This article will summarize and compare two articles, Active and Passive Euthanasia, by James Rachels and Active and Passive Euthanasia: A Reply by Thomas Sullivan. Euthanasia is defined as killing a human being with the intention of ending their suffering. There are two types of euthanasia, active and passive. Passive euthanasia is when an individual is allowed to die by withholding medical care, such as switching off life-support machines or not performing life-extending operations. Active euthanasia is when medical professionals and family members make the decision to actively end a patient’s suffering and consequently, their life by means such as lethal injection.
James Rachels asserts that both active and passive euthanasia involve some type of action on the part of the physician. Rachels maintains that killing someone is no worse than letting someone die, so active euthanasia is no worse than passive euthanasia. Thomas Sullivan disagrees with Rachels’ viewpoint and asserts that the moral intention is more important than the action. The traditional doctrine concerning the divergence between active and passive euthanasia is that there is an important moral distinction between the two and while passive euthanasia is sometimes permissible, active euthanasia is always forbidden. The American Medical Association maintains that active euthanasia is never permissible because it involves the intentional termination of a human life (Cahn, 2005).
James Rachels challenges the traditional doctrine for many reasons. First, active euthanasia is often considered more humane than passive euthanasia. The traditional doctrine leads to decisions regarding life and death of human beings on irreverent grounds. This doctrine is based on the dissimilarity between killing someone and letting someone die, which has no moral significance. Rachels maintains that since the arguments in support of this doctrine are invalid, the doctrine is therefore, unsound (Cahn, 2005).
The vast majority of human beings believe it is morally wrong to kill another human being. Some people believe that passive euthanasia is more morally permissible than active euthanasia because in passive euthanasia the doctor does not directly participate in the ending of the patient’s life. According to James Rachels, “It is not exactly correct to say that in passive euthanasia the doctor does nothing for he does one thing… he lets the patient die” ( Cahn, 2005, p. 299). Rachels argues that if we believe that passive euthanasia is morally right then we must also agree that active euthanasia is morally right because in both cases the action or inaction results in the same outcome, the death of a human being (Cahn, 2005).
Rachels provides an example of two men, Smith and Jones. These two men have identical circumstances. They will both inherit a great deal of money when their six year old cousin dies. Smith drowns his cousin while the child is taking a bath and makes the drowning appear to be an accident. Jones sneaks into the bathroom while his cousin is bathing with the intention of killing the child, but as Jones enters the bathroom he observes his cousin bump his head and fall under the water. Jones watches the child die and does nothing to help. Jones makes a conscious decision not to take action (Cahn, 2005).
Some would say that Jones is less guilty than Smith because he did not commit the actual act of murder. If the difference between killing someone and letting someone die were of moral importance, then one would say that Jones’s was less guilty than Smith. Both Smith and Jones had the same motive, personal gain. Both Smith and Jones wanted the same end result, the death of the child in order to obtain an inheritance. According to Rachels, the action of Smith and Jones are equally immoral (Cahn, 2005). So, although physicians do not euthanize patients for personal gain, we can make a comparison. If we compare the case of Smith and Jones to a physician who allows their patient to die by withholding treatment and a physician who gives their patient a lethal injection, the end result is the same, the death of a human being. In matters of right and wrong, most people do not think that intention is of great importance, but what is of importance is actions and results. If one does not find a difference in killing someone and letting someone die in the case of Smith and Jones, then one should not find a difference in active and passive euthanasia.
Rachels argues that the traditional doctrine leads to decisions regarding life and death which are made on irreverent grounds. He uses an example of an infant with Downs Syndrome who is in need of an operation for an intestinal blockage. This operation is not highly dangerous and can save the infant’s life. These operations are not usually performed in cases such as this because both physicians and parents often deem that it is better for the child to die rather than live, what they consider to be, a disadvantaged life as a result of their Downs Syndrome. This leads us to question the worth of human life. The bottom line is that it is the Downs Syndrome and not the intestinal blockage that is the real issue at hand. According to Rachels, in this case, passive euthanasia is used immorally (Cahn, 2005).
Thomas Sullivan holds the traditional doctrine that while passive euthanasia is permissible in some cases where the right intention is present, active euthanasia is never permissible. Sullivan criticizes Rachels’ views on euthanasia. He believes the intention of the action is more important than the result of the action. Sullivan believes that in the example of Smith and Jones, both men had the same intention, so both men are equally guilty (Cahn, 2005).
Sullivan explains that in cases of passive euthanasia, although physicians know that death is inevitable, there is no intention on the part of the physician to cause death. Sullivan believes that although a physician has the knowledge that if they do not take action and provide treatment their patient will die, the cause of death is not intentional. It is inevitable that the patient will die. Sullivan declares that there are certain criteria for moral intentions concerning euthanasia. Prior to carrying out the act of euthanasia a physician must ask himself, “Is the action or refraining aimed at producing a death? Is the termination of life sought, chosen or planned? Is the intention deadly? If so, the act or omission is wrong” (Cahn, 2005, p. 304). Sullivan maintains that there is a difference between passive and active euthanasia. In passive euthanasia, a physicians’ intent is not to cause their patient to die, but the intent is to let the natural life cycle continue without any medical intervention.
Thomas Sullivan also disagrees with Rachels in the case of the infant with Downs Syndrome. Sullivan states that no physician would withhold surgery because to do so would be morally wrong. Sullivan believes that Rachels does not fully understand the American medical Association’s view on euthanasia and that he misinterprets their doctrine. According to Sullivan, the American Medical Association believes that both passive and active euthanasia is wrong in most cases (Cahn, 2005).
Thomas Sullivan focuses on the moral permissibility of the intention of an action. He believes the intention is more important than the action. Rachels’ position is that actions and intentions are two separate entities. Actions and intentions can not be compared because they are totally different concepts. Rachels also believes that an individual’s inaction is a conscious decision and results in a consequence. When a physician performs euthanasia the end result is the same, a human being dies, regardless of the intention. Since the action’s end result is the same in both active and passive euthanasia, there is no moral distinction between killing a patient and letting a patient die. If we believe it passive euthanasia is morally acceptable, we must also believe that active euthanasia is morally acceptable (Cahn, 2005).
Sullivan believes that active euthanasia is murder. When an individual’s death is imminent, and they are suffering, the individual should be allowed to ask their physician to end their pain and suffering. To allow a terminally ill patient to die painlessly and with dignity is the morally right decision. There are cases when active euthanasia is more humane than passive euthanasia. Individuals should have the right to die with dignity and perspicuity. When an individual is suffering a great deal of pain, which can not be controlled with medication or other medical treatment, they should have the right to decide about their own lives and their own death. To deny terminally ill patients the right to die with dignity is unjust and cruel.
The distinction made by the American Medical Association between active and passive euthanasia is fundamental to the field of medical ethics. Medical ethics endorse passive euthanasia in some cases, but forbid active euthanasia in all cases. For example, a patient is dying of an incurable disease and is in excruciating pain that can not be alleviated with medical treatment. The patient will die in a few days. The patient does not want to continue for the next few days because the pain is intolerable and asks the doctor to end his life. The patient’s family is in agreement that over the next few days the patients quality of life will be greatly diminished and will be intolerable. If the doctor agrees to withhold treatment, it will take the patient longer to die and meanwhile the patient will endure a great deal of unnecessary pain. If the doctor agrees to give the patient a lethal injection, the patient will die quickly and painlessly. In a case such as this, once a decision is made not to prolong life with medical treatment, active euthanasia is preferable to passive euthanasia. To prolong a patient’s life and have them suffer rather than alleviate the suffering is in direct opposition to the humanitarian impulse that impelled the decision not to prolong life in the first place. Rachels’ view is that if one is allowed to die slowly by withholding treatment the pain and suffering will be immense, but if the patient is given a lethal injection, their death will be quick and painless (Cahn, 2005).
After carefully reviewing the arguments regarding passive and active euthanasia, the question that appears most important is whether there is a moral distinction between the two. I agree with James Rachels that there is no moral distinction between passive and active euthanasia for several reasons. Active euthanasia refers to the positive contribution to the acceleration of death, whereas passive euthanasia refers to the omission of steps that might otherwise sustain our life, even if by sustaining life we suffer a great deal of undue pain. If one does not find a difference between ‘killing’ and ‘letting die’ in the example of Smith and Jones, then one should not find a moral distinction between active and passive euthanasia.
The one common link in the Golden Rule, Kantian principle and utilitarianism is that to be a moral person one must be sensitive to the needs of others (Cahn, 2005). If we apply these moral principles to active and passive euthanasia, we must agree that there is no rational moral distinction between allowing someone to die and actively assisting them to die. The intention and outcome are the same in both cases, but active euthanasia is, in many cases, the more compassionate and humane choice.
References
Cahn, S. (Ed). (2005). Exploring Philosophy: an introductory anthology. New York, N.Y.: Oxford University Press.
