Lecture Notes James Rachels, “Active and Passive Euthanasia

Lecture Notes
James Rachels, “Active and Passive Euthanasia” (1975, 1997)
Keith Burgess-Jackson
28 January 2015
1. Biography. James (Jim) Rachels was born in Columbus, Georgia, on 30 May 1941. He died
(of cancer) in Birmingham, Alabama, on 5 September 2003, at the age of 62. He earned a B.A.
degree at Mercer University (Macon, Georgia) in 1962 and a Ph.D. degree at the University of
North Carolina (Chapel Hill) in 1967. He taught at the University of Alabama (Birmingham) from
1977 to 2003. Earlier, he had taught at the University of Richmond, New York University, the
University of Miami, and Duke University. His son Stuart is Associate Professor of Philosophy at
the University of Alabama in Tuscaloosa, Alabama. His son David is Professor of English at
Newberry College in Newberry, South Carolina. According to Stuart (The Legacy of Socrates:
Essays in Moral Philosophy [2007], 237), the essay entitled “Active and Passive Euthanasia,”
which was originally published in the New England Journal of Medicine in January 1975, has
been “Reprinted in roughly three hundred anthologies.” We are reading a revised version of
the essay, from James Rachels’s collection, Can Ethics Provide Answers? And Other Essays in
Moral Philosophy (1997). Page references are to the 1997 version.
2. The traditional doctrine (of active and passive euthanasia). 1 “[I]t is permissible, at least in
some cases, to withhold treatment and allow a patient to die, but it is never permissible to take
direct action to kill a patient” (63). This doctrine was endorsed by the American Medical
Association (AMA) in 1973, and continues in force. (Read the pertinent provisions.) The
doctrine implies that, other things (such as consequences) being equal (ceteris paribus), “killing
patients is worse than letting them die” (63). Rachels says that “a strong case can be made
against this idea” (63). In other words, Rachels believes that there is no intrinsic difference
between killing and letting die, i.e., that the bare difference between the two is morally
irrelevant/insignificant.2 “If one is accepted, the other should be accepted as well” (63). Note
that the inequality/disparity can be removed in either of two ways:
•
•
Continue to believe that it is permissible to allow a patient to die, but start believing
that it is permissible to kill a patient. (This is Rachels’s preferred option.)
Continue to believe that it is impermissible to kill a patient, but start believing that it is
1
The traditional doctrine may rest on what Jonathan Glover calls the “acts-and-omissions doctrine.” He
writes: “Is it worse to kill someone than not to save his life? What we may call the ‘acts and omissions doctrine’
says that, in certain contexts, failure to perform an act, with certain foreseen bad consequences of that failure, is
morally less bad than to perform a different act which has the identical foreseen bad consequences. It is worse to
kill someone than to allow them [sic] to die” (Jonathan Glover, Causing Death and Saving Lives [Harmondsworth,
England: Penguin Books, 1977], 92-3).
2
There are three distinctions to be drawn. The most general is that between acts and omissions. More
specific is that between killing and letting die. More specific still is that between active and passive euthanasia.
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impermissible to allow a patient to die. (I don’t know of anyone who takes this tack.)
3. The doctrine leads to unnecessary suffering. There are cases (such as that described on
pages 63-4) in which AE produces less suffering than PE. “The process of being ‘allowed to die’
can be relative slow and painful, whereas being given a lethal injection is relatively quick and
painless” (64). Letting Down’s syndrome babies die (as opposed to treating them or killing
them) is “patently cruel” (64). Criticism: The argument begs the question, for it assumes the
truth of consequentialism. The proponent of the distinction rejects consequentialism.
4. The doctrine “leads to decisions about life and death being made on irrelevant grounds”
(65). When Down’s syndrome babies have obstructed intestines, the doctrine implies that it is
morally permissible to let them die but not to kill them. But it’s irrelevant that such babies
have obstructed intestines. Either it’s permissible to kill all Down’s syndrome babies (even
those without obstructed intestines) or it’s impermissible to let any of them die (even those
with obstructed intestines). Skip this argument.
5. Rachels’s argument against the killing-and-letting-die doctrine (my wording; see page 66
for Rachels’s wording):
a. If the difference between killing and letting die is in itself a morally important matter,
then Jones’s behavior is less reprehensible than Smith’s behavior.
b. It is not the case that Jones’s behavior is less reprehensible than Smith’s behavior (i.e.,
Jones’s behavior is just as reprehensible as Smith’s behavior).
Therefore,
c. It is not the case that the difference between killing and letting die is in itself a morally
important matter (from a and b, modus tollens).
The argument is valid, which means that the conclusion follows logically from the premises.
The proponent of the killing-and-letting-die doctrine (who rejects c) can either grab the bull by
the horn (i.e., reject a) or bite the bullet (i.e., reject b). Note: In saying that Jones’s behavior is
less reprehensible than Smith’s behavior, one is not saying that Jones’s behavior is not
reprehensible. It may be only a bit less reprehensible. On a scale of 1 to 100, Smith’s killing
may have a reprehensibility quotient of 100, while Jones’s allowing to die may have a
reprehensibility quotient of 99. This is the “masking or sledgehammer effect” that J. P.
Moreland (following Richard L. Trammell, “Saving Life and Taking Life,” The Journal of
Philosophy 72 [13 March 1975]: 131-7, at 132) mentions in “James Rachels and the Active
Euthanasia Debate,” Journal of the Evangelical Theological Society 31 (March 1988): 81-90, at
89:
The fact that one cannot distinguish the taste of two wines when both are mixed with
green persimmon juice fails to show that there is no difference between the wines. The
taste of the persimmon juice is so strong that it overshadows the difference. Similarly
the intentions and motives of Smith and Jones are so atrocious, and both acts are so
clearly unjustified, that it is not surprising that other features of their situation (killing
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versus letting die) are not perceived as the morally determinative factors in the cases.
Mill’s Method of Difference:
Albert
|
Betty
----------------|---------------Oatmeal
|
Oatmeal
Toast
|
Toast
Peanut Butter
|
Peanut Butter
Jelly
|
Jelly
Apple Juice
|
--------------------|---------------Sick
|
Not Sick
Conclusion: Apple juice caused Albert’s sickness.
Rachels:
Jones
|
Smith
------------------------|-----------------------Motive: Personal Gain
|
Motive: Personal Gain
End in View: Death
|
End in View: Death
Result: Death
|
Result: Death
Letting Die
|
Killing
------------------------|-----------------------Reprehensible
|
Reprehensible
Conclusion: No moral difference between killing and letting
die.
Trammell/Moreland:
Occasion #1
|
Occasion #2
------------------------|-----------------------Green Persimmon Juice
|
Green Persimmon Juice
Red Wine
|
White Wine
------------------------|-----------------------Tastes Bad
|
Tastes Bad
Conclusion: No taste difference between red wine and white
wine. (This is a refutation by logical analogy. An
argument with the same form as Rachels’s argument has true
premises and a false conclusion, which means it is invalid.
This shows that Rachels’s argument, too, is invalid.)
The remainder of Rachels’s essay is discussion.
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6. Antilogism (inconsistent set of propositions).
a. It is morally permissible to allow a patient to die.
b. There is no intrinsic moral difference between killing a patient and allowing a patient to
die.
c. It is morally impermissible to kill a patient.
The AMA accepts a and c but rejects b (or rather, is committed to rejecting b). Rachels accepts
a and b but rejects c.
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