Active V Passive Euthanasia Essay, Research Paper

Euthanasia, derived from the Greek word “eu-thanatos” meaning simply “a good death”, is an issue that challenges our hearts and our minds. This paper attempts to identify and clarify the active/passive distinction inherent in the debate on euthanasia, before concluding, through an analysis of writers such as Rachels and Foot, that the distinction is in itself morally important.

Passive euthanasia is defined as allowing a patient to die by withholding treatment, while active euthanasia is defined as taking measures that directly cause a patient’s death. Essentially, the terms active and passive address how close the causal connection is between an action and an individual’s death

Those who state that active termination of a patients life can never be justified appeal to many strong arguments in support of their assertion. Firstly, it is thought that if a person seeks to end their life through active euthanasia, then they intrinsically contradict the value of their autonomy; Secondly, active euthanasia violates the fundamental prohibition against killing, except of course in the case of self-defense or defense of others; Thirdly it is thought that there would be a general reduction of respect for human life if official barriers to killing were removed; and lastly it is believed that if made a public policy, active euthanasia could lead to involuntary euthanasia.

Those who argue against active euthanasia understand that there is a demand for active euthanasia as a response “to the fear of entrapment in a technologically sophisticated, seemingly uncaring world of medicine”. Nevertheless, it is my view that unrestrained freedom to end one’s life or to have it ended by a physician ought not to be the only response to that fear; nor is such a response without grave social implications. I agree with the conclusion of advocates against active euthanasia who state that there must be better palliative care for those who suffer tremendously and for the terminally ill, rather than to actively terminate their lives.

In “Active and passive euthanasia,” a paper published more than 20 years ago, James Rachels challenges the doctrine that passive euthanasia can be morally permissible but active euthanasia cannot. He argues that killing someone is not, in itself, worse than letting someone die. No distinction can be sustained, and so active euthanasia is not worse than passive euthanasia. In his view, we should decide whether euthanasia is permissible in a particular case, irrespective of the means by which death would be brought about with the view of favouring the means that is most humane. Consequently according to Rachels, in cases where a dying patient’s suffering cannot be adequately relieved by palliative care, active euthanasia should be favoured over passive euthanasia because it ends the suffering faster.

Rachels observes and acknowledges the belief that actively killing someone is morally worse than passively letting someone die. Nevertheless he propounds that they do not differ since both have the same outcome: the death of the patient on humanitarian grounds. It is his opinion that the difference between the two is accentuated because we frequently hear of terrible cases of active killings, but not of passive killings.

Raches’ opinion that there is no important moral distinction between killing and letting die is best expressed through the example of Smith & Jones. In this hypothetical situtation Mr. Smith stands to gain a large inheritance if his young cousin were to die. Motivated by greed, Smith sneaks into the bathroom while the cousin is taking a bath and drowns her. Mr. Jones also stands to gain a large inheritance if his young cousin were to die, and he too sneaks into the bathroom, planning to drown her. Just as Jones enters the bathroom, the girl slips, hits her head, and falls face down, unconscious, in the water. Jones is poised to force her head back down should it be necessary, but it is not. The girl drowns while Jones does nothing.

Rachels reasons that if the difference between killing and letting die were in itself a morally important matter, one should say that Jones’s behavior was less reprehensible than Smith’s.

Surely they were not, he argues, for it is ludicrous to suggest that Jones behaved better because he did not actually kill his cousin but “merely” let her die. Thus, Rachels concludes, there is no inherent moral distinction between killing and letting die.

It is apparent that Rachels’ conclusions are deficient on a number of accounts. First, at best Rachels gives cases of two morally deplorable actions, not two equally deplorable actions. The difference is important. Rachels argues, rather, for the latter by appealing to the emotions. That is, with the same motive and result as Smith, Rachels argues, Jones was not just bad (as Smith was in fact bad) but rather that Jones was just as bad as Smith was. He accomplishes this through the telling of the cases. The “intuitively” less despicable case Rachels tells with morally incendiary details: “Jones is delighted…ready to push the child’s head back…[w]ith only a little thrashing about, the child drowns…as Jones does nothing.” On an emotional level this in effect makes both cases appear equally deplorable.

Rachels offers several arguments in favor of the moral permissibility of active euthanasia, one of which is an argument from mercy. He begins by describing a classic case where a person named Jack is terminally ill and in unbearable pain and states that Jack’s condition alone is a compelling reason for the permissibility of active mercy killing. A more formal utilitarian version of this argument is that active euthanasia is morally permissible since it produces the greatest happiness. Critics have traditionally attacked utilitarianism for focusing too heavily on happiness, and not enough on other intrinsic goods, such as justice and rights. Accordingly, Rachels offers a revised utilitarian version: active euthanasia is permissible since it promotes the best interests of everyone (such as Jack, Jack’s wife, and the hospital staff). Rachels also argues that the golden rule supports active euthanasia insofar as we would want others to put us out of our misery if we were in a situation like Jack’s. Again, a more formal version of this argument is based on Kant’s categorical imperative (”act only on that maxim by which you can at the same time will that it should become a universal law”). The categorical imperative supports active euthanasia since no one would willfully universalize a rule which condemns people to unbearable pain before death.

It is also reasoned that it is considered bad to be the cause of someone’s death and that death is regarded as a great evil. However, if it has been decided that active or passive euthanasia is desirable in a given case, it has also been decided that in this instance death is no greater an evil than the patient’s continued existence. A good point is raised here, because death is supposedly inevitable in either case, so according to Rachels, if a doctor allows a patient to die or gives him a lethal injection, then the motives and ends are essentially the same. Thus Rachels would maintain that when the motives and other circumstances are the same, as in the Smith and Jones cases, it becomes clear that whether a person is killed or allowed to die is morally irrelevant.

Another version of this reasoning can be seen in Tooley’s moral symmetry principle. This principle states that there is no moral difference between intentionally performing an action or ommission if three criterion are met: Firstly that the motivation is the same; secondly that the outcome of both the action and ommission are the same; and lastly that the action involves minimal effort. In appealing to this principle, Rachel would conclude that the Smith & Jones case (which meets the aforementioned criteria) shows the distinction between active and passive euthanasia cannot be sustained with reference to moral importance and relevance.

In “Killing and letting die,” Philippa Foot claims that Rachels’ view is “extremely implausible” and offers examples in which the distinction between killing and letting die clearly seems to be morally relevant.

First consider the dilemma of Dr. Brown, who has a limited supply of a drug and 6 patients who will die without it. The dilemma arises because 1 patient needs the entire supply of the drug to survive, while the other 5 need only one-fifth of the amount. Should he let 1 die to save 5? Then consider the dilemma of Dr. Green who has 5 patients who will die unless they undergo organ transplantation, but the organs they require are unavailable. It occurs to her, however, that there is a healthy clinical clerk on the ward with all the organs necessary to supply the 5 patients. Should she kill 1 to save 5?

Both dilemmas involve choosing between life for 1 person and life for 5. The only difference is that Brown would have to let 1 die to save 5, whereas Green would have to kill 1 to save 5. But this difference is morally critical, for it is obvious that Brown should choose life for 5, whereas Green should choose life for 1.

We must now ask why the distinction between killing and letting die seems morally relevant in the Brown and Green cases, but not in the Smith and Jones cases. Foot argues that the answer lies in the kinds of rights and duties associated with killing and letting die.

Rights can be divided into 2 types, negative and positive. Negative rights are our rights not to be interfered with and not to be harmed, for instance, the right not to have our property taken away. Positive rights are our rights to goods and services, such as our right to food and medical care. Corresponding with a person’s negative and positive rights are other people’s negative and positive duties: we have a negative duty not to harm others and a positive duty to feed the hungry.

Foot argues that the difference between the Smith and Jones cases is that Smith fails in his negative duty not to kill, whereas Jones fails in his positive duty to lend assistance. The moral significance of this difference is only academic, however, because in the circumstances described it is equally wrong to fail in either duty. The cases of Brown and Green are more complicated. If Brown lets 1 person die to save 5, he fails in his positive duty to provide the 1 person with medical care. If Green kills 1 person to save 5, she fails in her negative duty not to kill the 1 person. Here, though, the difference is morally important. In the Brown case, the positive right of 1 person to medical care obviously does not outweigh the positive right of 5 others to medical care. In the Green case, however, the negative right of the clinical clerk not to be killed does outweigh the positive right of the 5 to receive medical care. This is because “it takes more to justify an interference than to justify the withholding of goods or services.”

Consequently, it is morally permissible, indeed, required, for Brown to fail to provide 1 person with medical care, but it is wrong for Green to kill the clinical clerk.

Foot’s response to Rachels reveals that the distinction between killing and letting die can be morally relevant in some cases but not others. Therefore, Rachels’ argument appears to be invalid: even though he may be correct that the distinction is morally irrelevant in the context of the case involving Smith and Jones, it does not follow from this that the distinction is always morally irrelevant.