Active and Passive Euthanasia

by James Rachels

The traditional distinction between active and passive euthanasia
requires critical analysis. The conventional doctrine is that there is such an important moral difference between the two that, although the latter is sometimes permissible, the former is always forbidden. This doctrine may be challenged for several reasons. First of all, active euthanasia is in many cases more humane than passive euthanasia. Secondly, the conventional doctrine leads to decisions concerning life and death on irrelevant grounds. Thirdly, the doctrine rests on a distinction between killing and letting die that itself has no moral importance. Fourthly, the most common arguments in favor of the doctrine are invalid. Rachels, therefore, suggests that the American Medical Association policy statement that endorses this doctrine is unsound.

Genres: Philosophy

Unknown Binding

First published January 1, 1975

About the author

James Rachels, the distinguished American moral philosopher, was born in Columbus, Georgia, and graduated from nearby Mercer University in 1962. He received his Ph.D. in 1967 from the University of North Carolina, Chapel Hill, studying under Professors W. D. Falk and E. M. Adams. He taught at the University of Richmond, New York University, the University of Miami, Duke University, and the University of Alabama at Birmingham, where he spent the last twenty-six years of his career. 1971 saw the publication of his groundbreaking anthology Moral Problems, which helped ignite the movement from teaching metaethics in American colleges to teaching concrete practical issues. Moral Problems sold 100,000 copies over three editions. In 1975, Rachels wrote "Active and Passive Euthanasia," arguing that the distinction so important in the law between killing and letting die has no rational basis. Originally appearing in the New England Journal of Medicine, this essay has been reprinted 300 times and is a staple of undergraduate education. The End of Life (1986) broadened and deepened these ideas. Created from Animals (1990) argued that a Darwinian world-view has widespread philosophical implications, including drastic implications for our treatment of nonhuman animals. Can Ethics Provide Answers? (1997) was Rachels' first collection of papers; The Legacy of Socrates (2007) was his second. Rachels' textbook, The Elements of Moral Philosophy, is currently the best-selling book in philosophy. Shortly before being diagnosed with cancer, Rachels finished Problems from Philosophy, an introduction to his subject, published posthumously.

Over his career, Rachels wrote 6 books and 86 essays, edited 7 books and gave about 275 professional lectures. His work has been translated into Dutch, Korean, Norwegian, Italian, Japanese, Indonesian, Spanish, Portuguese, Chinese, and Serbo-Croatian. He is widely admired as a stylist; his essays and books are remarkably free of jargon and clutter. A major theme in his work is that reason can resolve difficult moral issues. He has argued for moral vegetarianism and animal rights, for affirmative action (including quotas), for the humanitarian use of euthanasia, and for the idea that parents owe as much moral consideration to other people's children as to their own.

Reviews

[Ipsa · Rating 3 out of 5]

The opinion that euthanasia is morally permissible is traceable to Socrates, Plato, and the Stoics. The word "euthanasia" was first used in a medical context by Francis Bacon in the 17th century, to refer to an easy, painless, happy death, during which it was a "physician's responsibility to alleviate the 'physical sufferings' of the body." Bacon referred to an "outward euthanasia"—the term "outward" he used to distinguish from a spiritual concept—the euthanasia "which regards the preparation of the soul."
James Rachels in this article puts the traditional distinction between active and passive euthanasia under a critical lens. He challenges this doctrine on the grounds that it rests on a distinction between killing and letting die that itself has no moral importance. He gives the example of a patient about to die in the next few days, of an incurable cancer of the throat; who is in such agony that it cannot be satisfactorily alleviated. He requests the doctor to put him out of his misery. Now even if the doctor agrees to withdraw treatment, it may take the patient longer to die, and so he may suffer more than he would if more direct action were taken and a lethal injection given; thus active euthanasia is more preferable here. To say otherwise is to endorse the option that leads to more suffering rather than less, and is contrary to the humanitarian impulse that prompts the decision not to prolong his life in the first place.
One of the classic ideas in ethics called Acts and Omission says that there is a moral difference between carrying out an action, and merely omitting to carry out an action; which is why passive euthanasia is morally better than active. Rachels challenges this viewpoint on the grounds that if a person actively murders someone, while the other person stands by and simply lets a child drown, for example, morally they will be at par with each other, even if legally only the first person will be charged with murder. The point is that the bare difference between killing and letting die does not, in itself, make a moral difference.
Rachels argued that killing ‘in itself’ is not any worse than letting die, and if this is right then active euthanasia is not any worse than passive euthanasia. It is not exactly correct to say that in passive euthanasia the doctor does nothing, for they do do one thing that is very important: they let the patient die. The decision to let a patient die is subject to moral appraisal in the same way that a decision to kill them would be subject to moral appraisal: it may be assessed as wise or unwise, compassionate or sadistic, right or wrong. Fixing the cause of death may be legally significant, but this notion cannot be used to ascertain a moral difference between active and passive euthanasia.
Rachels ends his argument by saying whereas doctors may have to discriminate between active and passive euthanasia to satisfy the law, they should not do any more than that. In particular, they should not give the distinction any added authority and weight by writing it into official statements of medical ethics.