PHI 227 Biomedical Ethics

Actively killing and letting die (Acts and omissions)

1. "Euthanasia" is an ambiguous term
   1. Originally, it meant "good or happy death"
   2. Using the word "euthanasia" to refer to forgoing treatment begs the question
   3. The expression "passive euthanasia" is not used as much as it used to
   4. The original term "euthanasia" is replaced with "foregoing treatment," "assisted suicide" and "mercy killling."
2. Forgoing treatment (Allowing to die). It means letting the disease process take its course and the patient die a natural death. It involves:
   1. Withholding intervention. Not starting treatment when there is no hope of curing the patient
   2. Withdrawing intervention. Stopping treatment when it is no longer beneficial
3. Arguments against distinguishing between actions and omissions
   1. Consequentialist argument.
      1. a. Consequentialist arguments The rightness or actions depend on their results. It is morally insignificant whether these result are produced by actions or by omissions. The patient is going to die soon whether he is actively killed or allowed to die.
      b. Critique of the consequentialist argument It makes people responsible for the outcomes that result from what they do as well as those that result from what they omit to do.
   2. Objection If there is no difference between actively killing and letting die, and actively killing is allowed only under stringent conditions, then incompetent patients will never be allowed to die no matter their condition is.
4. Arguments in favor of distinguishing between actively killing and letting die
   1. Consequentialist arguments The consequences to society are worse. What will the world be like if we legalize active killing? There will be a greater tolerance for active killing of incompetents and others. 2. Critique of the consequentialist argument
      1. The empirical studies in the Netherlands are inconclusive
      2. It is possible to create safeguards to ensure that only those who meet certain criteria are killed
   2. The argument from patient autonomy Letting die implies respect for autonomy and is, in Kantian terminology, a perfect duty, it is negative liberty not to interfere. Killing with the patient's consent implies facilitating a patient's choice. It is an imperfect duty.



The doctrine of double effect (Direct and indirect effects)

1. There is, from the moral point of view, a difference between what a person aims at and what he foresees but does not intend.
   1. It is always wrong to perform an action whose intended consequences are bad but its foreseen but not intended results are good.
   2. It may be right to perform an action whose intended results are good but its foreseen results are bad, provided:
      1. The action itself is not immoral
      2. The bad consequences are not a means to the good ones
      3. The good consequences that are intended outweigh the bad consequences that are foreseen.
2. Critique of the doctrine of double effect
   1. Dodging the problem rather than facing it
   2. An action becomes moral or immoral depending on whether it is described as intended or foreseen.
   3. It is counterintuitive. People are usually held responsible for consequences they foresee not merely for those consequences that they intended.



Ordinary and extraordinary means

1. Definitions
   1. Ordinary means: common and inexpensive
   2. Extraordinary means: sophisticated, expensive, and scarce
2. Morality
   1. Traditionally, extraordinary means are optional
   2. Traditionally, ordinary means are required
3. Critique of the traditional conception Cannot be used to determine the morality of an action; something is extraordinary or ordinary depending on the circumstances. Antibiotics are ordinary, this does not mean that they mandatory. For some patients, they may not be appropriate.



Questions on the readings

Rachels, "Passive and Active Euthanasia"
1. Is Rachels for or against euthanasia?
2. What, according to Rachels, is the difference between active and passive euthanasia?
3. Which form of euthanasia is usually considered more ethical? What is Rachels view?
4. What is the purpose of the hypothetical case involving Smith and Jones?
5. To whom did Rachel write this article? What does he suggest his readers do?