Ethics - Euthanasia

Euthanasia

refers to ending the life of a person who is terminally ill

James Rachels

is there a significant moral difference between active and passive euthanasia?

there is no moral difference between passive and active euthanasia, that they are morally equivalent, thus, for him, they are both acceptable.

Active Euthanasia

This kind of euthanasia refers to taking a positive action to kill a patient. o This kind of euthanasia is always forbidden. o Example: Lethal injection made of potassium chloride

Passive Euthanasia

This kind of euthanasia refers to refraining from doing anything to keep the patient alive and halting treatment, medication, and surgery with the intention of letting the patient die “naturally” of their illness. o This kind of euthanasia is permissible.

Emotional Divide between the two types

Through this, it would be easier for people to defend and advocate for “The right to death with dignity” than “euthanasia.” Moreover, aside from emotional impact, the choice of terms were also chosen to create a term for healthcare professionals and religious writers that has as much psychological distance as possible.

People barely hear of cases of ‘letting die’

Due to this, people are led to believe that killing is morally worse than letting someone die. For as reported in the media, killing or murder is terrible, thus, killing is painted more to be in a bad light.

Passive euthanasia as a way out of doctors’ dilemma

The distinction between active and passive euthanasia is driven by what doctors are willing to do. o Example scenario: A patient dying from an incurable cancer of the throat, who is in incredible pain decides, along with his family, to end his life to end his suffering.

Doctor’s Dillema

Problem: Most doctors would not administer a lethal injection (active euthanasia), not only because of the possible legal consequences but because doing so would mean killing someone, which goes against very deep moral feelings of doctors, especially since they have the business of saving and protecting the lives of others, and not destroying them.

• Solution: This is where passive euthanasia comes in, for the doctrine states that active euthanasia is prohibited, but doctors can withhold treatment to honor the patient’s request of dying sooner, without actually killing them and just letting them die from their terminal illness

1973 American Medical Association Statement

The intentional termination of the life of 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. The advice and judgment of the physician should be freely available to the patient and/or his immediate family

For Rachels, despite being carefully phrased, the AMA’s statement was vague o

3 Propositions

Killing patients is absolutely forbidden; however, it is sometimes permissible to allow patients to die.

2. It is permissible to allow a patient to die if: a. there is irrefutable evidence that he will die soon anyway: b. “extraordinary” measures would be required to keep him alive, and c. the patient and/or his immediate family requests it.

3. Doctors should make their own advice and judgments available to the patient and/or his immediate family when the latter are deciding whether to request that the patient be allowed to die.

Criticism #2 “No-coding”

This means that the consent of the patient nor his immediate family members’ are commonly sought at the event that there is nothing that can be done to get a person’s heart beating again.

Criticism #2-b

This is because the definition of “extraordinary” in this context is unclear, especially with fast-evolving medical equipments and standards; imposing this guideline might result in incorrectly withholding treatment in cases that are not “extraordinary” by any reasonable standard.

Active and Passive the same

Rachels agreed with Dr. D. C. S. Cameron’s statement that the difference between euthanasia and letting the patient die by omitting life-sustaining treatment is nothing but a moral quibble. o “If the results are the same, why should it matter so much which method is used?”

Rachels pointed out that once we judge a patient would be better off - or at least, no worse off dead, it should not matter whether the patient was killed or let die, for either way, the patient ends up dead.

Active preffered than Passive

Active euthanasia is preferable when it has been decided not to prolong the life of the patient anymore. But why is that? This is because the process of being “allowed to die” can be relatively slow and painful, while administering a lethal injection is quick and painless.

“The important choice between doing something and doing nothing.”

This counterargument states that there is a difference between active and passive euthanasia, for doctors simply do nothing in passive euthanasia, and the patient dies naturally because of their illness, while, in active euthanasia, doctors do something to bring about the patient’s death. o In this light, passive euthanasia seems like the better option.

Rachel’s Criticism over “The important choice between doing something and doing nothing.”

This is a misleading argument, for it leaves out the part that doctors do one thing in passive euthanasia, and that is they let the patient die.

“Dr. X did not save him, and neither did you, and neither did I.” • TRUE: None of us saved the patient. • NOT TRUE: We all let the patient die. This is because one must be in a position to save the patient in order to let the patient die. With this, it can be observed that physicians or doctors are in a special moral position, which not everyone is in.

The act of letting someone die may be intentional and deliberate, just as the act of killing may be intentional and deliberate.

The story of Smith and Jones: Smith: Drowns his six-year-old cousin to death to gain a large inheritance. Jones: Watches and does nothing as his six-year-old cousin “accidentally” drowns.

Rachels’ argument: There is no difference between killing and letting die because the defense of “I didn’t kill, I just let him die” did not have any weight in the accused's favor. Moreover, the difference between killing and letting die does not make any difference to the morality of actions with regards to life and death.

J Russell Elkinton - The concept of being the cause of someone’s death

This counterargument states that when we let someone die (passive euthanasia), we are not the cause of death of that person. Furthermore, as written Dr. J. Russell Elkinton (1968) in the Villanova Law Review, they die not from the act but from their incurable illness. Meanwhile, if we kill someone (active euthanasia), we are the cause of their death

Rachels’ Criticism - The concept of being the cause of someone’s death

There is a distinction between being and not being the patient’s cause of death, as well as, letting someone die and not letting anyone die. Death is no greater evil than the patient’s continued existence. Two kinds of euthanasia stand or fall together. • If the death is not a good thing, then no method of euthanasia is justified.

“Duty not to harm people is generally more stringent than our duty to help them.”

This counterargument states that we do not have a strict moral duty of helping a poor man from a different country, but we have a strict moral duty to refrain from doing anything to harm him. o Simply put, killing violates our duty not to harm, while letting die is just a failure to provide help

Rachel’s Counterargument - “Duty not to harm people is generally more stringent than our duty to help them.”

Proximity plays a role in the vanishing of the alleged asymmetry between the duty to help and the duty not to inflict harm

Rachels denies the general asymmetry between the duty to help and the duty not to harm, not only because of the special case of the relation of doctors and patients, but because there is no proof that killing a patient equates to harming the patient. For, as Rachels said, “even if we grant that our duty to help people is less stringent than our duty not to harm them, nothing follows about our duties with respect to killing and letting die in the special case of euthanasia.”

Deontologist Criticism of James Rachels

deontologists believe otherwise, for they might allow passive euthanasia, but not active euthanasia. This is because Immanuel Kant argued that our rationality is more valuable than anything, and in the event that one loses their rationality and dignity because of their illness, one may opt to ask for passive euthanasia. But why isn’t active euthanasia allowed? This is because deontologists argue that we have a duty not to kill human beings, even if they ask for it. For, the duty of preservation and sanctity of life is being upheld by deontologists, with this, we must respect someone’s right to life even when they want to die

Disparity Criticism of James Rachels

The disparity in the intention of context in the Smith and Jones example is also criticized for oversimplifying complex medical and ethical decisions by using a faulty analogy of a situation involving malicious motives, which are not comparable to the compassionate motives in euthanasia.

Utilitarianism Criticism

Utilitarianism is said to justify killing if it leads to better outcomes, however, as mentioned by Rachels himself, there is no proof that killing a patient equates to harming the patient, thus, there is also a chance that killing a patient does equate with harming the patient. With this in mind, it can be said that Rachels' arguments overlook deeply held moral duties and legal rule