Medical Ethics Handout 27

Euthanasia III
Recall:
Active Euthanasia – performing an action that directly causes someone to die.
Passive Euthanasia – allowing someone to die by not doing something that would prolong life.
The Difference Thesis – All else being equal, killing someone is morally worse than letting them die.
Rachels grants that there is a genuine difference between acts of killing and acts of allowing to die, but does not think that there is an essential moral difference between the two act types.
Brock
Two Goals:
First – to argue that there is no essential physical difference between acts of killing and acts letting die.
Second – to argue that the likely benefits of a legal policy that allows for active euthanasia outweigh the possible costs.
Killing and Letting Die: With A Vengeance
Brock’s first goal: there is no essential physical difference between acts of killing and acts of letting die.
Compare:
Rachels: Consider cases that are alike w.r.t. all features except whether the act in question is a killing or an allowing to die. If the two cases are morally on par, then there is no essential moral difference between killing and letting die.

Brock: Consider cases that are alike w.r.t. all features except whether the agent performing the action in question is justified in performing it. If one case is an allowing to die and the other case is a killing, then there is no essential physical difference between killing and letting die.

What physical difference?

Medical Ethics Handout 27

The Respirator Cases:
“A patient terminally ill with ALS disease…is completely respirator dependent with no hope of ever being weaned. She is unquestionably competent but finds her condition intolerable and persistently requests to be removed from the respirator and allowed to die.” Her physician removes her from the respirator.
Does the physician kill her, or let her die?
“Suppose the patient has a greedy and hostile son who mistakenly believes that his mother will never decide to stop her life-sustaining treatment and that even if she did her physician would not remove her from the respirator. Afraid that his inheritance will be dissipated by a long and expensive hospitalization, he enters his mother’s room while she is sedated, extubates her, and she dies.”
Does the son kill her, or let her die?
The Argument against the Killing/Letting Die Distinction
1. If a physician extubating a patient from a respirator is merely letting her die, then a greedy son extubating his mother from a respirator is merely letting her die.
2. A greedy son extubating his mother from a respirator is not merely letting her die.
3. Therefore, a physician extubating a patient from a respirator is not merely letting her die.
P1 Rationale:

P2 Rationale:

Responses:
3 Options—
1) Reject premise 1; perhaps the difference between killing and letting die is not a physical difference.
2) Reject premise 2; the son merely let his mother die.
3) Accept conclusion; the physician killed the patient.

Medical Ethics Handout 27

There are serious problems with option 2:

Options 1 and 3 both require us to abandon the typical understanding of the killing/letting die distinction. If we reject premise 1, then…

If we accept the conclusion, then…

Either way, it seems like there is not a substantial difference between active and passive euthanasia. Voluntary Active Euthanasia and Public Policy
As always, the moral and legal permissibility of an act are separate but related. It is conceivable that voluntary active euthanasia is not inherently wrong, but should nonetheless be illegal. Brock considers the pros and cons of a policy that allows for voluntary active euthanasia:
Pros
 It would possible to respect the selfdetermination of competent patients
 It benefits everyone who supports voluntary active euthanasia (comparison to insurance)
 It would be possible to alleviate the suffering (physical and psychological) of patients for whom passive euthanasia and
modern