Euthanasia is defined by Webster’s Dictionary as the killing of a person with the intent to end suffering. It is broken down into two categories, active euthanasia and passive euthanasia. Active euthanasia is when doctors and family members decide to actively kill to end suffering. Passive euthanasia lets the suffering person die by withholding extraordinary medical care allowing the disease kill instead of a person. The American Medical Association holds that active euthanasia is impermissible, due to it involving the intentional termination of a human life by another human. Philosophers have argued for and against this stance, discussing the moral permissibility of such an action. James Rachels, a well-known contemporary philosopher, argues that active and passive euthanasia both require an action by the doctor. Thomas D. Sullivan combats Rachels’ view by looking into the moral significance of the intention. This philosophical analysis outlines classical arguments surrounding the moral permissability of active and passive euthanasia.
Common intuition distinguishes a difference between active and passive euthanasia by the human decision to take another’s life. It is common belief that it is wrong to kill another human. Committing murder requires an action to end another human’s life, which makes a person responsible for the death of another. Using this logic, many are unable to find a moral difference between murder and performing active euthanasia. Opponents of active euthanasia deem this action wrong because they believe the decision to end human life in all circumstances is morally impermissible. On the other hand, passive euthanasia allows no one person to take responsibility for a death because the life ending decision is not made. These common intuitions fail to take into account the action of inaction.
Though many will agree with the idea that passive euthanasia seems more morally permissible than active, James Rachels denies this viewpoint. “It is not exactly correct to say that in passive euthanasia the doctor does nothing, for he does one thing…. he lets the patient die.”(106) He explains that if one kind of euthanasia is morally correct then both are and vice versa. Rachel uses an example of making the decision to shake someone’s hand. When two people meet for the first time, .the traditional action to take would be to shake hands. If one person does not shake in an introduction, a conscious decision of inaction is made. From this inaction, there is a consequence of alienating the person being met. So by not taking making an action, there still is a consequence.
This rationale is then used by Rachels to prove that there is no moral distinction between active and passive euthanasia. He uses the example of Smith and Jones to prove this point. Smith will receive a large inheritance if his baby cousin dies. So while his cousin is taking a bath, Smith walks in the bathroom and drowns the baby, making it look like an accident. Jones also will receive a large inheritance if his baby cousin dies. While his cousin is taking a bath, Jones walks into the bathroom intending to kill him. Instead, his cousin hits his head and falls in the water upon Jones’ entry. Jones does not save his cousin; he sits back and waits for him to die, thinking about the inheritance he will receive when life ends. Rachels explains, “both men acted from the same motive, personal gain, and both had exactly the same end in view when they acted.”(105) There is no moral defense in these situations, therefore, the acts are deemed immoral. So if a doctor lets a patient die for humane reasons, this act uses the same moral rule to allow for a lethal injection for humane reasons.
The rule, which makes passive euthanasia as morally wrong as active, is the idea of positive rights. Positive rights are when someone has the right to be provided with something. There are two people on a country road, an adult riding his bike east and a seven-year-old boy riding his bike westbound. Just as the adult passes the young boy, a speeding car hits the boy and races off. The boy is now lying on the ground crying for an ambulance. Since the adult is the only person that knows of this accident, he is obligated to find help as fast as possible. The boy has a positive right for the adult to find him medical attention. In the situation with Jones, the little cousin has a positive right for Jones to save him. The baby has a right to live in that situation because it’s Jones’ responsibility to save human life if possible. It is clearly possible for Jones to save his cousin, so he violated his cousin’s right to live. This proves that it was Jones’ violation of his cousin’s positive rights, which makes his decision immoral.
Philosopher Thomas Sullivan criticizes Rachels by explaining that the intentions of an action are more important than the outcome of an action. In the cases of Smith and Jones, both had the same intentions and therefore are both equally responsible for the death that occurred. Sullivan declares, “the traditional view is that the intentional termination of human life is impermissible, irrespective of whether this goal is brought about by action or inaction.”(109) If a baby was born with a fatal respiratory problem and a simple procedure can fix it, the parents should decide to pay for the operation to save the baby’s life. But the parents do not want a baby with health problems from birth, so they decide to not have this surgery. By not having the surgery, the baby dies because the parents allow the respiratory problem to kill the child. The decision made to let the baby die was based on the parents not wanting a baby with a physical disability to take care of, instead of extending the life of their child. The parents intentions of not wanting this child makes this decision of inaction immoral.
In the case of passive euthanasia, even though there is knowledge of death coming sooner due to inaction, death still is not intentional. Sullivan proclaims criteria for moral intentions of euthanasia by asking three questions. “Is the action or refraining aimed at producing a death? Is the termination of life sought, chosen, or planned? Is the intention deadly? If so, the act or omission is wrong.”(109) An analogy using this logic can be seen in a light bulb example. Person X screws a new light bulb into a lamp. Everyday X uses the light from this lamp so s/he can see while doing homework. X know that after every hour that passes, the life of the light bulb is getting shorter and eventually will burn out. X's intentions are not to let the light bulb burn out; it was to have light while doing my homework. There is a clear distinction between the two. Relating this analogy to passive euthanasia, the doctor’s intentions is not to cause death to the patient, rather it is to let life take its course without the intervention of medical procedures. Sullivan holds the traditional position, that active euthanasia is not morally permissible while passive can be permissible in with the right intentions.
A response to Sullivan’s criticism focuses on the difference between act and intention. Rachels uses the example of Jack and Jill to explain how determining the intention of an act does not make the act itself wrong. Jack visited his sick and lonely grandmother with the intention to brighten her day. Jill visited the same grandmother with the intentions of being written into her will, but still brightened her day and cheered her up. The act of cheering the grandmother up is the same in both situations. An action is separated by the end result and the intention to achieve the end result. The result of an action should be judged either good or bad, not taking into account the intentions. The same with the intentions of an action, this should be judged good or bad not based on the end result. These two parts of an action are completely different from each other and cannot be judged together. The intentions of an action make no difference in the action’s actual outcome.
Intentions determine whether a person’s character is good or bad. According to Rachels, “the intention is not relevant to determining whether the act itself is morally right.” (114) A person’s character is judged by their personality. Jill’s personality seems to be cruel and selfish even though her actions show otherwise. Being both cruel and selfish are bad traits, which directly relate to having a bad character. The more bad traits a person has, the worse their character is and vice versa. So because Jill’s act had the exact same outcome as Jack’s, the act is deemed good. The intention of the act only affected her character and not the actual action of visiting her grandmother.
The traditional doctrine that Sullivan favors is not best in all cases. Sullivan explains that this doctrine “is simply a prohibition of murder,” (120) in reference to active euthanasia. Medical decisions are made on a case-by-case basis and are determined depending on each individual’s wants and needs. To condone constant suffering of a terminally ill person near death would be morally wrong. The morally right decision would allow the dying person and their family to end life if it will stop the constant unbearable pain. An example of this can be seen in the story of Happy the Fisherman. The only activity Happy wanted to do was to go fishing. He would get up in the morning, have breakfast and go fishing on a daily basis and was very content with his life. Happy made sure that he wrote out medical instructions in case something should happen to him because he thought that the only way to live life was to be an active functioning human being. Happy one day felt sick and could not get up to go fishing. He then went to the hospital to find that he caught a rare bacterial disease from decomposing fish, which will rot his inner organs within one month. After 1 week Happy is hooked up to a respirator and faces certain death within weeks. In Happy’s written instructions he said that if terminally ill and breathing from a respirator for longer than 1 week then pull the plug and end life. Ending Happy’s life would end the constant suffering of feeling his internal organs rot away. This act would be called murder under the traditional doctorine. However, in light of the circumstances of the case, active euthanasia may be considered more humane.
Rachels argument looks at intentions and actions as two separate ideas which can not be compared. He also explains how inaction is still an action because there is a consequence. When performing euthanasia, no matter the intentions, someone still dies. Therefore, one side argues that there is no moral distinction between letting die and killing someone because the action’s result is the same. If letting a person die is morally permissible then killing someone is also, and vice versa. The focus of Sullivan’s argument looks at the moral permissibility of the intention of an act, which he believes is important than the act itself. Therefore, the classical arguments deeming moral permissability surround the difference between action and intention.
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