Active and Passive Euthanasia
Where We Are
Today's class changes the topic slightly. Throughout our discussion of abortion, one issue that has lurked around the edges has been whether aborting a fetus is more like killing it, or more like merely not taking on an onerous burden in order to keep it alive. When Thomson describes the famous violinist, she is having us to imagine that aborting a fetus is just like unplugging from the violinist - we know that if we do, the violinist will die, but it's not the same thing as stabbing the violinist to death while you're hooked up to him or her.
In class 5.2, Philippa Foot compared the Doctrine of Double Effect to the Doctrine of Doing and Allowing. Both doctrines, she noted, require a distinction between what you do and what you merely allow to happen. According to the Doctrine of Doing and Allowing, this distinction is morally important in its own right, and according to the Doctrine of Double Effect, it is merely a consequence of a more important distinction between what you directly intend and what you merely foresee will happen. Foot thought, recall, that the Doctrine of Double Effect leads to specious moral reasoning about cases like abortion - for example, to the conclusion that if a pregnancy threatens the life of the woman, it is wrong to abort the fetus (because that would require intending its death directly as a means to saving the woman), but okay to allow the pregnancy to continue even though this will kill the mother (because the death of the mother is only a foreseen side-effect, and not directly intended).
James Rachels
James Rachels taught for many years at the University of Alabama at Birmingham, and wrote about a number of practical ethical issues, including euthanasia, affirmative action, animal rights, and parental obligations.
Just as Foot worries that the Doctrine of Double Effect leads to specious reasoning in the case of abortion, Rachels worries that the Doctrine of Doing and Allowing leads to specious moral reasoning about a different topic: Active and Passive Euthanasia.
Active vs. Passive Euthanasia
'Euthanasia' just means, literally, 'good death'. But in practice, we use the word 'euthanasia' with regard to killing or allowing someone to die whose life would otherwise be very poor. It is possible to accept the idea of euthanasia in principle, without agreeing about what sorts of lives are so poor that they would justify letting someone die or even killing them in order to avoid such lives. Famously, the Nazi regime executed many people who were disabled or mentally ill under a program of so-called 'euthanasia'. But euthanasia can also be applied at the end of life, when people suffer from debilitating and extreme pain with no reasonable expectation of recovery.
When we talk about euthanasia, we always want to make a few important distinctions. Voluntary euthanasia is euthanasia where someone wants to and chooses to die. Involuntary euthanasia, which was practiced by the Nazis, is where the patient does not get to decide or actively wants to stay alive. Interesting contemporary ethical discussions of euthanasia are about voluntary euthanasia. Another important distinction that is often made - the one that Rachels' article is about - is between what are called active and passive euthanasia. In active euthanasia, someone is directly killed, but in passive euthanasia, a decision is merely made to withhold treatment. For example, a decision may be made to not put someone on a ventilator, even though this would keep them alive, and so they suffocate to death. Contemporary medical practice and law still emphasize this distinction.
Finally, in the United States we often talk about something different: physician-assisted suicide. In physician-assisted suicide, the physician neither kills the patient directly nor withholds treatment; she merely gives the patient the ability to decide to end her own life painlessly at the time of her choosing. Physician-assisted suicide is believed by many to be a way of helping some patients to avoid painful deaths in a way that is guaranteed to be voluntary rather than involuntary and passive rather than active, so much of its interest turns on the assumption that there is an important ethical distinction between active and passive euthanasia.
The Reading
And that brings us to the reading for this class. Rachels is arguing that there is no morally important distinction between active and passive euthanasia. This relates directly to what we have been doing in class, because part of his overall argument is an argument that there is no morally relevant distinction between doing and allowing. This contradicts Foot's endorsement of the Doctrine of Doing and Allowing from our last class, and it contradicts the idea that there is in general a distinction between positive and negative responsibility, which we discussed in week 5.
As you read Rachels' article, be careful not to misinterpret what he is saying about the example involving Down's Syndrome. In my experience, many students misunderstand this passage the first time through. Rachels is not saying anything negative about Down's Syndrome.
Course Video #7: Reconstructing Compound Arguments
Just in time for Assignment #3, we get our seventh course video, focusing on how to extend the skill of reconstructing arguments from simple arguments to compound arguments. Make sure that you watch both videos and think through why I've outlined this particular process, because if you don't follow this process, you are going to make significant mistakes on your assignment.
