Active euthanasia is defined as the intentional act of causing the death of a patient experiencing great suffering, while passive euthanasia is death brought about by omission ie. Letting them die (bbc.co.uk, 2018). The act of Euthanasia is performed when the patient or patient’s family and doctors believe that their pain and suffering is so bad that they would be better off dead, or when one believes their quality of life will soon become so bad that they would be better off dead. Thus, the motive of the person performing euthanasia is to benefit the patient, by ending their suffering. Some think that it is acceptable to withhold treatment and allow a patient to die, but that it is never acceptable to kill a patient by a deliberate act as their distinction is morally significant (bbc.co.uk, 2018). However, In this essay I will be arguing that the distinction between passive and active euthanasia are not morally significant because they both have the same intention, for the same reason and the same outcome (the doctor believes the patient is suffering and so ends their life, due to humane reasons), also active euthanasia may decrease the amount of suffering to the patient and their family which should be favoured over the slight difference the doctor may believe it makes to their moral standing. In order to argue this, I will be using James Rachels’ article and focus on the arguments of the difference between killing and letting die.
The distinction between killing and letting die is commonly thought of as action or inaction, however this is not always the case. For example, cartwright gives the example of a man falling off a cliff, and someone attempting to save them with a rope; if the saviour feels himself falling and decides to let go to save himself, he is letting the other person die rather than actively killing while acting. In this way, the distinction between killing and letting die may be better understood as contributing to the chain of events that end in the persons death or allowing the causal chain to carry on by itself, knowing it will end in death (Cartwright, 1996). In this way, active euthanasia could be thought of as actively contributing to the patient’s death via an action – using a lethal injection, while passive euthanasia simply allows the chain to continue – by withholding medication.
The first problem with this is that it can be argued that both active and passive euthanasia involve the same action, with the same intention, for the same reasons. For example, the doctor decides to end the patient’s life for humane reasons because they believe the patient is suffering and is better off dead. In the passive euthanasia case, the doctor still makes an action to take away medication which he knows will lead to the patient’s death. This means that passive euthanasia does not allow the causal chain to continue, as without their input, the patient would still be taking medication and would not die. Therefore, there is no moral significance between passive and active euthanasia and they both involve acting in a way that will kill the patient, with the same intentions and the same outcome.
The second concept commonly used in the Euthanasia debate is the idea of killing and letting die. From now on, I will be focusing on this concept as it aims to show a moral significance between passive and active euthanasia as passive euthanasia only involves ‘letting someone die’ which is not as bad as killing someone, which is what active euthanasia involves.
Rachels’ uses an analogy to show there to be no moral difference between killing and letting die in situations regarding euthanasia. This analogy states that Smith intends to kill his six-year-old cousin to gain a large inheritance, so he drowns him in a bath and stages it as an accident. However, another man, Jones, also stands to gain a lot of money if his six-year-old cousin dies. He therefore intends to drown him in a bath. When he goes into the bathroom, the child is already drowning. Jones stands idly by as the child dies in what is an ‘accident’. In each instance the men killed or let the child die, however, it doesn’t seem as if one of them is in a better position morally as they both intended the same thing for the same reason, and they had the same outcome. In this way, a doctor who lets a patient die for humane reasons is just as moral as a doctor who gives a lethal injection for humane reasons. Just as if the disease turned out to be curable, the decision to end the patient’s life would be just as regrettable in both situations. Therefore, the distinction between passive and active euthanasia is not morally significant as they both have the same intention, for the same reason with the same outcome. (Rachels, 1975)
Cartwright replies to this with his own analogy to show that there is a difference in moral significance when one person is faced with the decision to kill or let die. In this example a doctor has two patients who are dying of organ failure. To save their lives, the doctor would need to kill a healthy person to use their organs, or he could let the two patients die. In this way it is easy to see how intuitively it would be worse morally to kill the healthy person rather than let the two die. (Cartwrights, 1996)
However, it can be argued that this analogy is not sufficiently similar to euthanasia as the doctor would not kill a healthy person. The idea of euthanasia is to end the patients suffering in a humane way, to minimise pain for the patient and family. However, in this example by cartwright the persons life is unjustly ended because they have a quality of live that means they would be better off living, whereas in euthanasia cases, the patient is better off dead.
This may also be argued for Rachels argument as both men had bad intentions and also killed a healthy person. Therefore, it is important to show the problem with arguing from analogy. One problem with arguing from analogy in these situations is that because they play to our intuitions, changing one detail in an example seems to change out thoughts on the subject completely which is not helpful as the examples are fiction and don’t seem to move us closer to finding an answer to the question. The distinction between killing and letting die may lead to different intuitions in different cases because there are many factors that contribute to the ‘rightness’ and ‘wrongness’ of an act which are complex and act on each other in different ways. Therefore, prima facie James’ examples may seem to show us that intuitively, killing and letting die has no moral distinction however this is due to the factors ad words used in the analogy and not because the principle is true.
This is a strong argument against James’ first argument however, analogies are made to show people’s intuitions about a general principle. James’ analogy was sufficiently similar to euthanasia as both men intended to kill the child for the same reasons, and it ended in death. Our intuitions seem to tell us that it is reasonable to say that in this case – and cases like it – killing and letting die has no moral significance because of these reasons. In cartwright’s analogy, the intention of the doctor was different in the two situations – in one, the doctor would kill a healthy person in order to save the other two, and in the second he refuses to kill the healthy man and lets the other two die, presumably because he believes killing is wrong. The outcome of these two options are also different and so do not resemble euthanasia. Therefore, although it is a weaker form of argument, James’ analogy still shows that intuitively, in cases like euthanasia, there is no moral difference between killing and letting die.
In conclusion, there is no moral significance between passive and active euthanasia as they both involve a doctor intentionally acting in a way that will end a person’s life because they believe it is humane, and both actions result in the death of the patient. Also, the argument that passive euthanasia only involves letting someone die, while active euthanasia involves killing someone is wrong, because passive euthanasia involves a decision and an action that is similar to active euthanasia as shown by Rachels’ argument from analogy. Therefore, the distinction between passive and active euthanasia are not morally significant because they both have the same intention, for the same reason and the same outcome.