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Is Rachels correct that there is no significant moral difference between active and passive euthanasia?
The terrifying decision regarding if there is a moral difference between active and passive euthanasia has been part of a large ethical discussion in the world of medicine. As a result of the American Medical Association (AMA) statement, many physicians still consider it acceptable to allow their patients to die by withholding treatment, but not acceptable to actively kill them. In contrast to this view, scholar James Rachel has described that there is truly no moral difference between actively killing and letting a patient die. Rachel’s distinction between euthanasia is that active euthanasia encompasses killing of the patient, and passive euthanasia involves failing to prolong the patients’ life. I correspondingly argue that choosing not to act is an action, and passive euthanasia takes the same level of moral appraisal as active euthanasia. Both cases have the same motivations and outcomes; the patient dies. This view is also supported by Abrahamic religious doctrines like the Ten Commandments, the Six Axioms of Faith and the Torah. This paper also suggests that if active euthanasia is immoral at all, passive euthanasia could basically be more immoral than active euthanasia. Therefore, if active euthanasia is considered immoral then passive euthanasia should too.
The social attitude of euthanasia is an area that should be highlighted when discussing the morality of killing. Abrahamic religions like Islam. Judaism and Christianity all argue for the sacredness of life. In Christianity, there is the commandment, ‘thou shall not kill’. Islam teaches the taking of a life is a sin, and killing in any form is precisely forbidden under Jewish principle. Outside of these religious attitudes towards either effectively killing the life of another, or allowing the person die without intervening, there are several opinions in the world of medicine. The central distinction between active and passive euthanasia rests on the American Medical Association policy that in many cases, ‘it is permissible to withhold treatment and allow a patient to die but it is never tolerated to directly kill a patient’ (BBC News). This distinction is irrelevant to the concept of morality. A strong case can be made in contradiction with the AMA claim. James Rachels (1974, p104) points out that many babies are born with Down’s syndrome. Most of these babies are healthy with the assistance of medical care, however some are born with many hereditary defects; intestinal blockages being one of them. In many cases babies born with this deficiency are rejected the operation to cure it, therefore allowing the infant to die. It seems morally incorrect to judge whether a baby is worth surviving depending on this deficiency. If this is the case, then all babies with Downs syndrome should die. Accepting such a distinction between active and passive euthanasia highlights the unacceptable flaws of treatment of these babies. Letting a baby die by accepting it to dehydrate over a period of time has the same moral assessment than giving a lethal injection that would end its life. Whichever action the doctor takes, it follows the same motivations and end result, the baby dies. The only difference between the two is the method in achieving death. This is not adequate enough to defend them as being morally different. Therefore James Rachels’ theory; there is no significant moral difference between active and passive euthanasia, can be supported in the sense that active euthanasia is no less bad than passive euthanasia. Islam, Christianity and Judaism; the worlds largest religions, also support Rachels viewpoint through their rules regarding the sacredness of life.
Many individuals may find the judgement, ‘active euthanasia is no less bad than passive’ difficult to process. Obviously standard situations in killing a human being are horrible, and since we hear about killing more often than ‘letting somebody die’ we instantaneously believe it to be worse. Nonetheless, I argue that killing is not in itself worse than letting a patient die. Instead active euthanasia can be preferable to passive euthanasia, since it has the potential to be beneficial in certain circumstances where it could minimise suffering (Rachels, 1975, pg104). Now I am only arguing that active euthanasia could be advantageous strictly if the patient is intensely suffering with a terminal illness that will already kill them. The judgement in allowing a patient to die follows the moral evaluation in the same way that a decision to kill them would be. In the case where a patient is dying due to a terminal tumour of the bones and is in excruciating pain, which can no longer be eased. He is incurable and assured to die very soon even if treatment is provided. However the patient does not want to continue existing. Assume the doctor agrees to provide a lethal injection, with the justification that their patient is in terrible pain and since he is going to die anyway, it would be wrong to make him suffer needlessly. This analogy provides a solid defence not to increase the patients’ agony and also take into consideration the ‘quality’ of the patients’ life. Philosopher Nancy Dickey in her book, Euthanasia: a concept whose time has come, accepts the arguments above andexplains that in recent years people have appeared to support the idea of euthanasia (Dickey, 1992, pg 522). Some doctors in the medical network see euthanasia as a compassionate way to end unnecessary pain. Passive euthanasia can essentially be more torturous than receiving a fatal shot that is rather quick and less painful. Therefore, killing the patient for this reason has no significant moral difference as allowing the patient to suffer excruciatingly. If however the doctor let a patient die that was suffering from a curable disease, the doctor would certainly be culpable since he needlessly killed the patient. It would them be suitable to place charges against him. Since active euthanasia is against the law in many countries, all doctors and surgeons should be aware with the legal consequences of their actions. Accordingly, these doctors and surgeons should be mindful that the law has the ability to force a moral rule upon them that is defenceless, ultimately having an effect on their practices.
This paper has extensively identified the viewpoint that there is no moral difference between killing and letting die therefore there is no significant moral distinction between active and passive euthanasia. Although the American Medical Association policy states that many doctors approve the disagreement with active euthanasia as it is in contradiction of the medical profession, and accept passive euthanasia, the considerations throughout the essay discuss that there is not a moral difference between the two. The considerations throughout this paper therefore accept Rachels theory. I believe the person who does not intervene with life sustaining actions in keeping the sick patient alive is just as guilty for the death of the patient as the physician who goes ahead with the euthanisation. The inactive taking of a life is still a life taken irrespective of whether the person killed wanted to die or not. In saying that I do claim that active euthanasia is preferable and more humane over passive euthanasia, in cases of minimising suffering. Passive euthanasia is already legally permitted. Since physicians face the struggle of having to discriminate between passive euthanasia and active euthanasia as a result of the law, I believe they can both be justified in certain circumstances. With all the different perspectives on this issue, the viewpoint that there is no moral difference between active and passive euthanasia is the most weight bearing argument.
- Alanazi, Mohammed Ratoubi, and Mansour Moklif Alanzi. “Is there a moral difference between killing and letting die in healthcare?.” International Journal of Research in Medical Sciences 3, no. 1 (2017): 1-10.
- Dickey, Nancy W. “Euthanasia: a concept whose time has come.” Issues L. & Med. 8 (1992): 521.
- Rachels, James. “Active and passive euthanasia.” Bioethics: An Introduction to the History, Methods, and Practice (1975): 77-82.
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