Humane Topics for Euthansia

1. 1
Unit 10:
Chapter 10: Euthanasia
Class: 61412

2. Home Stretch of the Semester
Unit 10: November 27-December 6:
 Euthanasia (Chapter 10, pp. 199-230) Euthanasia is
the taking of life as a form of “mercy killing.”

 December 6: Paper/Project is due

Unit 11: December 2-11:
 Student Selected Unit: Chapter 15: Punishment and
the Death Penalty. Read textbook pp. 375-416.

 December 12-14: Final Exam
 (Covers material from the second half of class)
 Note the final exam is Thursday to Saturday
2

3. Applied Ethics
Euthanasia is the part of philosophical ethics known as:
Applied Ethics and
Medical Ethics
Applied Ethics: taking ethical theories and applying them to ethical issues
Forms of applied ethics:
 Professional ethics (lawyers, accountants, car dealers, etc.)
 Business ethics
 Social and political ethics
 Medical Ethics
 Environmental Ethics
 Legal philosophy (Jurisprudence)
 Computer Ethics
3

4. Medical Ethics
Medical Ethics concerns ethics in medicine
Issues like:
 Access to health care
 Ethics of Abortion
 Ethics of Euthanasia
 Cloning and genetic engineering
 Ethics in medical research
 Ethics in medical practice
4

5. Theoretical Considerations for
Applied Ethics
Remember
Consequentialism and non-Consequentialism
These are not theories themselves but aspects of
theories
Applied Ethics issue have:
Non-consequentialist pro and con arguments
Consequentialist pro and con arguments
Effectively, at least 4 arguments per issue!
5

6. Ethical Consideration:
Killing another human being is wrong, except
A fundamental and universal moral principle is that taking the life of
another is morally wrong. There are widely regarded exceptions to
this rule:
o Killing in warfare: taking the lives of enemy combatants for the
purpose of prevailing in a “just war.”
o Capital Punishment: taking the life of a capital criminal: a murderer,
traitor, etc as punishment for their crime.
o Abortion: terminating the life of a fetus for the purposes of birth
control, preventing the birth of a “deformed” or “defective” infant,
protection of the life of the pregnant woman, relief of emotional
trauma (e.g. terminating a pregnancy resulting from rape).
o Euthanasia: ending the life of a grievously suffering or severely
personally incapacitated individual.
Note: not everyone recognizes that these situations constitute
exceptions to the principle that killing another human being is wrong.
6

7. Killing another human being is
wrong, except (?) …
All of these cases are morally controversial.
Just war, capital punishment, abortion and
euthanasia all have their opponents either
completely and in part.
These respective fields of applied ethics work
rationally to consider when, if ever, these
forms of killing are morally acceptable.
7

8. Euthanasia controversy:
Brittany Maynard
Brittany Maynard (1984 – 2014)
 American woman with terminal brain cancer
 She decided that she would end her own life "when the
time seemed right."
 Was a strong advocate for the legalization of aid in dying.
 January 1, 2014 was diagnosed with grade 2 astrocytoma,
a form of brain cancer
 Despite surgery the cancer returned in April 2014, and she
was given six months to live.
 She moved from California to Oregon to take advantage of
Oregon's Death with Dignity Law,
 Her claim: "death with dignity was the best option for me
and my family.“
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9. Euthanasia controversy:
Brittany Maynard
Brittany Maynard (1984 – 2014)
 Before she dies she was a co-creator of the Brittany Maynard Fund,
which seeks to legalize aid in dying in states where it is now illegal.
 She also wrote an opinion piece for CNN titled "My Right to Death with
Dignity at 29". http://www.cnn.com/2014/10/07/opinion/maynard-assisted-suicide-cancer-dignity/
 Maynard ended her life on November 1 surrounded by her loved ones.
 Maynard wrote in her final Facebook post:
 "Goodbye to all my dear friends and family that I love. Today is the day I have
chosen to pass away with dignity in the face of my terminal illness, this
terrible brain cancer that has taken so much from me ... but would have taken
so much more."
 When Maynard died, she had outlived her doctor's April 2014 prognosis
that she had six months to live.
 Because of that some raised questions as to the reliability of doctors'
prognoses on patient life expectancy and hence the timing of irrevocable
euthanasia decisions.
9

10. Legality of
Physician-Assisted Suicide
 Note that physician-assisted suicide is a form of euthanasia,
not euthanasia itself!
 Physician-assisted suicide is a form of euthanasia where a
doctor assists a person in terminating their own life.
 May 2013 Vermont became the fourth state to permit
physician-assisted suicide
 Vermont joined: Washington state, Montana and Oregon.
 Canada is currently considering permitting physician assisted
suicide http://www.nytimes.com/video/world/americas/100000004327836/assisted-suicide-bill-proposed-in-
canada.html?rref=collection%2Ftimestopic%2FAssisted%20Suicide&action=click&contentCollection=timestopics&region=str
eam&module=stream_unit&version=latest&contentPlacement=1&pgtype=collection
 Other states: Michigan, Maine, Massachusetts and California
have rejected physician-assisted suicide initiatives.
 New term for physician assisted suicide:
 Physician assisted death (idea here is that suicide has too
many negative connotations, thus the term clouds the issue
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11. 11
Intro: what is euthanasia?
Definition: the act or practice of painlessly
putting to death persons suffering from
incurable conditions or diseases.
First: Look at the types of euthanasia
Then: What Are The Moral Issues Involved
in Euthanasia?

12. 60 Minutes Video from 1998
 Does this video give a good sense of
what’s at stake in the euthanasia debate?
Kevorkian served 8 years in
prison after he turned over
the videotaped euthanasia
tape to police.
Link to Video
http://www.cbsnews.com/vi
deo/watch/?id=7368313n
He did not starve himself to death in prison but died at age 83 of natural causes
from diabetes. (in June, 2011).

13. 13
When is someone dead?
Textbook: 1968: Harvard Medical School ad hoc
committee to establish criteria for determining when
someone is dead.
Committee determined:
 Someone should be considered dead if he or she
has permanently lost all detectable brain function.
Whole brain death: the primary criteria used for legal
determination of death.
Clinical death: heart stops—the person may be revived.
 163: Whole brain death is distinguished from other
conditions:

14. 14
Persistent Vegetative State:
All cerebral cortex functions are lost,
but the brain stem remains functional
Higher brain functions are gone: thinking,
memory, emotion
Lower brain functions: breathing, heart beat
control, facial reflexes and muscles, gag and
swallowing abilities continue.
Terry Schiavo–an example of PVS

15. 15
Individual in a persistent vegetative state has lost all
conscious function: can't feel pain, for example
The individual in this state will never regain
consciousness.
However: someone can live in this state for many years.
Going through wake and sleep cycles, opening and
closing their eyes.
Unconscious but "awake"
Persistent Vegetative State:

16. 16
PVS v. coma
Contrast with someone in a coma:
they are unconscious but "asleep"
A person in a coma has a poorly
functioning brain stem.
They don't live as long as someone in a
persistent vegetative state.

17. 17
Coma misconceptions
In Quentin Tarantino’s
movie Kill Bill (2003),
Uma Thurman wakes
up from a coma and
within hours is able to
resume martial arts
and plots of revenge.
In reality coma victims rarely “wake up” and go back to
normal.
The longer the coma the poorer the chances of recovery.

18. 18
Key Moral Point here:
1. If someone is dead, euthanasia is not an
issue.
2. If someone is not dead, we or that person
may still judge that certain death-hastening
actions or inactions are permissible.
 We are looking at cases where a person is not dead
 What actions are permissible with regard to that
person's legal death.

19. 19
The Quinlan and Cruzan cases
(Terry Schiavo’s predecessors)
Karen Ann Quinlan (1975) –suffered brain damage
from anorexia: issue of disconnecting a respirator.
This was disconnected and she lived on for several years.
Court decision: Quinlan didn't lose her right of privacy by becoming
incompetent
She could thus (through her parents) refuse unwanted and useless
interventions by others to keep her alive.
None of the various state interests or social concerns of the case
were relevant.

20. 20
Nancy Cruzan–(1983)
25 years old at the time of her accident in 1983.
Left her in a persistent vegetative state until her death 8 years later.
Here: issue was withdrawing a feeding tube
Left to the determination by the parents.
Long protest over her case
Protestors carrying sings: "Nancy, we won't let you die"–just like the
Terry Schiavo case.

21. 21
1990 case of Cruzan v. Director,
Missouri Department of Health.
Supreme Court considered whether Missouri could insist on proof by
"clear and convincing evidence" of a comatose patient's desire to
terminate her life before allowing her family's wish to disconnect
her feeding tube to be carried out.
By 5-4 decision the Court upheld the state's insistence upon clear
and specific evidence that the patient would wish to have
intravenous feeding discontinued.
Later, additional evidence of Nancy's
wishes was discovered and feeding
was discontinued, leading to her death.
Her gravestone has two death dates:
1983, 1990

22. Euthanasia and the Law
 The 1990 Cruzan case effectively legalized (or clarified the legality) of
what is called Passive Euthanasia—the form of euthanasia where a
person is simply allowed to die without being provided excessive or even
ordinary treatment.
 As long as evidence can be provided that this is in accord with the
patients wishes (see Living Will and Advance Directives in the upcoming
slides, also the discussion of “the moral significance of the voluntary)
doctors may forego treatment.
 One everyday form of passive euthanasia: a hospital DNR order--a do not
resuscitate order—is a medical order that instructs health care providers
not to do cardiopulmonary resuscitation (CPR) if breathing stops or if the
heart stops beating. DNR orders allows patients to choose before an
emergency occurs whether they want CPR. Note: it is a decision only
about CPR and does not affect other treatments, such as pain medicine,
medicines, or nutrition. The doctor writes the order only after talking
about it with the patient (if possible), the proxy, or family.
 There are some who deny that passive euthanasia is even euthanasia
preferring to reserve the term euthanasia for active euthanasia (for our
class we will stand by the terms in textbook chapter 10).
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23. 23
206
MEANING AND TYPES OF EUTHANASIA
EUTHANASIA:–word comes from Greek roots
meaning: good death
Eudaimonia–good spiritedness, eulogy–
speaking well of someone]
Euthanasia is either hastening death, not taking
actions to prevent death, or actively causing
death–in order to prevent a greater suffering–
"Mercy killing"

24. Box Page 206
Passive euthanasia: stopping (or not starting some
treatment, which allows the person to die. The person’s
condition causes his or her death.
Active euthanasia: Doing something such as administering a
lethal drug or using other means that cause the person’s
death.
Voluntary euthanasia: Causing death with the patient’s
consent, knowingly and freely given.
Involuntary euthanasia: Causing death in violation of the
patient’s consent
Nonvoluntary euthanasia: Causing the death of a patient
who is unable to consent.
Physician-assisted Suicide: Suicide that results from a
physician’s prescription of lethal mediation.
24
Note the difference between involuntary and nonvoluntary euthanasia: the
first is euthanasia against the person’s wishes, in the second a euthanasia
decision is made in the absence of knowledge of the patient’s wishes.

25. 25
Active And Passive Euthanasia
Some people limit the term euthanasia to active
euthanasia.
Active Euthanasia: Doing something such as
administering a lethal drug dose or other
means, which causes the person's death.
Cases where someone actively brings about
death by some form of action—such as using
drugs or other death-causing devices.

26. 26
Pain Medication that Causes Death
a form of active euthanasia
Causing Euthanasia by giving an overdose of
pain medication.
Justification for this form of euthanasia:
 Moral principle of double effect
Medication given with intention of relieving pain,
if there is a second effect: the patient's death,
one not intended by the doctor, that is not
subject to prosecution as active euthanasia,
which is illegal in many states.

27. 27
Passive Euthanasia:
Passive Euthanasia: Stopping (or not starting)
some treatment, which allows the person to
die. The person's condition causes death.
Idea here: medical care providers are not
actively killing someone but allowing them
to die by not providing certain life-
prolonging treatment.
Some don’t put this under the heading of
euthanasia though it is still allowing a
person to die.

28. 28
When Passive Euthanasia takes place:
1. Stopping treatment because treatment doesn’t work
 Example:
1) Mr. Smith, age 72, has cancer.
 The chemotherapy is not working, he and the doctors decide to
suspend treatment and let the man live out his last days without
the discomfort of the chemotherapy.
Common: Jacqueline Kennedy Onassis chose this approach

29. 29
When Passive Euthanasia takes place:
2. Stopping treatment, or not using further treatment because:
A. the chances of the treatment working are too slight to make it worthwhile
 or
B. they would impose too much of a burden even if they did work.
Example: “J.” is in a persistent vegetative state, or otherwise completely
mentally incapacitated.
 Feeding is withheld and J. starves to death.
 This is arguably a case of passive euthanasia.
 Notice that J. can’t complain about not getting any food!
Feeding tube

30. 30
Pg. 208: Second distinction:
Ordinary and Extraordinary Measures
Important question: how much is an adequate amount of care.
Ordinary Measures: Measures or treatments with reasonable
hope of benefits, or the benefits outweigh the burdens to the
patient
Extraordinary Measures: Measures or treatments with no
reasonable hope of benefit, or the burdens outweigh the benefits
to the patients*
Some measures that are ineffective or excessively burdensome
have been called extraordinary
Sometimes these are called HEROIC measures.

31. 31
Some problems with distinction
1. Deciding what is an extraordinary and what is an
ordinary measure: can you always decide what
measures are ordinary and extraordinary?
2. What is “Normal Life” Trying to restore someone to a
normal life. There is no such thing as a normal life
 Any measure that would not restore a life to that norm
would then be considered extraordinary.

32. 32
More problems
3. Another problem: what would be considered an
ordinary measure in the case of one person might be
considered an extraordinary measure in the case of
another.
 Example: a blood transfusion.
4. A fourth problem: with medical advances—what
used to be considered extraordinary is not so today.
 Respirators, organ transplants, even antibiotics were
at one time only experimental treatments

33. 33
Voluntary And Nonvoluntary Euthanasia
The person whose life is to be euthanized makes the decision this is
voluntary euthanasia
If people other than the person to be euthanized make the decision
this is nonvoluntary euthanasia
involuntary euthanasia –euthanizing someone AGAINST their will.
This is the most clearly immoral version of euthanasia. Critics of
euthanasia worry about this form becoming more prevalent as
euthanasia gains acceptance
Nonvoluntary Euthanasia is not AGAINST the person's will!
Involuntary Euthanasia is.

34. 34
Voluntary and Non-voluntary
Textbook:
Voluntary Euthanasia: The person whose life is
at issue knowingly and freely decides what
shall be done.
Nonvoluntary Euthanasia: Persons other than
the one whose life is at issue decide what shall
be done.
Anther possibility: “Involuntary” Euthanasia:
euthanasia decision is made against the
person’s wishes—biggest fear of the
opponents of euthanasia

35. 35
Problem: figuring out what the patient
wants or would want
In some cases the patient is now able to express his or
her wishes.
Problem here: what would they want in this situation?
How would you figure out what your no longer
mentally competent close relative would want?
Look at the personality or past statements of the person.
Maybe they said something before they entered the
coma or persistent vegetative state.

36. 36
Advanced Directives
ADVANCE DIRECTIVE also called a Living Will
In this kind of directive the person can specify that they want no
extraordinary measures used to prolong their life.
"Durable power of Attorney" another way of doing this
Make someone a legal representative (your “attorney”—not
necessarily a lawyer) to make medical decisions.
The legal form for durable power of attorney allows the individual to
state what they would want done, or not done under certain
conditions.
These directives have moral force, and, in the states that recognize
them, legal force.

37. 37
Advanced Directives
Follow the link to a California Living Will form
http://ag.ca.gov/consumers/pdf/AHCDS1.pdf

38. 38
208 Recap
Combining The Types Of Euthanasia
Three distinctions within Euthanasia:
A. Active v. Passive Euthanasia
B. Passive Euthanasia involving the denial
of extraordinary v. ordinary measures
C. Voluntary, nonvoluntary and involuntary
euthanasia

39. Recap chart:
Six Types of Euthanasia
Kind of Euthanasia In Practice
1. Voluntary active euthanasia: Patient seeks euthanasia
2. Voluntary passive euthanasia: Withholding ordinary measures:
don't do anything to keep me alive
3. Voluntary passive euthanasia: Withholding extraordinary measures:
directive: no experimental surgery,
don’t try everything in the book.
4. Nonvoluntary active euthanasia: Others decide to give the fatal dose
5. Nonvoluntary passive euthanasia: Others decide to withhold ordinary
measures.
6. Nonvoluntary passive euthanasia: Others decide to withhold
extraordinary measures
39

40. 40
Physician Assisted Suicide
(related to euthanasia)
30,000 suicides per year in U.S.
Physician assisted suicide: a form of euthanatia:
A medical doctor assists patient in ending life in an effective and
painless manner—the patient technically commits suicide so
the doctor does not kill the patient, but the doctor gives
assistance to the patient in order that the patient may end his or
her life.
Question: is there a moral difference
between physician assisted suicide and active euthanasia?
American Medical Association opposes physician assisted suicide.

41. 41
Physician Assisted Suicide
Jack Kevorkian (1928-2011)
Used an elaborate method for physician assisted suicide
His "suicide machine"
Metal pole: bottles of three solutions attached:
1. Saline solution
2. Anesthetic
3. Potassium Chloride
Other forms of assisted suicide involve a doctor
prescribing, for example, pain medication with
instruction to the patient to take a fatal overdose
“when the time comes.”

42. 42
moral issues of euthanasia
Morality and The Law
Important distinction:
A. moral judgments about euthanasia—what is morally
correct? versus:
B. legal judgments—what should the law be?
Many things are immoral but not illegal: maybe they are
too hard or too trivial to prosecute
Maybe prosecuting them would involve too much
invasion of individual privacy
Textbook: “Just because euthanasia might be morally
permissible does not necessarily mean that it ought to
be legally permissible”—or vice versa.

43. 43
Legal and Moral issues of Euthanasia
In ethics we generally separate
legality from morality.
Consideration: If euthanasia is judged not
to be immoral, then the laws should be
changed!
Laws can be changed.

44. 44
2000 Dutch Parliament on
(active) Euthanasia
Approved legal guidelines for active euthanasia (doctors
wouldn't be prosecuted)
1. Person requesting to be put to death must be
competent at the time of the request and the request
must be consistent and repeated.
2. The person's suffering must be intolerable
3. The patient must believe that no reasonable
alternative is acceptable.
4. Euthanasia must be performed only by a physician
after consultation with at least one other independent
physician who has examined the patient.

45. 45
2000 Dutch Parliament on
(active) Euthanasia
5. A doctor has to provide the means to bring about the
patient’s death
6. Children age 12-16 must have parental consent (but
not older than 16)
7. Physicians must not suggest this possibility to patients
8. Euthanasia cases must be officially reported to the
authorities.

46. 46
Euthanasia in the United States
Oregon’s Death with Dignity Act of 1994.
 Opposed by the Bush administration, recently
upheld by the Supreme Court (2006)
 Allows for active euthanasia and physician
assisted suicides under controls similar to
those in the Netherlands.

47. 47
The Moral Significance of Voluntariness
We value individual rights, especially rights over
one's life.
The possible limits to this right is when it conflicts
with the interests or rights of others.
Under what conditions and for what reasons
should a person's own wishes prevail in
euthanasia matters?
How important is voluntary consent?

48. Consequentialism: the end result is what matters,
what determines whether the action is ethical or not
Non-consequentialism: actions are right or wrong
regardless of any consequences produced by those
actions
Pg. 214:
Making Moral Judgments about
Euthanasia:
Consequentialist and Non-
Consequentialist Considerations
48

49. 49
Pg. 214 Voluntary Consent:
Consequentialist Considerations
Respecting people's own choices about how they will die surely
must have some beneficial consequences.
People might gain a certain peace of mind here.
ALSO: Individuals might also be in the best position to make choices
that concern themselves.
However: other people are affected by this decision—their feelings
are also relevant.
Problem here: if we leave it up to the individual.
Does the individual always make the best choice?

50. 50
Consequentialist Utilitarian Grounds
Utilitarianism: making the decision that will
bring the greatest happiness.
Act and Rule Utilitarianism:
 Act utilitarianism: taking things on a case
by case basis: which action here will bring
the greatest happiness?
 Rule utilitarianism: what rules would bring
the greatest happiness to the greatest
number? (should we allow euthanasia or
not?)

51. 51
Pg. 215 Voluntary consent:
Nonconsequentialist Considerations
Main thing here: the moral value of autonomy
Question: what is autonomy? Why is it important?
If we appeal to personal autonomy here: we're appealing to a non-
consequentialist norm
Is autonomy good in itself?
If it is, then it carries great moral weight.
Problem: what if a person's mental competence and autonomy is
compromised by fear and lack of understanding

52. 52
Another non-consequentialist consideration
What about the value of life itself
Isn't euthanasia the taking of life?
Do we have a duty not to take a life?
How would we conduct this debate
from a natural law point of view?

53. 53
Pg. 216 Moral issues:
Active Versus Passive Euthanasia
Conceptual distinction:
 Actively ending a person’s life versus
 Allowing the person to die—not taking steps to
keep them alive.
1. Is there any moral difference between killing
and allowing to die?
2. Is passive euthanasia more morally
permissible than active euthanasia? (if so,
why?)

54. 54
217 Consequentialist Concerns
Act utilitarian perspective: looking at each
action with respect to its consequences.
If this person's death is the best outcome in this
difficult situation (that’s the basis of the moral
argument for euthanasia)
Then it doesn't matter how that death comes
about—actively or passively.

55. 55
Rule Utilitarian Perspective
Rule utilitarian perspective: what are the consequences of this
practice or policy?
Which would be the best policy: one that allowed those involved to
choose active euthanasia:
One that required active euthanasia in certain circumstances,
 a) Permitted euthanasia only in rare cases
Or
 b) completely prohibited it.
Which policy would make the most people happy or unhappy?

56. 56
Slippery Slope Argument
If we permit active euthanasia in a few reasonable cases,
we would slide and approve it in more and more cases
until we were approving it in cases that were clearly
unreasonable.
If we permit euthanasia when a person is dying shortly, is
in unbelievable pain, and has requested that his life be
ended, we will then permit it when a person is not
dying or has not requested to be killed.
Problems with slippery slope arguments—one step
doesn't imply every step down the line–we need
arguments to go from step to step.
Explanation of the slippery slope logical fallacy
http://www.garlikov.com/philosophy/slope.htm

57. 57
Non-consequentialist Concerns
Here role of autonomy is key:
Is autonomy so important that it should override any
concerns about bad results.
Nonconsequentialist ground for autonomy.
But also: concern for life: possible argument against
active euthanasia: all killing is wrong.
Natural law could be used to support this position: innate
drive toward living.

58. 58
Non-consequentialist Considerations
Kantian morality: ending life violates the categorical
imperative.
 Religious arguments (non-consequentialist arguments)
 Life and death are decisions for God to make, not
humans.
Active euthanasia is "playing God“
Is the “playing God” criticism a fair one?

59. 59
Consequential v. Nonconsequential
Question here:
If consequentialist arguments have primacy:
 Then concern for consequences is the most
important deciding factor.
 Empirical judgments about the predicted
consequences matter most
If nonconsequentialist arguments have primacy,
 Then it comes down to: the ultimate value of:
 personal autonomy versus
 the immorality of killing–for any reason
Primacy: the first or foremost concern—one that “trumps” (overrules) lesser
concerns (definition of primacy http://www.thefreedictionary.com/primacy )

60. 60
Ordinary Versus Extraordinary Measures
The morality of each (ordinary versus
extraordinary) is an issue partly because the
borderline between them isn't clearly drawn.
Cases of Karen Ann Quinlan and Nancy Cruzan:
Is a respirator or a feeding tube ordinary or
extraordinary?
The fact that one might be common while the
other is uncommon might not make much of a
moral difference

61. 61
Benefit and Burden considerations
What about benefit and burden?—these are difficult to
measure
➔ Should financial cost to a family
or a society be part of the calculation?
One danger here is that we might say that some people
should die simply because burdens of caring for them
are too great.
Question probably to be decided case-by-case: what is
ordinary v. what is extraordinary
Problem of casuistry!
$$$

62. 62
Readings
J. Gay-Williams
The Wrongfulness of Euthanasia
Published: 1979–anti Euthanasia
Not opposed to passive euthanasia
For him that isn’t really euthanasia
Euthanasia, by his definition, must involve
deliberately and intentionally taking the life of a
suffering person.
 Opposes active euthanasia: Three fold
argument

63. 63
Gay-Williams: Three fold argument
1. Violates natural law: human body has a
natural inclination to live. Euthanasia works
against this and thus violates human dignity.
2. Goes against self-interest.
Since death is final and irrevocable so inducing
death does not leave room for mistaken
diagnoses, miraculous recoveries or new
treatments that rapidly become available.
May incline us to “give up” too easily.

64. 64
3. Argument from practical effects
Availability of euthanasia might make
doctors less committed to saving lives.
Gay-Williams: “The dangers of euthanasia
are too great to all to run the risk of
approving it in any form. The first
slippery step may well lead to a serious
and harmful fall.”

65. 65
Slippery slope argument:
If we allow people who are hopelessly ill to take
their own lives, then we may ‘deputize” others
to do it for us.
The judgment of others becomes the ruling
factor.
Short step from voluntary euthanasia to “directed
euthanasia” to involuntary euthanasia.
To: for example, terminating the lives of the
“hopelessly” mentally ill.
Does this slippery slope argument make a case
against euthanasia?

66. 66
James Rachels,
“Active and Passive Euthanasia”
James Rachels, (1941-2003)
 American ethicist
In 1975 article Rachels rejects the
distinction between active and passive
euthanasia, including the idea that one is
morally acceptable while the other is not
(the view of Gay-Williams).

67. 67
James Rachels
Rachel’s example: a doctor agreeing to
withhold treatment for a terminally ill
cancer victim to avoid prolonging
needless suffering.
Rachels: withholding for example, a lethal
injection makes for more suffering by the
cancer victim.
Active euthanasia preferable to passive
euthanasia

68. 68
Argument by analogy
Smith stands to gain a large inheritance if
anything should happen to his six-year-
old cousin. So, Smith drowns the child
while he’s taking a bath and arranges
things so it looks like an accident.
Jones: in a similar situation, plans to drown
his cousin, but seeing him already
drowning, lets the child drown by himself.

69. 69
Key contention, page 226
Smith killed the child, but Jones only “let him
die.”
Rachels asks: is there any moral difference?
The bare difference between killing and letting
die does not make a moral difference.
Hence: killing is not in itself worse than letting
die.
Rachel’s conclusion: active euthanasia is not
any worse than passive euthanasia.
Do you agree with Rachel’s point?

70. Discussion Questions
1. What is the difference between the legal and ethical issues surrounding
the question of euthanasia? Should the question of whether or not
euthanasia (or any particular form, including physician assisted suicide)
is ethical determine whether euthanasia should be legal or not?
2. How do the consequentialist and non-consequentialist arguments for and
against euthanasia compare? Should we argue this issue from a
consequentialist or non-consequentialist point of view?
3. Compare J. Gay-Williams “slippery slope” and other objections to the
morality of euthanasia with James Rachels’ contention that active
euthanasia is not morally distinct from passive euthanasia. Remember
Gay-Williams is not opposed to passive euthanasia though he does not
consider it to be euthanasia.