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Lecture 5

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University of Toronto St. George

PHLB09 – Lecture 5 Agenda:  The distinction between ―killing‖ and ―letting die‖  Rachels: ―Active and Passive Euthanasia‖  Brock: ―Voluntary Active Euthanasia‖  Discuss the midterm James Rachels: “Active and Passive Euthanasia”  Challenges the moral distinction between ―killing‖ and ―letting die‖  Distinction appeals to the moral difference between ―acts‖ and ―omissions‖ o Passive euthanasia – respecting patient’s autonomy/informed decision o Active euthanasia – the act itself  There is a generally acknowledged moral distinction between active and passive euthanasia in medical ethics.  Is such a distinction justified? o Think between moral and legal sides of it – a slippery slope?  AMA Statement (1973):  ―The intentional termination of the life one human being by another—mercy killing— is contrary to that for which the medical profession stands and is contrary to the policy of the American Medical Association.  The cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent is the decision of the patient and/or his immediate family …‖ (216)  Thesis: There is no morally significant distinction between killing and letting die.  Responsible physicians should stop supporting (lending legitimacy to) policies that lend credence to it. First argument: Appeal to the needless prolonging of suffering  VPE/NPE justified based on the reasoning that it is wrong to needlessly prolong suffering. o Ex. Euthanizing your pet is merciful, humans should be able to reduce their suffering in a humane way too.  But, the mere withholding of treatment (PE) will prolong the patient’s suffering (compared to AE)  So why, given that the decision to withhold treatment is motivated by concern to end suffering, is AE not preferable?  Decision based on minimizing suffering  PE can, and often does lead to more suffering o Ex. in the 1980s, babies with Down syndrome with intestinal blockage were left to die from dehydration and starvation – more painful than euthanizing.  Why, once the decision to end life by withdrawing/withholding treatment has been made, and decided on the basis of reducing suffering, would we not choose the method that would end that same life with minimal suffering? PHLB09 – Lecture 5 Second argument: the distinction leads to decisions about life and death that are made on irrelevant grounds  Decision to withhold/withdraw treatment made on the basis that the life is not worth preserving  But the actual matter of life/death is often decided on irrelevant grounds  E.g. babies with Down syndrome and intestinal blockage – if it was a perfectly healthy baby with an intestinal blockage, we’d immediately fix the problem. o Whereas with the Down syndrome baby, we say it’s the intestinal blockage that killed it. Rachels: This is an absurd consequence!  The key question here is whether the life is worth preserving:  The intestinal obstruction is (ostensibly) the reason they are allowed to die.  Irrelevant! (No otherwise healthy baby would be denied the treatment)  The ―matter of life or death is being decided on irrelevant grounds.‖  This is a consequence of the mistaken moral importance attached to the distinction between killing and letting die. Killing not morally worse than letting die: Consider the following example:  Both Smith and Jones have a six-year-old cousin, and should anything happen to their cousin, they stand to gain a fortune.  Smith kills the child while he is taking a bath.  Jones also intends to kill the child while he has taken a bath, but finds that the child has slipped and allows him to drown. Notice: The only difference between the two cases is the distinction between killing (acting) and letting die (omitting).  Is Jones behavior morally permissible?  If there was some morally relevant distinction Jones’ defense ―I didn’t kill him, I only let him die‖ would have some weight.  Rachels: It doesn’t, therefore, there is no morally relevant difference between killing and letting die (between acts and omissions). o If PAE is permissible, then so should VAE because there’s no moral difference – omission is still a sort of action.  If a doctor is in position to let a patient die ―for humane reasons,‖ then he/she should be in a position to actively kill for humane reasons.  If the decision is wrong (if disease was curable for example), then wrong even if passive euthanasia.  If the decision is right, the method/act is not important.  AMA policy statement contends that the intentional termination of life is wrong, and that the withholding/withdrawing of treatment in these circumstances is not intentional termination of life.  Rachels: Of course it is: ―If it were not, there would be no point to it‖ (163) PHLB09 – Lecture 5  Distinction has generally been coextensive with morally permissible/impermissible deaths.  But the distinction between killing and letting die does not itself account for this.  Society tends to see a difference between active and passive. o Active tends to be murder o Passive tends to be in hospitals under certain (acceptable) circumstances  Morally preferable – a quick way to end suffering.  Rather, there are other moral features like motives and intentions that account for the moral differences between cases. o Rachels says that there’s no moral difference between acts and omissions based
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