Euthanasia can be loosely defined as the intentional ending of a life, most commonly to relieve pain or suffering.
Literally meaning “good death,” euthanasia is nonetheless viewed as a moral wrong by many people. The effects of euthanasia can extend beyond those people directly involved, necessitating the ongoing legal debate that has yet to reach a clear consensus on the national level. In the United States, a patient is allowed to refuse medical treatment that would otherwise prolong his or her life, but in very few states is it legal for a physician to directly bring about the death of a consenting patient — even one suffering great pain.
This article will present an argument for the moral permissibility of voluntary euthanasia — meaning the patient has given clear consent — under certain conditions, while also explaining why this permissibility of voluntary euthanasia in isolation directly pertains to its widespread legalization. If there is no clear moral distinction between active and passive euthanasia, active euthanasia should be given the same legality currently held by passive euthanasia.
The exploration of the permissibility and legalization of non-voluntary euthanasia, where the patient lacks the ability to give or withhold consent, is beyond the scope of this article and will not be addressed.
The American Medical Association forbids active euthanasia, insisting by the Hippocratic Oath that a doctor “do no harm.” Passive euthanasia, however, is usually permitted. Philosopher James Rachels believes the AMA statement is outdated. He claims there is no inherent moral difference between active and passive euthanasia.
Rachels divides his argument into three main points. Firstly, Rachels explains that passive euthanasia is commonly a much more painful process of dying than active euthanasia. Because active euthanasia usually brings about less pain, we should, at least in these instances, prefer it to passive euthanasia.
Secondly, Rachels says decisions based on the AMA statement are commonly made for irrelevant reasons. For example, Rachels presents the thought experiment of the Down syndrome baby. Some babies with Down syndrome are born with an intestinal blockage that, if not removed, will bring about the child’s death. Why would it be that we could allow a baby to die if he has this intestinal blockage, but his life will become worth preserving if he does not have it? Surely, Rachels argues, the baby having or not having this intestinal blockage is irrelevant to the decision of whether or not his life is worth preserving.
Finally, Rachels presents what is known as his “bare difference” argument. If all other external circumstances are the same, Rachels believes we can clearly see there is no moral difference between killing and letting die. To illustrate this, he presents the thought experiment of Jones and Smith, in which all circumstances are the same except Smith drowns a child while Jones merely lets him drown. Rachels argues both Jones and Smith committed a moral wrong and that their respective acts were equally wrong.
However, there are those who disagree. Philosopher Winston Nesbitt, for example, believes Rachels’ “bare difference” argument is fundamentally flawed. In his altered examination of the Jones and Smith case, Nesbitt argues the intentions of Jones and Smith must be clearly differentiated if the situation is to be a true comparison of killing and letting die. Therefore, we must assume Jones, who merely let the child drown, would never have been able to summon the will to kill him directly. Smith, on the other hand, always was able to and actually did physically drown the child. Nesbitt says we would much rather have Jones-like people in our society than Smith-like people, and therefore Smith’s act is worse than Jones’.
What Nesbitt mistakenly does, according to philosopher Roy Perrett, is transfer from act to agent evaluation. Because of this, his objections against Rachels’ “bare difference” argument hold no relevance. Nesbitt is merely examining the nature of each individual, and not the actual morality of the acts of killing and letting die.
Therefore, Rachels’ “bare difference” argument is sound, meaning active and passive euthanasia must be morally equivalent. However, this in itself does not directly guarantee the legalization of voluntary active euthanasia is itself morally justified.
The main opposing argument here comes mostly from a standpoint of practicality. Precisely because we cannot choose when passive euthanasia is an available option, it cannot really be abused given that the patient is truly consenting. However, active euthanasia is much more susceptible to abuse than is passive euthanasia. A doctor, although it would be reprehensible to do so, could certainly encourage a patient’s partaking in active euthanasia even in a circumstance where her life may not truly be in as grave of danger as she is led to believe.
Furthermore, in addition to being more susceptible to abuse, active euthanasia is also more susceptible to simple judgmental errors. We know in the case of passive euthanasia a patient still has the opportunity to make a miraculous, unforeseeable recovery. Few ever make such a recovery, but for the ones who did it would never have been possible if they had gone the route of active euthanasia. Human error is the key factor here, the main point being our cognitive and scientific abilities may not be advanced enough to predict a patient’s demise as accurately as needed to make an informed decision. Passive euthanasia allows nature to decide for us, bearing a burden we are simply not yet adept enough to carry ourselves.
Although voluntary active euthanasia certainly has a greater potential for abuse and error than voluntary passive euthanasia, I believe the amount of good produced by allowing a patient to choose for herself how her life will end outweighs any potential evil that could arise.
To illustrate this, we must examine our understanding of medical malpractice in general. Despite the fact that mistakes and abuses do occur, they are certainly not anywhere close to being the majority of treatment cases. This means medical practice on the whole produces a net good that severely outweighs all of the evils it also produces. Likewise, unless we believe most cases of active euthanasia would result in abuse or error, which is not likely, given the statistics of all other medical procedures, widespread legalization of euthanasia is likely to result in a net good.
If voluntary active euthanasia is as morally permissible as passive euthanasia in situations of isolation, and widespread legalization of voluntary active euthanasia will result in a net good outweighing any evils produced, it is then our moral duty to ensure voluntary active euthanasia achieves widespread legalization. ■