Looking at Active Euthanasia Through a Moral Lens

Matthew Hodder - Writer

In this article, the principle discussion will be the moral question around the subject of Euthanasia. More specifically, the distinction between Active and Passive Euthanasia, as examined carefully by Rachels (1975). We will first need to examine the difference between killing and letting die, and if they are morally different. Furthermore, we will be able to discuss the morality of Voluntary Active Euthanasia and whether we can ever allow a physician to intentionally end a life. We shall find that there are no suitable moral distinctions between killing and letting die, and therefore we should allow the practise of active alongside passive euthanasia.

Firstly, we will need to distinguish between two forms of euthanasia: active and passive. Broadly speaking, passive euthanasia involves the withholding of life-sustaining treatment to allow for death, whereas active euthanasia involves deliberate steps, such as a lethal injection, to end life. A loose synthesis of this is the issue of killing and letting die. It is important that we explore the moral implications of both of these before we make any definite statements on the morality of euthanasia. In many cases of Western medicine, “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” (Rachels, 1975, p.78). ‘Letting die’ in this case would mean letting the disease or complication kill the patient, rather than implicating the doctor in the death. This can be considered the early beginnings of an argument as to why killing is so much worse than letting die, morally speaking. If we imagine a cancer patient who has unfortunately reached the final stages of their illness, then stopping all treatment means that the cancer has killed the patient. This could be considered the better “moral” choice, because the doctor is not at fault for the initial disease and has taken no deliberate measures to end the patient’s life. In the case of the lethal injection, however, the doctor has chosen and acted to cause the death of the patient, not the cancer in spite of the fact that the cancer would have killed the patient anyway. It is tempting to think that, in ordinary life, that killing is much worse than letting die. There is an acute blameworthiness that comes with killing, and maliciousness that makes it so evocative. So, we will need to ascertain the relative moral difference between killing and letting die. 

The issue of biomedical ethics differs from the real world, in that ‘killings’ occur for very different reasons. A murderer may murder for love or money, whereas a doctor will not. My first counter objection to this line of argument is that if it weren’t for the cancer, the doctor and patient would never be in a situation where these kinds of decisions were forced to be made; the struggle against cancer is the key agent in the ethics of life and death. Therefore, I argue that we cannot lay blame on the doctor for taking measures to end the patient’s life since the cancer is still to blame, and the intentional killing to prevent further pain should be permissible. Further to this, Rachels argues that “If one simply withholds treatment, it may take the patient longer to die, and so he may suffer more than he would if more direct action were taken and a lethal injection given” (1975, p.78). This is certainly the kinder approach to it, but does that equate to the status of morally justified? To answer this question, we will need to argue of the commensurability of killing and letting die. 

grayscale photography of nursing bed

To begin, Rachels (1975) invites an example to examine the differences between killing and letting die. I shall briefly summarise this:

Smith will gain a lot of money if his six-year-old cousin were to die. He decides to help him along one day, so he goes and drowns him in the bathtub. Now there is Jones who is in a similar position. He also plans to kill his cousin, but as he approaches the bathtub, he notices that his cousin has hit his head and is lying unconscious in the water. Jones decides to standby and allow it to happen. 

Can we say that these two cases are any different? Rachels asks exactly the same question of us. Both men were committed to killing their cousin and were prepared to do it. It seems that luck is the only changed circumstance here. It certainly could be argued that the act of Smith’s killing is much worse than Jones because he simply did not save him. It seems logical that in terms of magnitude, holding the six-year-old’s head under is far worse than not bothering to get him out. This might be because Jones did not cause the unconscious drowning, whereas Smith deliberately caused the drowning. However, it seems more plausible to argue that these cases are morally equivalent. If we look at the intentions of both men, they were at best immoral. Based on this bad intention, this informed Jones’ decision to not save his cousin and thus implicates him as just as immoral as Smith. In further argument, I argue that choosing not to act is acting. This is based on the agency of choice, where the notion of human autonomy, of choosing one’s own conception of the good life is present when deciding on any matter. So, the decision to go out for a run and the decision to sit on the sofa are equally an extension of human decision-making, and in a sense, acting. In relation to Smith and Jones, they both had the intention to kill, and used equal choice to decide that their cousin would die, just in different ways. This therefore completes the argument that the choice of doing nothing is morally equal to the choice to act, and also the lack of difference between killing and letting die. If we bring our discussion back to active and passive euthanasia, and now include the argument that killing and letting die are of equal moral weight, we can say that once we permit that euthanasia is morally justified (at least in the passive sense), we will have no problem will allowing doctors to take action in ending patient’s lives when there is a competent, genuine request for it. This also brings the added kindness of sparing unnecessary discomfort to the patient in their final days. 

To give a conclusion, we started with the problem that active euthanasia is commonly found to be impermissible, whereas passive euthanasia is sometimes permissible. This was based upon the important distinction between killing or letting die. It firstly seemed plausible that killing was much worse than letting die, almost intuitively so. I then used an example from Rachels about Smith and Jones with the intention of arguing that there is no difference between the act of killing and choice to stand aside and let one die. I appealed to a notion of agency and choice to help. Once this was done, it was established that we should allow active euthanasia for all cases when looking through the lens of morality. 

Rachels, J. 1975. Active and Passive Euthanasia. The New England Journal of Medicine. (292),  pp.78-80


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