The subject of euthanasia, or the ending of someone’s life to prevent their future suffering, is a much-debated topic and the title suggests that often only passive euthanasia (indirect) is morally justifiable while active euthanasia (direct) rarely ever is. I will first describe the premises of the Kill and Let Die (KLD) principle and argue against it using Singer. Then I will provide a counter argument in favour of the KLD which I will in turn argue against. I will ultimately conclude that at the least there is often no fundamental moral difference between killing a patient through active euthanasia and letting them die via passive euthanasia.
The titular quote is based on the Kill and Let Die principle (KLD) which states that while it can be morally permissible to let someone die, it is not morally permissible to kill someone. If active euthanasia involves the deliberate act of ending someone’s life (i.e. killing), whereas passive euthanasia could be described as not acting to prevent someone’s immanent death (i.e. letting them die) then we can apply the KLD to argue that active euthanasia is never permissible, but passive euthanasia sometimes is. So, for example, it is never permissible, for a doctor to administer a lethal injection to hasten a patient’s death, but it might be morally permissible for a doctor to withhold treatment without which a patient will die.
I would consider that the intuition that killing is wrong is based on our particular reverence for the life of a person. By ‘person’ I adopt a definition of personhood based on Fletcher and Singer’s articulations as an entity that has a self-awareness of its identity with a past present and future, that is rationally conscious, and that can form preferences about itself and its future. Based on this definition I would also argue that each person possesses, as part of the social contract, a right to act towards the preferences that they have about their future. The act of killing a person then is to obstruct the enactment of their preference and desire about their future which is morally impermissible. Singer presents the medical case of an elderly woman who develops degenerative mental condition which renders her unable to look after herself, and must reside in a care-home. After losing control of her bodily functions including communication she is bed ridden and later develops pneumonia. A doctor treats the woman on three occasions with antibiotics, but the fourth time she falls ill the doctor, nurse, and woman’s family decide that the doctor should not medically intervene. Without treatment, six months later the woman dies of a urinary tract infection. In this case the actors have decided arbitrarily on a number of times in which they will intervene to prolong the quite meaningless and painfully degenerative life of someone who I imagine would, if they still possessed their faculties, rather not live through the such an inevitable decline. This stands as a rejection of the KLD principle in that the woman is allowed to die a slow and painful death for want of anyone to take responsibility for her quick, peaceful and potentially painless death. And yet, supporters of the KLD would argue that the former has greater moral permissibility than the latter.
One might support the KLD however since it is generally contrary to our intuition to kill a person and this position may cause us to take a view that only passive euthanasia is permissible as in this case we aren’t killing the patient. From Foot’s arguments, we can rebut that it is not the intention of the ‘actor’ that matters in the moral permissibility of the case but that fact that in and of itself killing is worse than letting someone die. For Foot, it is never permissible for us to be an originator of death. On this view, a person has a right to non-interference and this is related to their right to life, and it is therefore our negative duty, Foot would argue, not to cause their death. Foot also argues that persons also has a right to the provision of goods and services, but that does not mean that we have a positive duty to provide those goods and services to that person. For example, a speeding trolley is fast approaching a track to which five people are tied and I have access to the switch that would turn the trolley onto another track to which only one person is tied. Foot argues that not only is it morally permissible for me to do nothing, but it is morally impermissible for me to switch the track to kill the one person instead of five. This is because, regardless of our intention to save five people, it is imperative, for Foot, that we do not violate our negative duty to not interfere in someone’s right to life i.e. by killing the one person. This is how we might morally justify passive euthanasia, since a doctor has a duty not to kill a patient, but they do not have a duty to provide a service (in this case medical aid). However, I do not believe that this view stands up in related examples and is counter to our intuition based on the value of intention. In Rachels’ Smith and Jones example:
“Smith stands to gain a large inheritance if anything should happen to his six-year-old cousin. One evening while the child is taking his bath, Smith sneaks into the bathroom and drowns the child, and then arranges things so that it will look like an accident.
In the second, Jones also stands to gain if anything should happen to his six-year-old cousin.
Like Smith. Jones sneaks in planning to drown the child in his bath. However, just as he enters the bathroom Jones sees the child slip and hit his head, and fall face down in the water. Jones is delighted; he stands by, ready to push the child’s head back under if it is necessary, but it is not necessary. With only a little thrashing about, the child drowns all by himself, “accidentally,” as Jones watches and does nothing.”
The KLD view would be that that Jones had no duty to interfere in the events unfolding in front of him even though the consequence of his no interference is the child’s death, and the cost of his interference is so little. Regardless of the clearly morally bad reason for Jones’ non-intervention, i.e. to ensure his inheritance, the KLD approach disregards this entirely. According to the KLD Jones is not morally culpable in the death of his cousin, but clearly, we want to say that there is no substantial moral difference between the actions of Smith and Jones. I contend that when the means to saving the life are so simply achieved, as is the case with Jones, it is no longer a defence to say, ‘I am not morally culpable because I did not do anything’. In fact, I contend that deciding to let someone die by inaction, becomes an act in itself such as in this case.
I am arguing here to dismantle the view that letting someone die is always, or usually, morally superior to killing someone, and this has special significance in medical ethics when often the controversial cases involve a patient who has decided their life is not worth living and they cannot get the help they need to achieve this preference. Whether euthanasia is active or passive it is clear to the relevant parties involved that the intention is clear and known in both cases and that the outcome is clear and known. It can be generally agreed that relief from pain or suffering is the intention, and death is the outcome. I do not believe that attaching one’s self to the life boat of the KLD is enough for a doctor to absolve themselves of responsibility. One thing I can agree with from Foot’s analysis is that usually to be the originator of someone’s death is not a good thing and therefore to not want to be that originator is understandable. However, if it is generally agreed that from the patient’s perspective long term pain/suffering is a greater evil than death, then the originator of death is no longer taking responsibility for a morally bad thing.
In conclusion, I have explained the main premise behind the title and given cause for scepticism through Singer. I the presented a defence from Foot which attempts to point to an underlying moral principle for the KLD but I believe I showed how the intention behind our actions is morally relevant through Rachels’ Smith and Jones example. In respect to whether there is a bare moral difference between active and passive euthanasia, I believe the examples show clearly that if our intention is to alleviate pain and suffering then whichever means to this this end is most efficient is best.
2019-10-31-1572536584