoretical approach like that of Aquinas is generally going to
rule against either practice on the grounds that intentionally ending a human
life is always wrong. However, as we’ve seen, the doctrine of double effect
provides the basis for a more nuanced analysis, including the distinction
between “ordinary” and “extraordinary” means of life-support.
Gay-Williams, “The Wrongfulness
of Euthanasia”
 Gay-Williams (Ronald Munson) begins by noting that
public support of at least some forms of euthanasia is
on the rise.
 Though some have suggested this is due to the
increasing devaluing of human life, G-W suggests a
more noble (though still ultimately misplaced) motive:
feelings of sympathy and benevolence.
 These feelings are misplaced, insists G-W, because
euthanasia is morally wrong, a conclusion that G-W
justifies with three different arguments.
Setting the Terms
 As we typically do, G-W begins by establishing the terms of
his discussion.
 He defines euthanasia as the “intentional taking of a life of a
presumably hopeless person” either your own or someone else’s
(300c1).
 2 implications: you can’t accidentally euthanize someone and
the goal of the euthanizing is to end the ‘hopeless’ suffering of
the individual.
 G-W goes on to insist that there is no such thing as passive
euthanasia because the cases usually classified as such involve
the intentional cessation of treatment, and: “in such cases, the
person is not killed…nor is the death of the person intended”(ibid.).
 That is, the intention is to end suffering, rather than cause death.
The Argument from Nature
 The argument is straightforward.
P1. We are naturally inclined to our own survival.
P2. This is not just a conscious intention, “the organization of the
human body and our patterns of behavioral responses make the
continuation of life a natural goal” (301c1).
Conclusion: Euthanasia sets us against “our own nature.”
 Moreover, since “our dignity comes from seeking our ends,”
euthanasia “does violence to our dignity” (ibid.).
 This shows that euthanasia “requires that we regard
ourselves as less than fully human,” as creatures that are
not conscious of “our nature and our ends” (ibid.).
The Argument from Self-Interest
 This is another very simple argument.
P1 Diagnosis and prognosis is an inexact activity, and can
always be wrong.
P2 Until death, it is always possible that disease remission
or the invention of a life-saving treatment or technology
could reverse the situation of the individual.
P3 “Knowing that we can take our life at any time (or ask
another to take it) might well incline us to give up too easily”
(301c2)
Conclusion: Thus, accepting the permissibility of euthanasia
could lead to many unnecessary deaths.
The Argument from Practical
Effects
 Finally, the consequentialist argument to the conclusion
that euthanasia is morally wrong.
P1. Legalizing euthanasia could have bad effects on medical
care, because physicians would be less inclined to go “all
out” to save people, because killing them would be an option
P2 Legalizing voluntary euthanasia is the first step on a
slippery slope to nonvoluntary (unplugging people in comas)
and finally involuntary euthanasia (killing people against
their will) (i.e., slipping fatal doses to those doctors deem
hopeless.
Conclusion: To avoid these negative consequences,
euthanasia should be forbidden.
Final Analysis
(no pun intended)
 Ultimately, it’s the first argument that G-W rests his
case on, though the other two arguments do he thinks
provide compelling support for his conclusion.
Rachels, “Active and Passive
Euthanasia”
 Rachels’s focus in this article is the distinction between
active and passive euthanasia.
 As we saw, this is a distinction that Gay-Williams denies,
insisting that the concept of Euthanasia implies activity.
 Though Rachels does admit the distinction, noting that it is
central to the medical ethical discussion of the issue (as
enshrined in the AMA policy), he too denies its moral
significance, arguing that while the distinction is legitimate,
there is no moral difference between active and passive
euthanasia.
 Thus, whatever moral judgment we have of one, we must have
of the other.
AMA and Euthanasia
 Written in 1975, Rachels’s article focusses on the policy on
euthanasia adopted by the AMA in December of 1973.
 “The intentional killing of the life of one human being by
another—mercy killing—is contrary to that which the medical
profession stands and is contrary to the policy of the [AMA],”
but “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.”
 Though the language is different, the current version of the
policy (issued in June of 1994) takes essentially the same
position regarding the responsibilities of physicians, though it is
more circumspect about the withdrawal of life support.
http://www.ama-assn.org//ama/pub/physicianresources/medical-ethics/code-medical-ethics/opinion221.page
Active vs. Passive
 As James reads it, the 1973 AMA policy embodies the distinction
between active and passive euthanasia, but this distinction is
ultimately morally incoherent.
 Consider the example of the patient with incurable throat cancer
(303c2). The AMA policy would seem to allow an attending
physician to agree with a patient or family request to withdraw or
withhold life preserving treatment.
 But this course of action may in fact needlessly prolong the
suffering of the affected individual.
 Consider also the case of the downs baby with intestinal blockage.
According to Rachels, either the conservative (no euthanasia) or
the liberal (any euthanasia is ok) position is more understandable
than “favor[ing] letting ‘dehydration and infection wither a tiny
being over hours and days’” (304c1).
Active, rather than Passive
 Rachels’s conclusion from this analysis is that the AMA’s
preference for passive euthanasia is productive of needless
cruelty. It would be better for doctors to actively seek the
death of patients than merely withdraw or withhold care.
 He then makes a further point, “the conventional doctrine
(i.e., the distinction between active and passive euthanasia)
leads to decisions concerning life and death made on
irrelevant grounds” (304c1).
 For example, in the Downs case, the reason the parents are
allowing the babies to die is because they have Downs – there
is no way the intestinal blockage would be a reason to let nonDowns babies die.
Refusing the Distinction
 Rachels’s basis for rejecting the distinction between active and
passive is that there is no moral difference between the two, so you
should have the same policy for both.
 He offers the following thought experiment as the basis for an
argument from analogy in support of the conclusion.
 Consider two related cases:
1. Smith drowns his cousin to get the inheritance (304c2-305c1).
2. Jones allows his cousin to drown, also to get the inheritance (305c1).
 If, as it seems reasonable to conclude, Smith and Jones are equally bad,
the fact that Smith actively killed his cousin, while Jones passively allowed
his cousin to, makes no moral difference.
 To the extent that a doctor is in a relevantly similar position (and here
the relevant similarity is doing something or merely standing by), the
choice between active and passive euthanasia would similarly make
no moral difference.
A Possible Disanalogy
 Of course, the situations might not be relevantly similar: in active
euthanasia, the doctor does something (kills her patient). In passive
euthanasia, it is the patient’s condition that kills him.
 Rachels’s response:
1.
2.
It is wrong to say that in passive euthanasia the doctor does nothing. In
fact, she does do something: she lets the patient die. An omission in this
case is a decision.
The cause of death may be important from a legal point of view, but not
from a moral.
 Thus, Rachels concludes that there is no reason for the AMA to forbid
active but permit passive euthanasia.
 Though he doesn’t argue for this, the discussion of the desirability to limit
needless suffering (the grounds of the permissibility of passive euthanasia)
would seem to support the conclusion that active euthanasia is morally
permissible.
Steinbock, “The Intentional
Termination of Life”
 Steinbock’s article is a response to Rachels’s criticism
of the AMA policy.
 According to Steinbock, Rachels is mistaken in the
belief that the AMA doctrine rests on a distinction
between “intentionally killing” and “letting die”.
 As such, arguments showing that the distinction has no
moral force do not reveal that adherents to the AMA
doctrine are morally confused.
 The AMA doctrine does not imply support of the
active/passive euthanasia distinction: it rejects both.
Rachels’s Mistake
 Rachels’s mistake is in identifying the cessation of lifeprolonging treatment with passive euthanasia
(“intentionally letting die”).
 If it were correct to equate the two, then the AMA
statement would be self-contradictory, for it would begin
by condemning, and end by allowing, the intentional
termination of life.
 But if the cessation of life-prolonging treatment is not
always or necessarily passive euthanasia, this problem
needn’t arise.
Withdrawal does not equal
Euthanasia
 Making a distinction like we saw in the Gay-Williams
article, Steinbock insists that there are at least two
situations in which the termination of life-prolonging
treatment cannot be identified with euthanasia
(understood here as the intentional termination of the
life of one human being by another).
1. Where the patient has refused treatment.
2. Where continued treatment has little chance of
improving the patient’s condition and brings greater
discomfort than relief.
A Right to Refusal
 Steinbock’s distinction relies heavily on the claim that
patient consent relieves the doctor of responsibility: if
the patient or the patient’s authorized agents chose to
withdraw treatment, the doctor is removed from the
picture (and thus the AMA policy is no longer at issue).
 It’s generally agreed that the patient has a right to
refuse treatment – even where the treatment is
necessary to prolong life.
But not a right to assistance in
dying
 If one has the right to refuse life-prolonging treatment, why
doesn’t she also have the right to end her life, and obtain
help in doing so?
 On Steinbock’s analysis, the right to refuse treatment is a
right to bodily self-determination: in particular, a right to be
protected from unwanted interference from others (i.e., a
negative right).
 This negative right does not include a positive “right to die.”
 If it did, Steinbock insists, we would have to agree that
people have a right to be killed.
 Why shouldn’t we agree with this?
A Better Distinction
 The distinction that Steinbock thinks the AMA is really making is
between ordinary means to preserve life and extraordinary.
 Consider a case where treatment is unlikely to benefit for the patient,
but will cause more discomfort than the disease itself.
 Such treatment is often called “extraordinary,” but it is important to note
that what is ordinary in one instance may be extraordinary in another.
 “Ordinary” treatment is what a doctor would normally be expected to
provide.
 Failure for a doctor to administer ordinary treatment would constitute
neglect of the doctor’s moral (and legal) obligations.
 While a doctor is under no moral obligation to ignore appropriately
grounded requests to withhold extraordinary treatment, this is not
euthanasia.