Active and Passive Euthanasia by James Rachels
The distinction between active vs. passive euthanasia is essentially "to kill or let die." (Example: the direct action to kill a terminally ill patient as a form of 'mercy killing' or to merely withhold treatment)
Conventional doctrine (exemplified by the AMA doctrine) -- active euthanasia is always forbidden.
- Mercy killing ("the intentional termination of life of one human being by another") is wrong.
- The patient and immediate family decide on withholding treatment if and only if there is "irrefutable evidence" of imminent death.
Rachels argues that:
- Active is often more humane than passive. (Once the decision to not prolong agony is made, active euthanasia is preferable to passive. Namely, in the relevant case, passive would surely lead to an unnecessary period of prolonged suffering. Recall the dire cancer patient and the Down's baby.)
- The doctrine leads to decisions concerning life and death on irrelevant grounds. (The "excuse" to kill the Down's baby.)
- The doctrine rests on a distinction between killing and letting die that itself has no moral importance. (Greed to kill or let die your six-year-old cousin.)
- The most common argument in favor of the doctrine is invalid.
Rachels attempts to use examples to support his points:
- Active euthanasia is often more humane than passive.
- Case 1.1: Patient is dying of incurable cancer, in terrible unalleivable pain, subject to irrefutable imminent death.
- Because of the last clause, the patient and his immediate family has decided to end it.
- If the doctor withholds treatment (a la the doctrine) he would justify the action by noting that the patient would die anyway, and it is wrong to prolong suffering needlessly.
- But, if one simply withholds treatment, the patient may take longer to die, would thus suffer more, relative to the case of active euthanasia, i.e., lethal injection.
- Thus: once the decision to not prolong agony is made, active euthanasia is preferable to passive.
- (Otherwise, the patient would suffer more, which is contrary to the "humanitarian impulse" that prompts the decision to end.)
- Case 1.2: A Down's Syndrome infant suffers a malady (ex: intestinal blockage) that requires operation in order to live.
- Suppose his parents and the doctor decide not to operate, to let die.
- The baby would suffer dehydration and infection before dying.
- It would be cruel if the baby were not given a lethal injection (since its terminal fate is death).
- The doctrine leads to decisions concerning life and death on irrelevant grounds.
- Case 2.1: A Down's Syndrome infant needs a medically-doable operation (intestinal operation) unrelated to the Syndrome in order to live.
- The operation is not done because the child has Down's Syndrome, and thus it is better for the child to die.
- It is Down's Syndrome that is the defining grounds for death, not the operation.
- The presence of the intestinal blockage merely serves as the "excuse" for letting die. Since, if that's not the case, "nothing can be done, for one must not 'kill' it"
- Is killing worse than letting die?
- Cases: In both cases, the perpetrator stands to gain, perhaps through a large inheritance, if his 6-year old cousin were to die.
- Case 3.1: The perpetrator Smith purposefully drowns his cousin.
- Case 3.2: The perpetrator Jones plans to drown his cousin, but his cousin dies in an accident (which he did not cause), which Jones witnesses in full sight. Jones has the power to save his cousin, but he merely stands by and does nothing!
- Jones argues, "I didn't kill him; I only let him die."
- If letting die is less bad than killing, this "defense" is actually somewhat valid -- however, such a "defense" can only be regarded as a grotesque perversion of moral reasoning. Thus, no defense at all.
- Therefore: the bare difference between killing and letting die does not, in itself, make a moral difference.
- The most common arguments for the document are invalid.
- AMA identifies "intentional termination of life of one human being by another - mercy killing" to be forbidden, but it does not deny the cessation of treatment as intentional termination!
- People find killing worse than letting die because the media often portrays killing as terrible, essentially, the acts of murderous criminals with petty motives of robbery, perhaps, while "letting die" is a role played by doctors for humanitarian reasons.
- Both acts involve killing, thus: Killing, itself, is not what makes it worse than letting die, but the motives of the killer versus the "let-killer."
- Death is regarded as a great evil, thus it is bad to be a causer of death.
- Active -- directly causes death
- Passive -- does nothing. Patient dies from illness.
- But, if a doctor lets a patient with a curable illness die, he would be the cause of death.
- But, if euthanasia is decided upon for a case, "it has already been decided that in this instance death is no greater evil than the patient's continued existence."
- The cause of death is, in effect, as evil as the cause of life.
- Conclusion: the AMA should not give the distinction of active versus passive euthanasia any added authority and weight by writing it into official statements of medical ethics.