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Published online by Cambridge University Press: 13 April 2010
There is overwhelming consensus today that passively allowing someone to die in medical contexts is sometimes morally permissible and desirable. Active euthanasia, however, remains controversial. The legal systems and the medical establishments of both the United States and Canada maintain absolute, formal prohibitions against direct killing in medical settings. This clearly reflects the deep-seated belief, evident throughout our cultural and religious history, that there is some important moral difference between killing and allowing to die. Yet much that has been written recently on this topic by philosophers has denied moral relevance for this distinction. While this general conclusion appears to have gained popularity, especially within philosophy, the reasons advanced for it seem inconclusive to some. In what follows I examine the principal philosophical argument for the claim of irrelevance. I then develop an alternative view that, to my knowledge, has not been distinctly articulated in the current literature. I begin, however, with a preliminary discussion of the intuitive basis of the distinction between killing and letting die.
1 Rachels, James, “Active and Passive Euthanasia”, New England Journal of Medicine, 292 (January 1975): 78–80.CrossRefGoogle ScholarPubMed Also widely reprinted in anthologies on biomedical ethics.
2 Rule-utilitarian arguments against active euthanasia abound in the current literature of biomedical ethics. For a very helpful general discussion, see Beauchamp, Tom, “A Reply to Rachels on Active and Passive Euthanasia,” in Contemporary Issues in Bioethics, edited by Beauchampand, T.Walters, L. (Belmont: Wadsworth Publishing, 1982), p. 316–23.Google Scholar James Childless offers an interesting argument of this type specifically focussed on the fiduciary aspect of the medical profession. See his “To Kill or Let Die,” in Bioethics and Human Rights, edited by Bandman, E. L. and Bandman, B. (Boston: Little, Brown, 1978), p. 128–32.Google Scholar
3 Foot, Philippa, “Euthanasia”, Philosophy and PublicAffairs, 6, 2 (Winter 1977): 85–112.Google ScholarPubMed
4 This is a variation on a case I was given by my colleague, Michael Philips.
5 See Bennett, Jonathan, “Morality and Consequences”, in Tanner Lectures on Human Values II, edited by McMurrin, S. M. (Cambridge: Cambridge University Press, 1981), p. 44–116.Google Scholar It may be thought that Bennett, in his 1980 Tanner Lectures, forever laid to rest the idea that the killing/letting-die distinction could possibly have variable moral relevance between different contexts. This is mistaken. In the first place, Bennett's primary concern is with the distinction between positive and negative causal instrumentality in general and, by his own account, the killing/letting-die distinction, as actually used, does not cleave along the same lines as does the distinction between positive and negative instrumentality (p. 49–50). Therefore, as Bennett is aware, there is an opportunity for the accusation that, whilehe may have shown that the distinction between positive and negative instrumentality never makes a moral difference, this proves nothing about whether the ordinary distinction between killing and letting die can have variable moral significance (p. 65). Secondly, and most importantly, Bennett claims only thatthe difference between positive and negative instrumentality can never be a source of basic reasons for moral judgment. By a basic reason he means a reason that refers to something that would always provide a reason for a certain judgment. Basic reasons contrast with derivative reasons, which refer to things that matter only because of their relation to something else, a particular contingency of some kind (p. 73). But this proposition is perfectly compatible with the claim that the killing/letting-die distinction displays contextual variability in moral significance. Its variability may be explained in terms of derivative reasons. Regarding my example of Rodrigo and Judas I suggest an explanation of the differential moral significance ofkilling versus letting die which refers to certain moral norms which I conceive to hold contingently. These norms, regulating revenge and the private pursuit of justice, may not be justified or reasonable in every possible moral world; they derive from general considerations about the kind of beings we are, ourcollective interests and the function of morality as a social instrument. Similarly, reasons that explain the differential moral significance of killing versus letting die by involving basic rights could be considered derivative reasons, depending on one's account of basic moral rights.
6 Hart, H. L. A. and Honore, A. M., Causation in the Law (London: Oxford University Press, 1969) p. 34.Google Scholar
7 Ibid., p. 35.
8 I want to thank my colleagues, Don Brown, Howard Jackson, Tom Patton and Peter Remnant, as well as Randy Carter for their many helpful commentsand suggestions for improving this paper.