EUTHANASIA:  SOME NECESSARY DISTINCTIONS

(A) Active vs. Passive Euthanasia

  -- Often described as the distinction between "killing" and "letting die", or between an "act of commission" and an "act of ommission".

  -- This distinction is embodied in many ethical codes, like that of the American Medical Association, but is this a genuine distinction?  If the consequences are the same, what's the difference?  If "letting nature take its course" is supposed to be the difference, then what counts as "natural" in an age where ordinary medical treatment throughout one's life is massively interventionist?

(B) Voluntary vs. Nonvoluntary vs. Involuntary Euthanasia:

  -- Voluntary euthanasia includes cases in which someone takes their own life, but 
also cases in which they "deputize" someone else.  For example, a person may sign 
a "living will" requesting that they not be put on artificial life support if they suffer 
tremendous and permanent damage to their brain.  (Williams calls the latter cases 
"directed euthanasia", and distinguishes them from the former.)

  -- Nonvoluntary euthanasia occurs when there is no specific consent (in the present 
or in the past) given by the person who is killed, because they are not in a position 
to give or withdraw consent, but the decision is made by their family, friends, or 
doctor acting "on their behalf".

  -- Involuntary euthanasia consists of killing someone who explicitly requests not to 
be killed.  There is generally no support for this practice; however, opponents of 
voluntary or nonvoluntary euthanasia sometimes argue that any form of euthanasia 
at all will open a "slippery slope" to involuntary euthanasia.

(C) Self-administered euthanasia vs. other-administered euthanasia (e.g., "physican-assisted suicide".)

  -- Combining these various distinctions gives us at least ten possible categories of 
euthanasia:

       Self-administered:

1. Active, voluntary
2. Active, nonvoluntary  (possible category, depending on state of mind?)
3. Passive, voluntary
4. Passive, nonvoluntary (possible category, depending on state of mind?)

      Other-administered:

5. Active, voluntary
6. Active, nonvoluntary
7. Active, involuntary (presumably bad)
8. Passive, voluntary
9. Passive, nonvoluntary
10. Passive, involuntary (presumably bad)


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J. GAY WILLIAMS - "THE WRONGFULNESS OF EUTHANASIA"


(A) Euthanasia = acting against nature (454)

  -- "All the processes of nature are bent towards the end of bodily survival.  
Euthanasia defeats these subtle mechanisms..."

  -- "...euthanasia sets us against our own nature....[it] does violence to our dignity" 
by going against our natural goal of continued survival.

(B) Euthanasia might not be in our best interest (454)

  -- We might think we are terminally ill, but we (and our doctors) could be mistaken.

  -- Possibility of new miracle treatment

  -- Possibility of spontaneous recovery

  -- The available option of euthanasia might weaken our will to live (which may 
impair our fight against our illness), or may encourage us to die to free others of 
financial or emotional burden.


(C) The practice of euthanasia will have other bad effects (455)

  -- Euthanasia goes against doctors' and nurses' commitment to saving lives (see: 
Hippocratic Oath), and if this commitment is weakened, the quality of health care 
may decline.  More patients will be judged "better off dead".

  -- The slippery slope: where will the killing stop?  We will slide from voluntary 
euthanasia to "directed euthanasia" to social policies of involuntary euthanasia.


Conclusion:  "Suffering is a terrible thing...but suffering is also a natural part of life with 
values for the individual and for others that we should not overlook.  We may legitimately 
seek for others and for ourselves an easeful death.  Euthanasia, however, is not just an 
easeful death.  It is a wrongful death." (455)


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JAMES RACHELS  -- "THE MORALITY OF EUTHANASIA"

Note opening qualifier:  "...we will be concerned with the morality of individual acts of killing in such cases:  considered separately, are they morally wrong?  This is slightly different from asking whether euthanasia ought to be illegal...."  (Hence, it may be possible to agree with Rachels and still argue that euthanasia ought to be illegal?)


(A) Mercy and Utilitarianism -- Two Forms of Utilitarian Argument For Euthanasia

   Argument 1:

  (1)  Any action is morally right if it serves to increase the amount of happiness in the world or to decrease the amount of misery.  Conversely, an action is morally wrong if it serves to decrease happiness or increase misery.
  (2)  Killing a hopelessly ill patient, who is suffering great pain, at his own request, would decrease the amount of misery in the world.
  (3)  Therefore, such an action would be morally right.

                     Objection:  premise (1) is not plausible as a general claim.


    Argument 2:  (replace "happiness" with the wider notion of "interests")

  (1)  If an action promotes the best interests of everyone concerned, then that action is morally acceptable.
  (2)  In at least some cases, euthanasia promotes the best interests of everyone concerned.
  (3)  Therefore, in at least some cases euthanasia is morally acceptable.


(B) The "Golden Rule", and Kant's "Categorical Imperative"

  -- The "golden rule": you should not apply a moral principle to anyone else that you  would be unwilling to have applied to yourself.  Euthanasia meets this test, in at least some cases.

  -- Kant's Categorical Imperative (1789):  "Act only according to that maxim which you can at the same time will to become a universal law."  
(Two-minute digression:  contrary to what Rachels says, this is not intended to be a version of the golden rule, which is why Kant is opposed to mercy killing.)


(C) Skepticism About Unexpected Cures, Spontaneous Recovery, and Medical 
Breakthroughs

  -- There are at least some cases in which doctors know with absolute certainty that a patient is terminally ill and is not going to recover (e.g., advanced stages of cancer).

  -- Medical research does not suddenly produce unexpected miracle cures; it proceeds by  "slow and painstaking investigation".  Also, even if a cure is close to being achieved, some patients are already so far advanced in their disease that the cure would not help them.