READING FOR WEDNESDAY • “Voluntary Ac9ve Euthanasia” • By: Dan W. Brock • pp. 131‐144 1 Ac9ve and Passive Euthanasia James Rachels 2 Ac9ve & Passive Euthanasia •  Eu‐thanasia –  Eu = Greek prefix for “good” as in euphoria, or euphemism. –  thanasia = Greek for “death.” •  So by defini9on it is only euthanasia if death is really “good” i.e. beVer than living on. 3 Ac9ve & Passive Euthanasia •  AMA Dec. 4 1973 –  The inten9onal termina9on of the life of one human being by another—mercy killing—is contrary to that for which the medical profession stands […] –  The cessa9on 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 pa9ent an/or his immediate family. 4 Ac9ve & Passive Euthanasia •  Legality of Euthanasia –  Ac9ve Euthanasia is illegal everywhere in the world except Belgium and the Netherlands –  Passive Euthanasia (under certain circumstances) is legal everywhere in the US. •  In legal limbo is palia9ve (pain) care that may shorten the pa9ent’s life. –  Assisted Suicide is legal in 3 states. •  Oregon, Washington, and Montana •  And in Switzerland (where it is only illegal if it is done with “selfish mo9ve”.) •  According to a study of 10,000 doctors, 46% of doctors think that Assisted Suicide should be legal under some 5 circumstances. Ac9ve & Passive Euthanasia •  Rachel’s sees three broad reasons that weigh against the tradi9onal ac9ve/passive euthanasia dis9nc9on. 1.  Ac9ve Euthanasia is some9mes (much) more humane. 2.  The dis9nc9on leads to making life/death decisions on irrelevant grounds. 3.  No moral difference between killing and lelng die. 6 Ac9ve & Passive Euthanasia •  The Down Syndrome Baby Case (used to make Rachels’ first two arguments). –  In the US 1 in 600 babies is born with Down Syndrome. –  Most are born otherwise healthy, but some are born with congenital defects (such as intes9nal obstruc9ons) that require surgery to live. –  Some9mes in such cases the parents opt not to give the child the surgery, and allow it to pass away via passive euthanasia. 7 Ac9ve Euthanasia as More Humane •  If the decision to allow the baby to die is taken then “dehydra9on and infec9on wither [the] 9ny being over hours and days.” (Shaw 1972) •  This is not only excrucia9ngly painful to the child, it is a terrible ordeal for hospital staff* and parents. 8 Ac9ve Euthanasia as More Humane •  Rachels’ point is that whether you believe such babies are beVer off dying or not, the passive euthanasia op9on makes no sense. •  “I can understand why some people are opposed to all euthanasia, and insist that such babies must be allowed to live, I think I can also understand why other people favor destroying these babies quickly and painlessly. […But] [t]he doctrine that says that a baby may be allowed to dehydrate and wither, but may not be given an injec9on that would end its life without suffering, seems so patently cruel as to require no further refuta9on.” (127‐8) 9 Medical Decisions Made on Irrelevant Grounds •  Life or Death decisions about some being should be made on grounds relevant to the ques9on of whether that being is beVer off living or dying. •  Whether a baby’s intes9nal tract is blocked is irrelevant to whether that baby is beVer off living or dying (it is easily fixed). •  But on the current policy, whether such a baby dies or lives depends crucially on whether the baby has such an otherwise irrelevant defect. 10 Medical Decisions Made on Irrelevant Grounds •  “It is the Down’s syndrome, and not the intes9nes, that is the issue. The maVer should be decided, if at all, on that basis, and not be allowed to depend on the essen9ally irrelevant ques9on of whether the intes9nal tract is blocked.” (128) 11 Ac9ve & Passive Euthanasia •  The moral killing/lelng die dis9nc9on. –  The claim here is that all other things being equal, killing is always worse than lelng die. –  The intui9on is that doing something that brings about another’s death is worse than standing by and allowing that death to come about by some other means. 12 Medical Decisions Made on Irrelevant Grounds •  If it is true that killing is always (intrinsically) worse than lelng die, then this fact alone could provide a moral explana9on (jus9fica9on) for why we allow the laVer under certain circumstances, but never the former. •  But Rachels argues via a thought experiment that there is no intrinsic difference between the two. 13 Medical Decisions Made on Irrelevant Grounds •  Situa9on 1 (killing) •  Smith: –  Stands to inherit by death of cousin. –  One day, this cousin is taking a bath under Smith’s supervision. –  Smith pushes the child over in the bath and drowns him. 14 Medical Decisions Made on Irrelevant Grounds •  Situa9on 2 (lelng die) •  Jones: –  Stands to inherit by death of cousin. –  One day, this cousin is taking a bath under Jones’s supervision. –  Although Jones plans to drown his cousin just like Smith, before Jones can knock him over the child slips and falls of his own accord, drowning while Jones stands and watches (ready to hold his head under if he comes up). 15 Ac9ve & Passive Euthanasia •  Between Smith and Jones, who is more morally to blame? •  A = Smith •  B = Jones •  C = They are equally morally to blame. 16 Ac9ve & Passive Euthanasia •  So the “bare difference between killing and lelng die does not, in itself, make a moral difference.” (128) •  According to Rachels the problem in the AMA posi9on is that it forbids “mercy killing” as the “inten9onal termina9on of the life of one human being by another” but fails to recognize that passive euthanasia is as much the “inten9onal termina9on of the life of one human being by another” as ac9ve euthanasia is. 17 Ac9ve & Passive Euthanasia •  Just because in passive euthanasia the inten9onal ac9on in ques9on is one that is best described as a refraining from physical interven9on, rather than as a physical ac9on, that does not make it any less of an inten9onal ac9on. –  Insult the queen example. •  And both ac9ons (passive or ac9ve) have the result that the life of another is terminated. So they are both the inten9onal termina9on of one life by another. 18 Ac9ve & Passive Euthanasia •  There are plenty of appropriate and powerful reasons and arguments why ac9ve and passive euthanasia might both be wrong (perhaps a preventable death can never be a good one). •  There are also plenty of appropriate and powerful reasons and arguments why they are both not wrong, (some forms of living have a nega9ve value to which death is preferable). •  However, Rachels argues, we have no good moral arguments or reasons for dis9nguishing between the two and allowing one, but not the other. 19 Trolleys and Bullets •  Imagine a trolley is bearing down on 3 people who are immobilized on the track, and if something isn’t done it will run them down and kill them. •  You are standing next to a junc9on switch that will switch the trolley over to another track. However, on that track one person is immobilized and will surely be hit by the trolley and die. •  Is it morally permissible to pull the junc9on switch to save the three people, thereby bringing about the death of one other? •  A = YES •  B = NO •  Would you pull the junc9on switch and re‐route the trolley? •  A = YES •  B = NO 20 Trolleys and Bullets •  Imagine the same trolley is bearing down on 3 people on the tracks. You are on a bridge overlooking the tracks under which the trolley will pass before heading toward the three unlucky souls. •  Standing next to you is a very fat person. You know that if you push the fat person off the bridge and onto the tracks this will stop the train before it hits the three people. •  Is it morally permissible to push the fat person off the bridge to save the three people, thereby bringing about the death of one other? •  A = YES •  B = NO •  Would you do it? •  A = YES •  B = NO 21 Trolleys and Bullets •  You are standing in line to get into a movie when you turn around and see someone poin9ng a gun at you and pulling the trigger. •  Are you allowed to dodge out of the way of the bullet even though you know that as a result the bullet will hit the person standing in front of you in line? •  A = YES •  B = NO •  Are you allowed to take the person behind you in line and pull him/her into the path of the bullet? •  A = YES •  B = NO 22 Ac9ve & Passive Euthanasia •  So there are life or death situa9ons in which playing certain kinds of ac9ve roles can make a moral difference against certain kinds of passive roles. •  What might the difference be between these cases and Rachels’ bathtub case where the ac9ve/passive dis9nc9on does not seem to make a moral difference? •  It is a live moral debate how exactly to treat these ques9ons…. 23