Killing and Letting Die Is there a moral difference?

Euthanasia  ‘Good death’: do you think that there are situations where it would be better for someone to die than to go on living?  David Hume’s essay on Suicide is a famous piece that addresses this question—published posthumously, of course.  When we think of euthanasia, it’s usually in a medical context: a sick patient, perhaps a hopeless case, in uncontrolled or poorly controlled pain.

Medical Ethics  Medical ethics is a kind of professional ethics– these codes set out rules for professionals of many kinds, describing how they are expected to deal with  Many codes of medical ethics draw a sharp line between ‘active’ and ‘passive’ euthanasia (i.e. between killing patients in certain circumstances, and merely withholding measures that would keep them alive).  While passive euthanasia is accepted, active euthanasia is proscribed as a violation of the moral code/ professional ethics of physicians.

Rachels’s argument  James Rachels thinks this is a mistake.  In fact, Rachels thinks sometimes it would be better to kill a patient rather than merely let the patient die.  What’s his argument for this?

One example  Consider a cancer patient in the process of dying, but still days from the end. His pain is not controlled, and he and the family ask the doctor to end his pain, even if it means dying sooner.  If passive euthanasia is allowed, the doctor can withhold any treatments that are extending the patients’ life, and thus end his suffering a little sooner, saving the patient from a day of pain.  But if active euthanasia is allowed, the doctor can give a lethal injection now, saving several days of pain.  Surely active euthanasia would be better here.

Another example  Sometimes infants with Down’s syndrome also have intestinal blockages.  Allowing passive euthanasia enables families and doctors to agree to withhold treatment in these cases, leading to a long, slow death from dehydration.  Allowing active euthanasia would allow families and doctors to kill these infants immediately.  Again, this seems better: even if you don’t agree with killing or allowing these infants to die, surely it’s better to simply kill them than to have them suffer so.

Worse yet  Intestinal blockage is actually irrelevant to the decision being made here: the blockage could easily be fixed.  But its presence leads to a life and death decision, while a Down’s infant who does not have a blockage faces no such decision.  So life and death for these two infants is decided by something trivial and irrelevant: the presence or absence of a blockage, not the Down’s syndrome, which (after all) is the real reason family and physicians decide not to treat.

A thought experiment  Smith and Jones.  What’s the only difference Rachels allows to distinguish these two monsters?  Does that difference make a moral difference?  If it doesn’t, can there really be a moral difference between killing and letting die, per se?

Acting and not acting  “The important difference between active and passive euthanasia is that, in passive euthanasia, the doctor does not do anything to bring about the patient’s death”  What is the difference between not doing something that would prevent a certain outcome, and doing something that directly brings it about?  Can this difference carry any moral weight, all by itself?

In particular  Here we are considering cases where what the physician does (or doesn’t do) leads to the patient’s (earlier) death.  If we allow passive euthanasia, we’ve accepted that (in some cases) earlier death can be a good thing– as good (or at least, as acceptable as) the alternative of continued treatment and longer life.  But in this situation, surely it’s not wrong to be (a) cause of the patient’s death, i.e. not wrong to practice active euthanasia.