Euthanasia

Section X. Euthanasia

Catholic Church's View on Euthanasia

• Euthanasia is considered illicit even if a person requests it due to suffering and a desire for release from the body.
• It's deemed a "false mercy" and a "perversion" of mercy, as true compassion involves sharing another's pain, not ending their life.
• Euthanasia is seen as more perverse when carried out by relatives or doctors, who are expected to provide care and love during painful terminal stages.
• Euthanasia is most serious when it involves murder committed without the person's request or consent.
• Physicians or legislators who decide who should live or die are seen as arrogating power, reminiscent of the temptation in Eden to "become like God" (cf. Gen 3:5).
• Only God has power over life and death (Dt 32:39; cf. 2 Kg 5:7; 1 Sam 2:6), exercised with wisdom and love.
• When humans usurp this power, it leads to injustice and death, putting the weak at the mercy of the strong.
• This undermines the sense of justice and mutual trust in society.

James Rachels on Active and Passive Euthanasia

• James Rachels argues against the moral significance of the distinction between killing and letting die.
• He suggests that if passive euthanasia is permissible, active euthanasia should be considered similarly.

Killing and Letting Die

• Allowing patients to die is an ancient idea, with Socrates approving of physicians not prolonging "good-for-nothing lives."
• Both Christians and Jews historically viewed allowing to die in hopeless suffering as permissible, while opposing killing.
• The morality of allowing people to die has gained importance with advanced medical treatments.
• Devices like respirators and intravenous feeding can maintain life indefinitely, even in "human vegetable" states.
• Maintaining life artificially in such cases is considered pointless, and ceasing treatment is seen as morally acceptable.
• Pope Pius XII reaffirmed that we may "allow the patient who is virtually already dead to pass away in peace."
• The American Medical Association condemns mercy-killing but permits ceasing treatment for terminally ill patients.
• A distinction is made between active euthanasia (taking action to kill) and passive euthanasia (refraining from keeping alive).
• Active euthanasia involves actions like lethal injections, while passive euthanasia involves withholding medication or life-sustaining therapy.
• Some writers prefer terms like "death with dignity" over "passive euthanasia" to avoid the emotional impact of the word "euthanasia."
• Rachels uses "active euthanasia" and "passive euthanasia" for convenience, arguing that the terms don't affect the argument's substance.

Moral Equivalence

• Rachels argues that active and passive euthanasia are morally equivalent; there is no reason to prefer one over the other in principle.
• He is not arguing whether either practice is acceptable, but that they stand or fall together.

Practical Consequences of the Traditional View

• The traditional distinction between active and passive euthanasia has adverse consequences for patients.
• Consider a patient with terminal cancer in unbearable pain; doctors have three options:
  1. End life with a lethal injection.
  2. Withhold treatment, allowing death in one day.
  3. Continue treatment, prolonging life for five days.
• The traditional view allows option 2 but not option 1.
• If the justification for allowing death is to alleviate pain, withholding treatment prolongs suffering compared to a lethal injection.
• A preference for withholding treatment incorporates the worst of both extremes.
• The cruelty of this distinction is illustrated in cases of Down's syndrome infants with duodenal atresia (blocked intestine).
• Doctors may decide not to perform surgery, leading to a prolonged death from dehydration and infection.
• This ordeal is considered unnecessary; an injection would end life at once.
• The decision to let Down's syndrome babies with blocked intestines die, while others without blockage live, is irrational.
• The intestinal blockage is not the reason for the decision; it's the Down's syndrome itself.
• Decisions should be based on Down's syndrome, not irrelevant factors like intestinal blockage.
• This situation is possible due to the idea that there's a moral difference between letting die and killing.

The Bare Difference Argument

• The Equivalence Thesis states there is no morally important difference between killing and letting die.
• The bare fact that one act is killing and the other is letting die is not a good reason to judge the former as worse.
• Other differences between acts may be morally significant, such as respecting family wishes or avoiding suffering.
• Rachels argues that the Equivalence Thesis is true, though not every act of letting die is as bad as every act of killing.
• In science, to isolate an element's influence, cases are studied where everything else is held constant.
• Consider two cases: Smith drowns his cousin for inheritance, while Jones watches his cousin drown and does nothing.

Smith and Jones

• Smith killed the child, while Jones merely let the child die; this is the only difference.
• Both men acted from the same motive, had the same end in view, and their conduct resulted in the same outcome.
• Jones's defense of only letting the child die doesn't hold morally.
• When no further differences are introduced, the bare difference between killing and letting die doesn't affect the morality of actions.
• This is called the "Bare Difference Argument."
• In euthanasia cases, the difference between killing and letting die doesn't make a difference from a moral point of view.
• If a doctor lets a patient die for humane reasons, it's the same as giving a lethal injection for humane reasons.
• If the decision was wrong, it's equally regrettable regardless of the method used.

Counter-Arguments

• Some find it hard to accept the moral equivalence, confusing whether killing is worse than letting die with whether actual cases of killing are more reprehensible.
• Most actual cases of killing are terrible (murders), while cases of letting die involve humanitarian concerns.

Three Counter-Arguments

1. Being the Cause of Death

• Killing someone makes one the cause of death, while letting die means the condition causes death.
• Ramsey argues that in omission, no human agent causes the patient's death.
• But there's also a distinction between letting someone die and not letting anyone die.
• If euthanasia is desirable in a case, death is no greater an evil than continued existence.
• There's nothing wrong with causing death if it's a good thing; if it's not a good thing, no form of euthanasia is justified.
• The two kinds of euthanasia stand or fall together.

2. Duty Not to Harm vs. Duty to Help

• Our duty not to harm people is generally more stringent than our duty to help them.
• Killing violates the duty not to harm, while letting die is merely a failure to help.
• However, this only seems true when considering distant strangers or cases requiring substantial sacrifice.
• In cases where it's easy to help someone close at hand, the asymmetry vanishes.
• Doctors have a duty to help their patients; therefore, the asymmetry has little relevance.
• It's not clear that killing a patient is harming them if they would be no worse off dead.

3. Psychological Impact on Physicians

• Allowing a patient to die is impersonal, while giving a lethal injection makes the physician responsible.
• Feelings of guilt may be inevitable when giving a lethal injection.
• However, guilt feelings may be irrational and don't necessarily indicate wrongdoing.
• We must decide whether the conduct is wrong based on objective reasons.

The Physician's Commitments

• Some argue that physicians are dedicated to protecting life, making it impossible for them to engage in active euthanasia.
• This argument suggests a qualified defense of the active/passive euthanasia distinction.
• Everything turns on the nature of the physician's commitment, whether moral or professional.

Moral Commitments

• Many doctors believe active euthanasia is immoral, but this belief doesn't necessarily make it wrong.
• People should be allowed to follow their own consciences and not be compelled to do what they think is wrong.
• Doctors who believe abortion is immoral shouldn't be required to perform it.
• Similarly, physicians who disapprove of active euthanasia shouldn't have to engage in it.

Professional Commitments

• Doctors might be professionally committed against active euthanasia through explicit codes of conduct or simply by being physicians.
• Rigterink suggests that "the point of medicine is to preserve human life whenever it occurs."
• Consider the parallel argument that mechanics shouldn't destroy cars, even if they're beyond repair.
• The concept of a profession can't be used to show it's wrong for a professional to do something outside the concept.
• If a doctor isn't acting "as a doctor" in practicing active euthanasia, it's not necessarily wrong.
• However, if medicine implies that those engaged in it cannot be involved in mercy-killing, then medicine is morally defective.
• We could define "smedicine" as a profession that helps make the passage to death as easy as possible when a meaningful life is gone.

Thomson's Objection

• Thomson argues that if she cuts off Alfred's head he will die, and wanting him to die, cuts it off; Bertha knows that if she punches Bert in the nose he will die-Bert is in peculiar physical condition and, wanting him to die, punches him in the nose. But what Bertha does is surely every bit as bad as what Alfrieda does, so cutting off a man's head isn't worse than punching a man in the nose.
• If Thomson were right, we would have to scuttle the Bare Difference Argument.
• I don't think she is right: the Alfrieda-and-Bertha argument is not absurd, as strange as it is.
• We need first to notice that the reason it is wrong to chop someone's head off is, obviously, that this causes death.
• The Alfrieda-and-Bertha argument presupposes a distinction between the act of chopping off someone's head, and a victim's death. (It is stipulated that, except for the fact that Alfrieda chops off someone's head, while Bertha punches someone in the nose, the two acts are "in all other respects alike.".)
• Thomson has specified, however, that in the cases of Alfrieda and Bertha there is no difference in this regard either; and so their acts turn out to be morally equivalent.
• The parallel construal of the conclusion to the Smith-and-Jones argument is: the bare fact that one act is an act of killing, while another act is an act of letting die, is not a reason for judging the former to be worse than the latter.

The Compromise View

• Some philosophers concede that, in the case of Smith and Jones, there is no moral difference between killing and letting die; but they continue to maintain that in the euthanasia cases the distinction is morally important.
• The Compromise View allows us to look at cases one at a time, and decide in each case whether the difference between killing and letting die is significant; but logic requires that the distinction be always, or never, important; there is no middle ground.

Principle I

• If the fact that A has P is a morally good reason in support of the judgement that A ought (or ought not) to be done, and B also has P, then that is also a reason, of equal weight, for the judgement that B ought (or ought not) to be done.

Principle II

• If the fact that A has P and B has Q is a morally good reason for preferring A over B, then if C has P and D has Q, that is a reason of equal weight for preferring C over D.

Foot's Argument

• Philippa Foot: asks, "When is this distinction morally relevant?" and answers "in cases in which rights are in question."
• I (and other defenders of the Equivalence Thesis) can easily concede that, in some cases, it may be permissible to let die but not to kill. Likewise, in other cases it may be permissible to kill but not to let die. This is perfectly compatible with the Equivalence Thesis.
• Equivalence Thesis only says that the reason one course, but not the other, is permissible, isn't simply the intrinsic "moral importance" of the difference between killing and letting die.