1. Introduction to Ethics Lecture 21 Active & Passive Euthanasia By David Kelsey

2. Rachels’ conclusion James Rachels wants to argue that the following principle is false: –It is permissible, at least in some cases, to withhold treatment and allow a patient to die, but it is never permissible to take any direct action designed to kill the patient. This is endorsed by the American Medical Association: –The intentional termination of the life of one human being by another…is contrary to that for which the medical profession stands and is contrary to the policy of the AMA…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…

3. Why Passive Euthanasia can be worse than Active Euthanasia In some cases being allowed to die can be a slow and painful death whereas being given a lethal injection is relatively quick and painless. For example: –say someone is dying of incurable throat cancer. –The pain can no longer be satisfactorily alleviated. –He asks the doctor for an end to his life. –But if one simply withholds treatment it may take the patient longer to die. Thus, the patient may suffer more than if a direct action is taken and a lethal injection given. Rachels thinks this situation actually recommends active euthanasia. –Because once the decision has been made not to prolong his agony passive euthanasia brings about greater suffering.

4. A second example A second example: –There are cases where an infant is born with Down’s syndrome and yet it requires some surgery in order to live. For example, to clear an intestinal obstruction. –In some cases the parents will decide not to operate and let the infant die. –In such cases, the doctors and nurses try to keep the baby from suffering while natural forces sap its life away. Rachels’ point: –if the decision has been made to let it die then a lethal injection is preferred for letting the infant die prolongs the infants suffering.

5. A second argument Rachels makes a second argument about the reasons given: –Consider again the case of an infant born with Down’s syndrome. –In cases where if there is no operation and the infant dies, the reason why such an operation is not performed is that the infant has down’s syndrome. –But if the life of such an infant is worth preserving what does it matter if the infant has an intestinal tract that is blocked and so needs a simple operation to preserve its life? –And if the life of such an infant is not worth preserving what does it matter if it has an intestinal obstruction? –So in such cases what’s relevant to deciding whether to perform the surgery or not is simply whether the life of such an infant is worth preserving…

6. Killing and Letting Die Rachels considers whether killing is worse than letting die. Rachels presents 2 cases exactly alike except for this one difference: 1. Smith will gain a large inheritance if anything should happen to his 6 year old cousin. –One evening while the child is taking his bath Smith sneaks in and drowns him. Smith then arranges things to look like an accident. 2. Jones will gain a large inheritance if anything should happen to his 6 year old cousin. –One evening while the child is taking his bath Jones sneaks in with the plan of drowning the child. However, just as Jones enters, the child slips and hits his head, falling face down in the water. –Jones is standing there ready to push the child’s head under the water if necessary but the child ends up drowning…

7. Rachels on Smith and Jones Rachels wants to argue that there is no moral difference between the cases. –For Rachels, Smith and Jones are equally bad. –Same motive and each acted for the death of the child Thus, “the bare difference between killing and letting die does not, in itself, make a moral difference.” So “If a doctor lets a patient die, for humane reasons, he is in the same moral position as if he had given the patient a lethal injection for humane reasons.” (865) So in conclusion Rachels claims that there is no moral difference between active and passive euthanasia.

8. An objection Rachels considers an objection: –If killing wasn’t worse than letting die we would hear about cases of one person letting another die as much as we hear about cases of one person killing another. –But we clearly don’t. –So killing must be worse than letting die. Rachels response: –It is clear that most cases of killing are worse than cases of letting someone die. –But what we fail to take into account are the other circumstances of the killing (the murderer’s motive, the act of killing, the death)

9. One more objection Rachels considers another objection: –Active euthanasia is worse than passive euthanasia –In passive euthanasia the doctor does not do anything to bring about the patient’s death. In active euthanasia the doctor kills the patient. –So the doctor who performs active euthanasia causes the patients death, but in passive euthanasia the cause of death is the ailment suffered. Rachels in response: –The doctor doesn’t do nothing to bring about the patient’s death. He withholds treatment… –And it is considered bad to be the cause of someone’s death because death is a great evil. –Yet in cases of active euthanasia death is the preferred course of action and so not an evil...