James Rachels on Active and Passive Euthanasia

In 1975, James Rachels (an American philosopher who specialized in ethics)wrote "Active and Passive Euthanasia", which originally appeared in the New England Journal of Medicine and argued that the distinction so important in the law between killing and letting die has no rational basis. Rachels’s Thesis: active euthanasia is not any worse than passive euthanasia.

Important assumption: THE JUSTIFICATION for "letting die" is to reduce harm & suffering of the patient. In situations for which passive euthanasia is permissible under this justification, there are no morally sound reason for prohibiting active euthanasia, and in some cases, active euthanasia is morally preferable to passive euthanasia. (Rachels says that he can understand someone who opposes both active and passive euthanasia as immoral practices, but cannot make sense of approving of one and not the other.)

The basis of the conventional doctrine is the distinction between "killing" and "letting die," together with the assumption that the difference between killing and letting die must, by itself and apart from further consequences, constitute a genuine moral difference.

Although most actual cases of killing are morally worse than most actual cases of letting die, we are more familiar with cases of killing (especially the terrible ones that are reported in the media), but we are less familiar with the details of letting die. This gap leads us to believe that killing is always worse.

First argument against the conventional doctrine is that many cases of "letting die" are WORSE (for the patient) than is killing them. If the patient is going to die either way, why is it morally permissible to dehydrate them to death? Either way, the patient is dead. But the conventional doctrine often adds a requirement of suffering before dying.

The refusal of treatment to some "defective" newborns, and the subsequent death by dehydration, shows that some cases of letting die are worse than killing.

Second argument is the Bathtub Example of Smith and Jones. It demonstrates that some cases of letting die are at least as bad as killing.

Therefore, the "bare" difference between killing and letting die doesn’t always make a moral difference.

Therefore, in many cases where it is right to let a patient die, it is also right to practice active euthanasia.

* Definitions:
- Active Euthanasia = taking a direct action designed to kill a patient
- Passive Euthanasia = deliberate withholding of treatment that could prolong patient's life, allowing the patient to die

Original article: James Rachels,"Active and Passive Euthanasia," New England Journal of Medicine, Vol. 292, No. 2 (January 9, 1975), pp. 78-80.
Source for this post: http://www.mnstate.edu/gracyk/courses/phil%20115/rachels_on_euthanasia.htm (repritned with permission).
See also: J. David Velleman, “Against the Right to Die”, http://homepages.nyu.edu/~jrs477/David%20Velleman%20- %20Against%20the%20Right%20to%20Die.pdf; Brock, D., “Voluntary Active Euthanasia”, Hastings Center Report, 22/2 (1993):10-22; Luke Gormally “Euthanasia and Assisted Suicide: Seven Reasons Why They Should Not Be Legalized”, in Linacre Centre; Tooley, Michael,"Voluntary Euthanasia:Active Versus Passive, and the Question of Consistency,"in Revue Internationale de Philosophie, 49/3 (1995): 305-22; John Hardwig, “Dying at the Right Time.Reflections on Assisted and Unassisted Suicide” in LaFollette, H., ed., Ethics in Practice (Blackwell, 1996); Walter Glannon, "Persons, Lives, and Posthumous Harms,"in Journal of Social Philosophy 36 (2001): 127-142.