Euthanasia is the deliberate act of bringing a person’s life to a premature end with the motivation of preventing further unmanageable and debilitating suffering. A clear distinction exists in the methods by which euthanasia is performed — active versus passive. Euthanasia can be defined as active in cases where a doctor directly contributes to terminating the life of a patient by providing the means that results in death, with the intention of ending their suffering. Passive, comparatively, can be defined as cases where the means of prolonging a patient’s life are withheld by a doctor to end their patient’s suffering, resulting in their death from the illness that ails them. Additionally, euthanasia can be broken down as voluntary, involuntary, and nonvoluntary. Referring to the level of consent, voluntary euthanasia is when the patient agrees to the procedure, whereas involuntary euthanasia is when the patient does not agree with the procedure; nonvoluntary euthanasia consists of cases where the patient is unable to provide consent — if someone is able to provide consent for them it is considered voluntary, if not then it is involuntary. Debate exists amongst contemporary philosophers over which cases can be permitted ethically, if any. Involuntary euthanasia is generally considered impermissible in all cases; for this reason, the discussion mainly considers whether there is a difference between killing and letting die, with regard to euthanasia. This paper addresses the arguments presented by James Rachels and Philippa Foot on their views of the distinction, or lack thereof, between killing and letting die. Rachels argues that, with regard to the morality of the action, there is no difference between killing (active) and letting die (passive). Foot disagrees and attempts to distinguish the two cases as having different ethical implications. Despite Foot’s objections, Rachels succeeds in establishing the moral equivalence of killing and letting die, and by doing so presents a strong argument for the permissibility of active voluntary euthanasia.
Rachels’ “Active and Passive Euthanasia” argues that the American Medical Association’s position on the intentional termination of one human’s life by another is wrong. It is his opinion that in some cases active euthanasia is more humane than passive euthanasia, and if this is the case, then the current prohibition of active euthanasia by a doctor is wrong. In cases where a person’s continued suffering would decrease the value of their life, active euthanasia is not only the morally correct action, but passive euthanasia is morally incorrect. He provides the example of infants born with significant defects who are kept alive until succumbing to a debilitating illness that would inevitably kill them, arguing that the lives of the disabled child, the family, and the doctors would all be benefitted by the ability to humanely and peacefully end the infant’s life without unnecessary suffering. Rachels goes further, describing situations where an infant is born severely disabled but its condition is not life-threatening, though it still lowers their quality of life. Rachels exposes a double standard — that parents and doctors aren’t able to ‘kill’ a child, only let it ‘die.’ If the disability severely lessens the quality of a person’s life, then the option should be provided to end it, regardless of whether the condition is fatal. Rachels’ point with these arguments is to highlight the commonly held belief that killing is morally worse than letting die — a belief he does not hold, suggesting instead that such situations carry the same moral implications when the only difference is killing or letting die. To justify this, Rachels offers this analogy:
In the first (case), Smith stands to gain a large inheritance if anything should happen to his six-year-old cousin. One evening while the child is taking his bath, Smith sneaks into the bathroom and drowns the child, and then arranges things so that it will look like an accident. In the second (case), Jones also stands to gain if anything should happen to his six-year-old cousin. Like Smith, Jones sneaks in planning to drown the child in his bath. However, just as he enters the bathroom, Jones sees the child slip and hit his head and fall face down in the water. Jones is delighted; he stands by, ready to push the child’s head back under if it is necessary, but it is not necessary. With only a little thrashing about, the child drowns all by himself, “accidentally,” as Jones watches and does nothing.
It is clear in each case that Smith and Jones have performed a morally wrong action; in both situations their cousin died as a result of their behavior. It is not clear, however, that Jones did anything better than Smith, morally or legally. Rachels acknowledges that this case is not equivalent to euthanasia — the doctor is concerned only with the proper care of the patient, not motivated by their own goals — but the analogy does describe how killing and letting die are equivalent from a moral standpoint. Active euthanasia should then be considered permissible if this is true, yet the AMA does not classify acts of passive euthanasia as an intentional termination of life. Perhaps it is because most consider intentional termination to be killing, and for the most part killing another human is a reprehensible act. Rachels argues that letting someone die is an act of killing them, the only difference being the role played by the doctor: in acts of active euthanasia, the doctor has to perform some action to induce the termination of life, while in acts of passive euthanasia, the doctor only has to let the patient die. Rachels opposes this thinking and suggests that letting someone die is doing something, in the same way killing them is — some responsibility lies on the part of the doctor regardless of whether the euthanasia is active or passive.
In “Killing and Letting Die,” Foot argues the contrary, that killing and letting die are not equivalent morally. Foot believes the cases appear nearly identical on the surface level but only reveal their differences after further investigation. She argues that having someone killed, or performing an action that results in their death, is not entirely killing them but carries the same moral implications — though she does not believe this logic holds for all comparisons of killing and letting die. To justify her position, Foot posits a type of agency which implies some higher level of responsibility. She describes how coroners often cannot determine a single cause of death; in these cases, a fatal sequence must be determined. A gunshot wound that leads to a person’s death would entail that the wielder of the gun killed them; likewise, with a person who died of poisoning, the person who provided the poison is responsible. Agency, as Foot defines it, is the chain of events, the highest of which bears the moral responsibility. As it applies to euthanasia, Foot is suggesting that a person can only bear moral responsibility for someone else’s death if they are directly implicated with regard to agency. If this is the case, then a doctor has no moral responsibility in cases of passive euthanasia — the doctor no longer provides life-saving care, and so the patient dies of the illness that ails them. The opposite is true of active euthanasia, where the doctor is directly responsible because they provided the means that resulted in the patient’s death. According to Foot, the doctor’s agency is the difference between killing and letting die, and the doctor would then have a moral motivation to only perform acts of passive euthanasia, avoiding responsibility for being the cause of their patient’s death. This would appear to directly counter Rachels’ argument, if Foot’s agency justification is sound. This, however, is not the case.
Foot’s arguments about the doctor’s agency are relevant to the debate over killing and letting die but fail to successfully object to Rachels’ arguments for ending the suffering of an ill person. The cause of death is important, especially as it pertains to euthanasia, but it does not determine the moral status of the action, and so it cannot be used as an objection to Rachels’ arguments. Whether the doctor contributes to the death or not, the goal of euthanasia is to prevent a person from enduring unnecessary suffering. Rachels argues that active euthanasia is, in some scenarios, preferred to passive euthanasia, and that the responsibility of the doctor plays no role in this determination, for good reason. He replies to objections similar to Foot’s like this:
Fixing the cause of death may be very important from a legal point of view, for it may determine whether criminal charges are brought against the doctor. But I do not think that this notion can be used to show a moral difference between active and passive euthanasia. The reason why it is considered bad to be the cause of someone’s death is that death is regarded as a great evil — and so it is. However, if it has been decided that euthanasia — even passive euthanasia — is desirable in a given case, it has also been decided that in this instance death is no greater an evil than the patient’s continued existence. And if this is true, the usual reason for not wanting to be the cause of someone’s death simply does not apply.
Rachels’ objection suggests that Foot has a point with regard to the cause of death in ordinary situations of killing, but argues that euthanasia is different. Euthanasia is typically regarded as evil, and when it is brought about prematurely, someone is meant to be responsible; in the case of euthanasia, however, the act of killing is not evil and is actually meant to benefit the person being killed. Rachels’ counterargument is well-adept at disarming Foot’s arguments for killing and letting die, when dealing with euthanasia.
Passive euthanasia is already common practice in the medical field, and as Rachels has argued, active euthanasia should be allowed, as it carries equal moral implications. Killing and letting die are no different, particularly when the act of killing benefits the person it is performed on. Cases exist where people are forced to suffer unnecessary pain and hardship because of a misguided belief that active euthanasia and killing are morally worse than passive euthanasia and letting die. The prohibition of active euthanasia does humankind a disservice and should not continue.