1. Katie Rose Brunner
Professor Holton
Philosophy 5: Contemporary Moral Problems
6 March 2015
To Kill or Let Die: An Invisible Distinction Between Active and Passive
Euthanasia
In his essay “Active and Passive Euthanasia,” James Rachels poses an argument
about the moral difference between active and passive euthanasia, which includes the
simple question: is there a moral difference? Rachels prefaces his essay in a very sound
manner; he explains that the conventional doctrine of active and passive euthanasia can
be challenged in four specific ways. Firstly, active euthanasia is more humane than
passive euthanasia. Secondly, the doctrine leads to choices involving life and death on
irrelevant grounds. Thirdly, the doctrine fails to provide important reasoning behind the
distinction between killing and letting die. Fourthly, the most prevalent arguments that
conquer with the doctrine’s statements are invalid. Rachels then presents to the reader a
foreshadowing conclusion: the American Medical Association’s statement that favors the
doctrine is, according to Rachels’ following arguments, unsound. The argument that
Rachels makes is backed up by factual examples as well as hypothetical situations.
Acknowledging the possibility of passive euthanasia being the more acceptable solution
to a patient’s unyielding agony strengthens his argument. However, Rachels then goes
backwards and criticizes the moral loopholes within this preference. When it comes to an
individual’s life and his/her choice to end it, the question still stands, and repeats
indefinitely: is there really a moral difference between active and passive euthanasia?
In medical ethics, the distinction between active and passive euthanasia is
imperative. Rachels acknowledges that there is an apparent difference between the
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2. morality of active euthanasia and passive euthanasia. He places the doctrine explaining
this difference at the beginning of his essay so as to pick it apart and criticize it bit by bit
throughout his argument. By first explaining what the doctrine suggests, Rachels is
rationally leaving room for the reader to think for him/herself before listening to his
argument. This is a strong tactic because rather than jumping into a biased and subjective
opinion piece, he is allowing the doctrine to truly sink into the reader’s mind so that its
original wording He then goes on to offer examples, both fictional and authentic, to prove
his point that, contrary to written doctrines, there is no moral difference between active
and passive euthanasia.
Rachels calls upon the reader to imagine a situation in which a patient is suffering
from throat cancer, which is causing an enormous amount of pain that cannot be
alleviated. With death surely in the near future, the patient asks the doctor to hasten this
process. The doctor’s only option, according to the doctrine, is to cease all forms
of medical aid and allow natural forces to kill the patient. Rachels breaks down the
morality of choosing passive euthanasia by emphasizing the lack of humanitarianism that
it involves. By withholding treatment, a doctor could potentially be perpetuating the
patient’s pain. Keeping a patient as comfortable and as painless as possible is
undoubtedly top priority for medical professionals. Since the patient is headed towards an
imminent death, without any possibility of recovery, the doctor’s and the family’s
priority should be ridding the patient of his/her pain. This example, which is fictional yet
surely common in real life circumstances, is strong in its validity by way of its being
undoubtedly the most basic in terms of the argument based on euthanasia’s moral
distinction. It involves the doctor, the patient, and the patient’s family; everyone is at
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3. fault if the patient suffers longer than necessary without treatment, if the ailment turns out
to be treatable. What could have been included is whether or not the family and/or the
patient asked the doctor to provide the patient with a lethal injection to surely hasten the
process. Regardless of the option the doctrine gives the doctor, the patient and the family
could have very well asked the doctor to consider active euthanasia, given the
circumstances. This would have included personalized responses from the people being
directly affected by the situation, which would have been an interesting addition to the
argument. Of course this would have to mean the situation was a real occurrence,
otherwise it would be subjective on Rachels’ part. Rachels does, however, include factual
circumstances in his examples supporting his arguments.
Here Rachels introduces babies into the moral situation—specifically babies with
Down’s syndrome, which is seen in 1 in 600 babies in the United States. Rachels
mentions that, while in some cases the baby can be treated and have a relatively normal
life, some babies are born with congenial defects or intestinal obstructions. These
problems require immediate operations, which sometimes lead the parents and the doctor
to agree upon letting the infant die by not operating. On the one hand, it may be
detrimental to the parents’ financial stance to go through with the operations to possibly
let the infant live without the assurance of the operation’s success. On the other hand, a
doctor’s intention is to save someone’s life while they can. When this situation involves a
life that has just begun—fresh to the wonders of the world, and ignorant of horrific
realities—what would be the point of allowing this brand new life form to experience
needless, prolonged pain? This is the only thing that he/she would know in life: pain. I
completely agree with Rachels’ argument that this is “so patently cruel as to require no
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4. further refutation” (Rachels 2) because it is not morally right to inflict pain on an
innocent infant, whether or not it is direct. If a doctor and/or family member were to
decide on active euthanasia to end the baby’s life, this would rid the baby of pain rather
than inflicting pain onto him/her.
Rachels goes on to explain his second argument through this Down’s syndrome
situation by proposing that decisions based on life and death are made on irrelevant
grounds due to what the conventional doctrine suggests. Rachels mentions that
sometimes even the simplest operation is overlooked when a child is born with Down’s
syndrome, and the parents and the doctor collectively decide that it would be better to let
natural forces take the baby’s life away. However, this is not a matter of distinction
between the morality of active or passive euthanasia. Rather, it is an issue of the morality
of the parent/doctor who decides that a baby with a disability is not worth saving.
Rachels’ mentioning of this point has a certain level of importance, though maybe not
within this argument. Bringing up this issue opens up an entirely different discussion, and
therefore could be easily left out of the essay and still leave a solid argument behind.
Irrelevant grounds are irrelevant to even mention.
Rachels’ third part of his argument involves an eerie hypothetical situation
comparing killing and letting die. In separate circumstances, Smith and Jones both have
an eye on their six-year-old cousin’s large inheritance, and plan to drown the boy while
he is in the bathtub. Smith actively drowns him with his hands, making it look like an
accident. Jones watches on as the boy slips and hits his head, falling to his death without
the help of Jones. Both men are involved in the death of the boy, but only Smith was
actively responsible for murder. But is Jones innocent? Surely not, because he initially
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5. planned to kill the boy, and did nothing as he watched excitedly as the boy drowned in
the bathtub. This is a very powerful argument when Rachels compares this to a doctor’s
position of deciding to cease treatment or give a lethal injection to an already dying
patient. Although the example involves murder, and acting out of personal gain, while a
doctor would be doing so for humane reasons, the big picture of the example is as
follows: no matter where one stands in a situation involving the suffering of another
person, doing something and doing nothing have no moral distinction when the
individual is involved in the situation.
To finish off his outstanding argument, Rachels crosses over to explain the
arguments behind the doctrine, and criticizes them for their absurdity. One argument is
that, in a situation where a patient is suffering from cancer, if the doctor provides a lethal
injection then he is the cause of the patient’s death. If the doctor ceases treatment, and the
patient dies, then cancer is the cause of the patient’s death. Rachels then compares this to
murder, which involves killing as a far from beneficial aspect in society. However, in this
situation involving a sick patient, killing vs. letting die is not the issue; intentions and
motives are important aspects in reacting to these situations. This is a conspicuously solid
argument because, as humans, we associate killing with wrongdoing. But when it
involves people whose jobs involve ridding patients from pain, we need to consider the
circumstances before jumping to conclusions. Additionally, if euthanasia has been
considered the best option in a certain situation, then it is suggested that “death is no
greater an evil than the patient’s continued existence” (Rachels 5). Therefore, not wanting
to be the cause of someone’s death is irrelevant to the situation. The situation only
involves the end of suffering at all costs.
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6. There is no moral difference between active and passive euthanasia when one is
legal, and one is not. The AMA policy not only states that endorsing passive euthanasia is
central to medical ethics, but it also considers active euthanasia both illegal and the exact
opposite of what medical professionals stand for. Moral differences may appear within
the consequences of such cases, but this would make active euthanasia the more
preferable option according to previously stated arguments. Rachels concludes in his
essay that, while doctors may have to favor one type of euthanasia over the other, they
should in no way offer authority and weight to their given distinction by including it in
official statements of medical ethics. I am compliant with Rachels’ argument because, I
too, believe that when it comes to a person’s life, no doctrine should tell him/her that,
given the choice, suffering for an unknown amount of time before death without any
treatment is morally better than ceasing the pain immediately.
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7. Works Cited
Rachels, James. Active and Passive Euthanasia. 1975
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