Active Euthanasia – performing an action that directly causes someone to die.
Passive Euthanasia – allowing someone to die by not doing something that would prolong life.
The Difference Thesis – All else being equal, killing someone is morally worse than letting
Rachels grants that there is a genuine difference between acts of killing and acts of allowing to
die, but does not think that there is an essential moral difference between the two act types.
First – to argue that there is no essential physical difference between acts of killing and acts
Second – to argue that the likely benefits of a legal policy that allows for active euthanasia
outweigh the possible costs.
Killing and Letting Die: With A Vengeance
Brock’s first goal: there is no essential physical difference between acts of killing and acts of
Rachels: Consider cases that are alike w.r.t. all features except whether the act in
question is a killing or an allowing to die. If the two cases are morally on par, then
there is no essential moral difference between killing and letting die.
Brock: Consider cases that are alike w.r.t. all features except whether the agent
performing the action in question is justified in performing it. If one case is an
allowing to die and the other case is a killing, then there is no essential physical
difference between killing and letting die.
What physical difference?
Medical Ethics Handout 27
The Respirator Cases:
“A patient terminally ill with ALS disease…is completely respirator dependent with no
hope of ever being weaned. She is unquestionably competent but finds her condition
intolerable and persistently requests to be removed from the respirator and allowed to
die.” Her physician removes her from the respirator.
Does the physician kill her, or let her die?
“Suppose the patient has a greedy and hostile son who mistakenly believes that his
mother will never decide to stop her life-sustaining treatment and that even if she did her
physician would not remove her from the respirator. Afraid that his inheritance will be
dissipated by a long and expensive hospitalization, he enters his mother’s room while she
is sedated, extubates her, and she dies.”
Does the son kill her, or let her die?
The Argument against the Killing/Letting Die Distinction
1. If a physician extubating a patient from a respirator is merely letting her die, then a
greedy son extubating his mother from a respirator is merely letting her die.
2. A greedy son extubating his mother from a respirator is not merely letting her die.
3. Therefore, a physician extubating a patient from a respirator is not merely letting her die.
1) Reject premise 1; perhaps the difference between killing and letting die is not a
2) Reject premise 2; the son merely let his mother die.
3) Accept conclusion; the physician killed the patient.
Medical Ethics Handout 27
There are serious problems with option 2:
Options 1 and 3 both require us to abandon the typical understanding of the killing/letting die
If we reject premise 1, then…
If we accept the conclusion, then…
Either way, it seems like there is not a substantial difference between active and passive
Voluntary Active Euthanasia and Public Policy
As always, the moral and legal permissibility of an act are separate but related. It is conceivable
that voluntary active euthanasia is not inherently wrong, but should nonetheless be illegal. Brock
considers the pros and cons of a policy that allows for voluntary active euthanasia:
It would possible to respect the selfdetermination of competent patients
It benefits everyone who supports
voluntary active euthanasia (comparison
It would be possible to alleviate the
suffering (physical and psychological) of
patients for whom passive euthanasia and