James Rachels on Active and Passive Euthanasia (in James E. White text)

The Conventional Doctrine (endorsed by the American Medical Association):

In certain situations, passive euthanasia ("letting die") is morally permissible. However, active euthanasia (physician-assisted death) is never morally permissible. Doctors can withhold treatment in many circumstances, and does nothing wrong if the patient dies, but the doctor must never, ever "kill" the patient.

Rachelsís Thesis: active euthanasia is not any worse than passive euthanasia  

Definitions:

  • Active Euthanasia = taking a direct action designed to kill a patient
  • Passive Euthanasia = deliberate withholding of treatment that could prolong patient's life, allowing the patient to die

Important assumption: THE JUSTIFICATION for "letting die" is to reduce harm & suffering of the patient.

In situations for which passive euthanasia is permissible under this justification, there are no morally sound reason for prohibiting active euthanasia, and in some cases, active euthanasia is morally preferable to passive euthanasia. (Rachels says that he can understand someone who opposes both active and passive euthanasia as immoral practices, but cannot make sense of approving of one and not the other.)

The basis of the conventional doctrine is the distinction between "killing" and "letting die," together with the assumption that the difference between killing and letting die must, by itself and apart from further consequences, constitute a genuine moral difference.

Although most actual cases of killing are morally worse than most actual cases of letting die, we are more familiar with cases of killing (especially the terrible ones that are reported in the media), but we are less familiar with the details of letting die. This gap leads us to believe that killing is always worse. 

First argument against the conventional doctrine is that many cases of "letting die" are WORSE (for the patient) than is killing them. If the patient is going to die either way, why is it morally permissible to dehydrate them to death? Either way, the patient is dead. But the conventional doctrine often adds a requirement of suffering before dying.  

The refusal of treatment to some "defective" newborns, and the subsequent death by dehydration, shows that some cases of letting die are worse than killing.

Second argument is the Bathtub Example of Smith and Jones. It demonstrates that some cases of letting die are at least as bad as killing.

Therefore, the "bare" difference between killing and letting die doesnít always make a moral difference.

Therefore, in many cases where it is right to let a patient die, it is also right to practice active euthanasia.

WARNING: Notice that Rachels does not defend active euthanasia (killing), because he never defends the morality of passive euthanasia. His goal is to challenge the distinction. In a case where "letting die" is immoral, killing may also be immoral. If "letting die" is always immoral, then one might have a sound moral reason to object to active euthanasia, too.

 

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Last updated Aug. 30, 2009