4.  Discussion of Some Important Arguments  -  Continued

4.4  Discussion of Philippa Foot's Argument in "Euthanasia":  Philippa Foot versus James Rachels

        Philippa Foot, in her article "Euthanasia", takes issue with the argument that Rachels offers in support of the claim that the actions of killing someone and of letting someone die are, in themselves, morally equivalent.  The relevant passage in Foot's article is the following:

        "Where then do the boundaries of the 'active' and the 'passive' lie?  In some ways the words are themselves misleading, because they suggest the difference between act and omission which is not quite what we want.  Certainly the act of shooting someone is the kind of thing we were talking about under the heading of 'interference, and omitting to give him a drug a case of refusing care.  But the act of turning off a respirator should surely be thought of as no different from the decision not to start it; if doctors had decided that a patient should be allowed to die, either course of action might follow, and both should be counted as passive rather than active euthanasia if euthanasia were in question.  The point seems to be that interference in a course of treatment is not the same as other interference in a man's life, and particularly if the same body of people are responsible for the treatment and its discontinuance.  In such a case we could speak of the disconnecting of the apparatus as killing the man, or of the hospital as allowing him to die.  By and large, it is the act of killing that is ruled out under the heading of noninterference, but not in every case."
"Doctors commonly recognize this distinction, and the grounds on which some philosophers have denied it seem untenable.  James Rachels, for instance, believes that if the difference between active and passive euthanasia is relevant anywhere, it should be relevant everywhere, and he has pointed to an example in which it seems to make no difference which is done.  If someone saw a child drowning in a bath it would seem just as bad to let it drown as to push its head under water.  If 'it makes no difference' means that one act would be as iniquitous as the other, this is true.  It is not that killing is worse than allowing to die, but that the two are contrary to distinct virtues, which gives the possibility that in some circumstances one is impermissible and the other permissible.  In the circumstances invented by Rachels, both are wicked: it is contrary to justice to push the child's head under the water?something one has no right to do.  To leave it to drown is not contrary to justice, but it is a particularly glaring example of a lack of charity.  Here it makes no practical difference because the requirements of justice and charity coincide; but in the case of the retreating army they did not: charity would have required that the wounded soldier be killed had not justice required that he be left alive.  In such a case it makes all the difference whether a man opts for the death of another in a positive action, or whether he allows him to die.  An analogy with the right to property will make the point clear.  If a man owns something, he has the right to it even when its possession does him harm.  But if one day it should blow away, maybe nothing requires us to get it back for him; we could not deprive him of it, but we may allow it to go.  This is not to deny that it may be an unfriendly act or one based on an arrogant judgment when we refuse to do what he wants.  Nevertheless, we would be within our rights, and it might be that no moral objection of any kind would lie against our refusal."   (Applying Ethics, pages 252-3)

Comments On Philippa Foot's Discussion

1.  Foot seems to agree with Rachels' judgment in the case of Smith versus Jones, as she says that in this case the requirements of justice and charity coincide, and that the one action "would be as iniquitous as the other".  But if she does agree with Rachel that Jones's action is as wrong as Smith's, on the grounds that considerations of charity are precisely as weighty as considerations of justice in this case, she needs to explain why the situation is any different in other cases.  In particular, how can she maintain that it is morally worse to kill an innocent person than merely to allow an innocent person to starve to death?

2.  A crucial case is the retreating army case, which Foot describes as follows:

        "Suppose, for example, that a retreating arm has to leave behind wounded or exhausted soldiers in the wastes of an arid or snowbound land where the only prospect is death by starvation or at the hands of an enemy enormously cruel.  It has often been the practice to accord a merciful bullet to men in such desperate straits.  But suppose that one of them demands that he be kept alive?  It seems clear that his comrades have no right to kill him, though it is quite a different question whether they should give him a life-prolonging drug.  The right to life can sometimes give a duty of positive service, but does not do so here.  What it does give is the right to be left alone."  (Applying Ethics, page 252)

        Foot's view here is that one has an obligation to refrain from shooting the soldier if he wants not to be shot, but no obligation to enable him to live longer if he wants to live longer.  Thus she says:  "The right to life can sometimes give a duty of positive service, but does not do so here.  What it does give is the right to be left alone."  And Foot contends that in accepting this conclusion, we have arrived at the distinction involved in the active versus passive euthanasia distinction.

        Foot is right about the retreating army case.  But once one is clear about that case, it is also clear that it does not support any conclusion to the effect that the active versus passive euthanasia distinction is significant in itself.

        To see this, consider a person who has been reflecting for some time on the question of whether to go on living, who is not in an emotionally disturbed state, and who decides to commit suicide, even though such an action is contrary to his or her own interests.  A person may very well have the right to commit suicide in cases where it is contrary to his or her own interest.  But on the other hand, it may very well be argued that it is not morally right to assist such a person to commit suicide - so that allowing the person's death, at his or her own hands, is permissible, but not bringing that person's death about, even when that is what the person wants.  Why so?  The reason is, first of all, that each person has a prima facie right that others not interfere with his or her actions, but does not have a prima facie right that others act in some particular way; and secondly, that while acting contrary to one's own interest is not prima facie wrong, acting contrary to someone else's interests is.  So while it may not be wrong to allow someone else to act contrary to his or her own interests, it would be wrong to assist him or her to do this.

        The solider who will be captured by the enemy and tortured and killed, and who nevertheless asks not to be shot, has a right to demand that he or she be allowed to act contrary to his or her own self-interest.  But the same soldier does not have a right to demand that others assist him in acting contrary to his or her own self-interest.

In short:

(1)  Not allowing someone to do what he or she wants to do is a wrong-making characteristic, even in (at least some) cases where what the person wants to do is contrary to his or her own self interest.

(2)  Not assisting someone to do what he or she wants to do is not a wrong-making characteristic in cases where what the person wants you to do is contrary to his or her own self interest.

(3)  On the contrary, assisting someone to do what he or she wants to do is often a wrong-making characteristic in cases where what the person wants you to do is contrary to his or her own self interest, and especially in cases where it is seriously contrary to his or her self interests.
 
 

4.5 Killing Versus Letting Die, and Justice Versus Charity:  How Are these Distinctions Relevant?

        The main point to be made, however, not only about Foot's article, but also about Rachels' article, and many other articles in this area, is that neither the killing versus letting distinction, nor the justice versus charity distinction, appear to have anything to do with voluntary euthanasia.  For suppose that, contrary to what Rachels' "bare difference" style of argument appears to establish, killing someone is prima facie more wrong than letting someone die.  Or suppose that considerations of justice are more weighty than considerations of charity.  How does either assumption support the contention that voluntary active euthanasia is in itself morally problematic while voluntary passive euthanasia is not?

        Consider first the killing versus letting die issue, and let us suppose, for the sake of argument, that, contrary to what Rachels and some other philosophers have contended, killing is in itself more seriously wrong than letting die.  How does this contention provide support for the view that while voluntary passive euthanasia is morally permissible, voluntary active euthanasia is not?  It would seem that the argument must run as follows:

        First, the claim that killing is in itself morally more wrong than letting die can be put as follows:

(*)  Both the property of killing a person, and the property of allowing a person to die, are wrong-making properties, but the former is a weightier wrong-making property than the latter.

        What is one to say about this argument?  One response would be that for this argument to work, it has to be the case not merely that killing is morally worse than allowing to die, but that it is much worse.  For if the former were only slightly worse than the latter, then surely there would be cases where the benefit of reducing the person's suffering was sufficiently great that the slight moral difference between killing and letting die would not be enough to change what would otherwise be a morally permissible action into one that was not morally permissible.

        But that is a minor point.  The crucial point is that (*) is not a satisfactory way of formulating the view in question concerning the relation between killing someone and letting someone die.  The reason is that whatever grounds there are for holding that there is a moral difference between killing and letting die are grounds for holding that a much more general principle is correct - the principle, namely, that it is intrinsically more wrong intentionally to cause a given harm than it is intentionally to allow that harm to occur.  Or, to put it in terms of wrong-making properties:

(**)  Both the property of intentionally causing a harm, and the property of intentionally allowing a harm to occur, are wrong-making properties, but the former is a weightier wrong-making property than the latter.

        The upshot is that to the extent that the killing versus letting die distinction is morally significant it is so precisely because it is just an instance of the more general intentionally causing harm versus intentionally allowing harm to happen distinction.  But then (*) is not an accurate formulation of what is true in the killing versus letting die case, since it fails to distinguish between situations where killing, or letting die, are harms, from cases where they are benefits.  What is needed, then, is not (*), but the following:

(***)  Both the property of killing a person, when the killing harms the person, and the property of allowing a person to die, when allowing the person to die harms the person, are wrong-making properties, but the former is a weightier wrong-making property than the latter.

        The point is precisely the same with regard to Philippa Foot's appeal to the different virtues of justice and charity: it has no relevance at all to the claim that voluntary active euthanasia is morally problematic, while voluntary passive euthanasia is not.  For although it may be true that, if a person would be harmed by being allowed to die, then letting that person die would be contrary to the virtue of charity, this is not so in the case of voluntary passive euthanasia - assuming that the person's decision to choose death is a rational one: in the latter case, letting the person die benefits the person, rather than harming him, and so it is in accord with charity, rather than contrary to it.  Similarly, though the killing of people in general is contrary to justice, it is not so in the case of voluntary active euthanasia if the person's decision to ask to be killed is a rational one.

        One final point.  Once one sees that the killing versus letting die principle must be a special case of the following principle -

(**)  Both the property of intentionally causing a harm, and the property of intentionally allowing a harm to occur, are wrong-making properties, but the former is a weightier wrong-making property than the latter.

(##)  Both the property of intentionally causing a benefit, and the property of intentionally allowing a benefit to occur, are right-making properties, but the former is a weightier right-making property than the latter.

(###)  Both the property of killing a person, when the killing benefits the person, and the property of allowing a person to die, when allowing the person to die benefits the person, are right-making properties, but the former is a weightier right-making property than the latter.

5.  The Moral Status of Euthanasia:  Consequentialist Arguments

5.1  Does the Practice of Voluntary Active Euthanasia Have Undesirable Consequences?

Crucial Point:  If one wishes to accept passive euthanasia, but reject active euthanasia, it will not do simply to argue that active euthanasia may have, or is likely to have, certain undesirable consequences:  one must also argue that passive euthanasia is not likely to have undesirable consequences of the same sort.

        On this topic it is extremely easy to stumble into inconsistency, advancing arguments against active euthanasia but not against passive euthanasia, even though they are as applicable to the latter as to the former.
 
 

5.2  Arguments of Type (2A):  Undesirable Consequences in Individual Cases?

        In an article "Some Nonreligious Views Against Proposed 'Mercy-Killing' Legislation", Minnesota Law Review, volume 42, number 6, 1958, pp. 969-1042, Yale Kamisar cites a number of undesirable consequences that he believes are likely to flow from the practice of voluntary active euthanasia in individual cases:

(l)  People will request active euthanasia in cases where they do not have a rational desire to die:  the intense pain of a terminal illness is likely to cloud the mind, and cause one to make irrational decisions.  So some people will be killed who, if they were able to approach the matter rationally, would not choose to die.

(2)  People suffering from a terminal illness may want to die at some times, and desire to go on living at other times.  There is a danger, then, that if active euthanasia is employed, people will be killed who do not have a fixed desire to die.

(3)  If active euthanasia is available, some people may request it not because life is no longer worth living for them, but for extraneous reasons - such as the fear that they are a financial burden to their family, or to society, or because they believe that others feel that they are cowardly for wanting to hang on to life.

(4)  If active euthanasia is available, then some people may request active euthanasia, and thus be killed, when if only they had hung on a bit longer, there would have been some new medical breakthrough that would have made it possible for them to have been cured.  So the practice of active euthanasia will result in people being needlessly killed.

(5)  If active euthanasia is available, people will also be needlessly killed due to mistaken diagnosis.  Believing that they are suffering from an incurable illness, they will have themselves killed.  If active euthanasia were not available, either such people would simply go on living, or the diagnosis might be corrected, and proper treatment initiated.

Issues

(l)  To what extent are these points sound?

(2)  To what extent do they apply to active euthanasia, but not to passive euthanasia?

5.3  Discussion of Issue  (2): Applicability to Passive Euthanasia?

1. Points (l) and (2) seem equally applicable to passive euthanasia: a terminally ill person may irrationally ask to be allowed to die, and the desire to be allowed to die may fail to be a fixed one.

Comment:  In neither case do these two considerations seem to have much weight.  If one is more or less constantly suffering, that may cloud one's judgment about other things, but it would seem to put one in an excellent position to make a judgment about the desirability of going on living.

2.  Point (3) is, if anything, stronger in the case of passive euthanasia. For cases in which passive euthanasia are being contemplated are ones where medical technology is being used to keep people alive, which may mean a serious financial burden.

3.  Point (4) seems equally applicable to active and to passive euthanasia.  If people are allowed to die, a medical discovery may subsequently be made that would have saved their lives.

Comment:  This fourth consideration seems unimpressive.  The basic point is that it is rational to live life on the basis of probabilities, not on the basis of sheer possibilities.

        Consider driving to a movie.  The chance that you will be killed driving to a movie is greater than the chance that you will be killed while sitting at home watching television.  Does it follow that if you are rational, you will never drive to a movie?  The answer is that the rational thing to do is to take into account both how much more enjoyment you would get from going to a movie, and how much more likely it is that you will die because you went to a movie.  The rational thing to do is not the thing that minimizes the chance that you will get killed; the rational action is, rather, the one that maximizes your expected happiness, where expected happiness is calculated, for each action, by considering every possible outcome, Oi, of that action, multiplying the value, Vi, that that outcome has for you by the probability, Pi, of that outcome, and then calculating the resulting sum for all of the possible outcomes.  So the expected value of action A is defined as follows:

Expected Value of Ai  =  Sum over all possible outcomes, Oi, of action Ai, of

                                        [Probability, Pi, of outcome Oi x Value, Vi, of outcome Oi].
 

4.  Finally, consideration (5) is the only one that is more applicable to active euthanasia than to passive euthanasia.  But even here it is only a matter of degree.