Lecture 19 rachels on euthanasia
- 2. Euthanasia (literally, “good death”): Either directly or indirectly causing someone’s death for that person’s benefit.
- 3. Active vs. Passive Euthanasia Active euthanasia: directly causing death for that person’s sake (e.g. by lethal injection) Passive euthanasia: allowing someone to die for their sake by not doing something that would prolong life (e.g. by removing feeding tube or ventilator, or refraining from giving vital medical treatment)
- 4. Voluntary vs. Nonvoluntary Euthanasia Voluntary Euthanasia: Euthanasia with the patient’s consent. Active voluntary: Directly causing the patient’s death with their consent. Passive voluntary: Withholding or withdrawing life-sustaining treatment with the patient’s consent. Nonvoluntary Euthanasia: Euthanasia without the patient’s consent. Active nonvoluntary: Directly causing the patient’s death without their consent. Passive nonvoluntary: Withholding or withdrawing life-sustaining treatment without the patient’s consent. Remember: For any of these to be euthanasia, they must be done for the patient’s benefit.
- 5. Two More Concepts Physician-assisted suicide (PAS): the patient takes their own life with the aid of a physician (typically, by the physician’s prescribing lethal doses of drugs). Palliative (comfort) care: care focused on relieving pain and promoting quality of life, even if a cure is impossible.
- 6. Rachels Thesis There is no important moral difference between passive euthanasia and active euthanasia. If the former is morally permissible, the latter is too.
- 7. In other words, according to Rachels, killing patients who would benefit from dying is not worse than letting them die.
- 8. Conventional Doctrine A doctor may not kill a dying patient, but she may sometimes withhold treatment, allowing a dying patient to die sooner. Justification for withholding treatment: it is wrong to prolong a dying patient’s suffering.
- 9. Three Problems with the Conventional Doctrine 1) Passive euthanasia leads to more suffering than active euthanasia. Thus, if the goal is to prevent suffering, then active euthanasia is preferable.
- 10. Three Problems with the Conventional Doctrine 2) Leads to cruelty 3) Leads to decisions about life and death being made on irrelevant grounds. Problems 2) and 3) are illustrated by babies with Down Syndrome and intestinal obstructions.
- 11. Why do people think that there is an important moral difference between active and passive euthanasia? • Because people think that killing someone is morally worse than letting someone die. • Rachels rejects this common idea. • “The bare difference between killing and letting die does not, in itself, make a moral difference.” (p. 704) • To see this, we must hold fixed people’s motives and intentions. • Compare Smith and Jones cases
- 12. Because the bare difference between killing and letting die makes no moral difference, there is no moral difference between a doctor who lets a patient die for humane reasons and a doctor who gives a patient a lethal injection for humane reasons.
- 13. The AMA’s mistake The AMA claims that withdrawing treatment (passive euthanasia) is NOT the “intentional termination of the life of one human by another.” Rachels: Withdrawing treatment IS the intentional termination of the life of a person by another. That is the whole point of withdrawing treatment, to end the person’s life earlier.
- 14. If Rachels is correct, then many people wrongly think that killing is worse than letting die. Why do people make this mistake? • Because most actual cases of killing are terrible – e.g., murder – whereas most actual cases of letting die are not terrible – e.g., doctors letting patients die for humane reasons. • So people begin to think of killing as worse than letting die.
- 15. Possible Objection Possible objection to Rachels: In passive euthanasia, the doctor does nothing to bring about the patient’s death, but in active euthanasia, he brings about the patient’s death. Rachels’s Response: 1. In passive euthanasia, the doctor does do something: lets the patient die. 2. If euthanasia is appropriate, the usual reason for not wanting to be the cause of someone’s death – that death is a great evil – does not apply.
- 16. Active Euthanasia Is Illegal, So What is the Point? Doctors should be concerned about the fact that the law is ruling out active euthanasia, which is often morally preferable to passive euthanasia because active euthanasia causes less suffering. Doctors should not wrongly give the distinction between active and passive euthanasia moral weight by writing it into codes of medical ethics, as the AMA has done.