There is as yet no widely agreed-upon solution to the standard textbook problem whether actively shutting off a life-sustaining medical device, e.g. a respirator, and thus bringing about a patient9s death amounts to active killing or just to an omission of further treatment. Apart from a range of astutely contrived case examples and respective particular solutions proposed in the literature, there seems to be no consensus on the normative principles such solutions should be grounded in, not even on the (...) need for such principles beyond sheer intuition. The present paper attempts to develop a normative approach based on fundamental principles of law. From this perspective, what is decisive for the question of ‘killing or letting die’ in such cases is not that death ensues from a behaviour that is active and relevantly causative, but rather, whether or not the agent in performing the deadly act transgresses the boundaries of the domain of his or her sole normative authority, and thereby intervenes in the protected sphere of another. Unless he or she does so, their behaviour cannot be classified as active commission regardless of the amount of causal activity it may display and regardless of its potentially harmful consequences. This conception is spelled out in detail and tested in a range of case examples, as are several of its corollaries that deviate from standard type solutions. (shrink)

Many people hold that there is an important moral distinction between passive euthanasia and active euthanasia. Thus, while the AMA maintains that people have a right quote to die with dignity, quote so that it is morally permissible for a doctor to allow someone to die if that person wants to and is suffering from an incurable illness causing pain that cannot be sufficiently alleviated, the MA is unwilling to countenance active euthanasia for a person who is in similar straits, (...) but who has the misfortune not to be suffering from an illness that will result in a speedy death. -/- A similar distinction with respect to infanticide has become a commonplace of medical thinking and practice. If an infant is a mongoloid or a microcephalic, and happens also to have some other defect requiring corrective surgery if the infant is to live, many doctors and hospitals believe that the parents have the right to decide whether the surgery will be performed, and thus whether the infant will survive. But if the child does not have any other defect, it is believed that the parents do not have the right to terminate its life. -/- The rationale underlying these distinctions between active and passive euthanasia, and between active and passive infanticide, is the same: the idea that there is a crucial moral difference between intentionally killing and intentionally letting die. This idea is admittedly very common. But I believe that it can be shown to reflect either confused thinking or a moral point of view unrelated to the interests of individuals. (shrink)

Christian pro-lifers often respond to Thomson’s defense of abortion that the violinist is allowed to die while the embryo is killed. Boonin and McMahan counter that this distinction does not provide an objection to extraction abortions that disconnect embryos and allow them to die. I disagree. I first argue that letting die and killing are not to be distinguished by differences between acts and omissions, moral and immoral motives, intentional or unintentional deaths, and causing or not causing a (...) pathology. I offer a taxonomy in which hysterotomies turn out to be killings. I then argue that if either the placenta is considered an organ of the embryo or the embryo is construed as a part of the pregnant woman, then abortion pills kill rather than allow death. So, assuming that killing people is morally worse than letting them die, extraction abortions can be condemned to the same degree as other abortions. (shrink)

Ever since the debate concerning euthanasia was ignited, the distinction between active and passive euthanasia – or, letting die and killing – has been marked as one of its key issues. In this paper I will argue that a) the borderline between act and omission is an altogether blurry one, and it gets even vaguer when it comes to euthanasia, b) there is no morally significant difference between active and passive euthanasia, and c) if there is any, it (...) seems to favor active instead of passive euthanasia. Therefore, while the distinction between active and passive euthanasia might be meaningful in terms of description, if it is considered to be endowed with moral weight and used on purpose of justifying one type of euthanasia instead of the other, it becomes morally problematic and misleading. (shrink)

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. (shrink)

Is it worse to kill someone than to let someone die? It seems obvious to common sense that it is worse. We allow people to die, for example, when we fail to contribute money to famine-relief efforts; but even if we feel somewhat guilty, we do not consider ourselves murderers. Nor do we feel like accessories to murder when we fail to give blood, sign an organ-donor card, or do any of the other things that could save lives. Common sense (...) tells us that, while we may not kill people, our duty to give them aid is much more limited. Some philosophers, however, have argued that common sense is wrong about this. They have defended the Equivalence Thesis, which says that killing and letting die are equally bad. This is a more specific version of the idea that there is no moral difference between making something happen and allowing it to happen. The Equivalence Thesis is a radical conception that would require changes in our ordinary moral beliefs. If it is true, then obviously our duty to give aid is much stronger than we commonly assume. But our views about other matters, such as euthanasia, will also be affected. Many people believe that “passive euthanasia”--allowing terminal patients to die, rather than pointlessly prolonging their lives--is sometimes permissible; but they also believe that killing patients is always wrong. If the Equivalence Thesis is true, this combination of beliefs is inconsistent. The idea behind the Equivalence Thesis is not that every individual case of letting die is equally as bad as every individual case of killing. Obviously, if we compare an ordinary murder--say, a man killing his wife out of jealousy--with the actions of a physician who humanely permits a suffering patient to die, the murder is much worse. Rather, the idea is that the difference between killing and letting die does not itself make a difference to the moral assessment of the actions. Other factors may still be important. (shrink)

Coggon’s remarks on a previous paper on active and passive euthanasia elicit a clarification and an elaboration of the argument in support of the claim that there is a moral difference between killing and letting die. The relevant moral duties are different in nature, strength and content. Moreover, not all people who are involved in the relevant situations have the same moral duties. The particular case that is presented in support of the claim that to kill is not (...) the same as to let die is based upon a rejection of consequentialism. (shrink)

ABSTRACT Those who wish to refute the view that it is worse to kill than to let die sometimes produce examples of cases in which an agent lets someone die but would be generally agreed to be no less reprehensible than if he had killed. It is argued that the examples produced typically possess a feature which makes their use in this context illegitimate, and that when modified to remove this feature, they provide support for the view which they were (...) designed to undermine. (shrink)

Considers the moral relevance of a distinction between killing and letting die, which distinction is sometimes morally critical, as shown in the difference between killing one to save five and leaving one to die while rescuing them A more basic distinction is, she thinks, between initiating a harmful sequence of events and not interfering to prevent it. The latter is sometimes permissible where the former would not be, because in general we have a stronger right not to (...) be interfered with than positively to be helped. (shrink)

abstract Applied ethics engages with concrete moral issues. This engagement involves the application of philosophical tools. When the philosophical tools used in applied ethics are problematic, conclusions about applied problems can become skewed. In this paper, I focus on problems with the idea that comparison cases must be exactly alike, except for the moral issue at hand. I argue that this idea has skewed the debate regarding the moral distinction between killing and letting die. I begin with problems (...) that can arise from attempts to produce comparison cases that are exactly alike, except for the moral issue at hand. I then argue that attempts to produce such examples are doomed to failure. Finally, I argue that abandoning concerns about similarity advances the debate regarding the moral distinction between killing and letting die. (shrink)

In some medical cases there is a moral distinction between killing and letting die, but in others there is not. In this paper I present an original and principled account of the moral distinction between killing and letting die. The account provides both an explanation of the moral distinction and an explanation for why the distinction does not always hold. If these explanations are correct, the moral distinction between killing and letting die must be (...) taken seriously in medical contexts. Defeasibly, when an agent kills she takes responsibility, but when an agent lets die she does not take responsibility. Therein lies the moral distinction between killing and letting die. The distinction, however, is defeated when an agent is already responsible for the surrounding situation. In such cases, killing does not involve taking any further responsibility and letting die does not avoid taking any responsibility. Medical examples are frequently complicated because patients' autonomous choices impact upon medical practitioners' surrounding responsibility. (shrink)

This collection contains twenty-one thought-provoking essays on the controversies surrounding the moral and legal distinctions between euthanasia and "letting die." Since public awareness of this issue has increased this second edition includes nine entirely new essays which bring the treatment of the subject up-to-date. The urgency of this issue can be gauged in recent developments such as the legalization of physician-assisted suicide in the Netherlands, "how-to" manuals topping the bestseller charts in the United States, and the many headlines devoted (...) to Dr. Jack Kevorkian, who has assisted dozens of patients to die. The essays address the range of questions involved in this issue pertaining especially to the fields of medical ethics, public policymaking, and social philosophy. The discussions consider the decisions facing medical and public policymakers, how those decisions will affect the elderly and terminally ill, and the medical and legal ramifications for patients in a permanently vegetative state, as well as issues of parent/infant rights. The book is divided into two sections. The first, "Euthanasia and the Termination of Life-Prolonging Treatment" includes an examination of the 1976 Karen Quinlan Supreme Court decision and selections from the 1990 Supreme Court decision in the case of Nancy Cruzan. Featured are articles by law professor George Fletcher and philosophers Michael Tooley, James Rachels, and Bonnie Steinbock, with new articles by Rachels, and Thomas Sullivan. The second section, "Philosophical Considerations," probes more deeply into the theoretical issues raised by the killing/letting die controversy, illustrating exceptionally well the dispute between two rival theories of ethics, consequentialism and deontology. It also includes a corpus of the standard thought on the debate by Jonathan Bennet, Daniel Dinello, Jeffrie Murphy, John Harris, Philipa Foot, Richard Trammell, and N. Ann Davis, and adds articles new to this edition by Bennett, Foot, Warren Quinn, Jeff McMahan, and Judith Lichtenberg. (shrink)

This article has two main sections. In Section I, I argue against the skeptic's position. I examine an attempt to see both prima facie objections as arising from features that killing and letting die have in common, and then argue that all such attempts are doomed to failure. In Section II, I explain how even defenders of the distinction's significance have misconstrued the difference between the two objections. In so doing I attempt to develop a better account of (...) why killing and letting die are prima facie objectionable. I also briefly explore some related matters. (shrink)

Some philosopher argue that the distinction between killing and letting die lacks moral significance, since the prima facie objections to both arise from a feature which killing and letting die share: Either way, an agent chooses a course of action resulting in someone's dying, when he could have chosen a course of action having the opposite result. I find this claim ambiguous. Does it mean that in either case, if the agent had chosen the alternative course (...) of action, the victim would not have died at all, at least not for some time yet? Or does it mean that if the agent had acted differently, the victim would have died a death numerically distinct from his actual death? ;I argue that killing is prima facie objectionable owing to the causal relation connecting the agent's action to the victim's token death. If an agent kills someone, his action is prima facie objectionable even if another agent would have killed the person moments later anyway. But failing to prevent a token death event is not in itself prima facie objectionable. On the whole, such a failure is prima facie objectionable only if preventing that token death event would have benefited the victim. And on the whole, preventing a token death event benefits the victim only if it prevents there from occurring any event of the type death of that person, at least for some time yet. ;I do not provide a positive rationale for attributing moral significance to the distinction between killing and letting die. Rather, I try to undermine skepticism about the possibility of providing such a rationale by demonstrating that the prima facie objections to killing and letting die cannot be accounted for in the same way. I also discuss the nature of killing and letting die, how both differ from enabling someone's death to occur, and the relationship between the concepts of harm and benefit. (shrink)

In their account of passive euthanasia, Garrard and Wilkinson present arguments that might lead one to overlook significant moral differences between killing and letting die. To kill is not the same as to let die. Similarly, there are significant differences between active and passive euthanasia. Our moral duties differ with regard to them. We are, in general, obliged to refrain from killing each and everyone. We do not have a similar obligation to try to prevent each and (...) everyone from dying. In any case, to be morally obliged to persist in trying to prevent their deaths would be different from being morally obliged to refrain from killing all other people even if we had both obligations. (shrink)

In a recent Article Carla Kary attempts to show that there should be a significant moral difference between instances of killing and letting die. I shall maintain in Section I that Kary's argument is somewhat weakened by the failure to note an important ambiguity in the notion of killing a person. I shall also argue in Section II that a similar ambiguity affects the notion of letting someone die, and that the failure to note this latter (...) ambiguity also weakens the position developed by Robert Coburn with regard to defective newborns. CiteULike Connotea Del.icio.us What's this? (shrink)

Traditional medical ethics and law draw a sharp distinction between allowing a patient to die and helping her die. Withholding or withdrawing life sustaining treatment, such as by abating technological nutrition, hydration or respiration, will cause death as surely as a lethal injection. The former, however, is a constitutional right for a competent or once-competent patient, while the latter poses a risk of serious criminal or civil liability for the physician, even if the patient requests it.

In 1975, The New England Journal of Medicine published James Rachels' article 'Active and Passive Euthanasia'. The argumentative method that Rachels introduced, the Bare Difference Argument (also known as the Contrast Strategy), became one of the most widely used tools in ethical reasoning. The argument, however, fails to show active euthanasia being morally permissible. It fails because Rachels takes the intuitions from the case where letting die is morally impermissible and applies the intuitions to cases where letting die (...) is morally permissible. While it is possible to create thought-experiments that are more analogous to euthanasia, in this respect, than Rachels' cases, they too are disanalogous to euthanasia with some of the relevant features. Creating the perfect analogy, however, would be a mistake too. Such a case would be too analogous; people would simply be divided on what kind of moral intuitions they would have. The problem thus highlights a methodological limit in philosophical bioethics and raises questions related to the roles of philosophical ethicists in the context of assisted dying. (shrink)

Routinely, in Arriving at decisions on what treatments to recommend in intensive care wards, the moral presumption is that there is an intrinsic difference between the positive duty to save lives and the negative duty not to take lives. The discontinuation of treatment – say stopping chemotherapy or removing a ventilator – is thought of as a “negative” action, an allowing to die, not “positively”, say as an act of suicide by the patient, or a killing by the hospital (...) staff. But the distinction between “positive” and “negative” here, despite its grave ethical import, is elusive and difficult to grasp firmly. St. Anselm of Canterbury was fond of citing the trickiness of the distinction between “to do” and “not to do”. In answer to the question “What's he doing?” we say “He's just sitting there.”, really meaning something negative: “He's not doing anything at all.” Sometimes the “negative” action is described in “positive” terms, or vice versa, and that makes one wonder if the distinction might be somehow trivial, a bit of jesuitry too insubstantial to bear much serious ethical weight. (shrink)

Introduction This paper defends the moral significance of the distinction between killing and letting die. In the first part of the paper, I consider and reject Michael Tooley’s argument that initiating a causal process is morally equivalent to refraining from interfering in that process. The second part disputes Tooley’s suggestion it is merely external factors that make killing appear to be worse than letting die, when in reality the distinction is morally neutral. Tooley is mistaken to (...) claim that we are permitted to kill bystanders who had no fair chance to avoid being at risk of harm. We can support the significance of the killing / letting die distinction by considering the difference between what we are permitted to do in self-defence against those who are going to kill us, and what we can do against those who are going to let us die. I also suggest that we are less responsible for the deaths we allow than for the deaths that we cause, since we do not make people worse off for our presence in cases where we fail to save them. (shrink)

This essay analyzes the principle of double effect and, to a lesser extent, the distinction between killing and letting die in the context of the Pittsburgh protocol for managing patients who may become non-heart-beating donors or sources of organs for transplantation. It notes several ambiguities and unresolved issues in the Pittsburgh protocol but concludes that neither the principle of double effect nor the distinction between killing and letting die (with the prohibition of the former and the (...) allowance of the latter under some circumstances) erects insurmountable obstacles to the implementation of the protocol. Nevertheless, the requirement of the principle of double effect that the intended good effects outweigh the unintended side effects necessitates careful attention to the probable overall impact of the proposed policy on organ procurement, particularly because public mistrust plays such a significant role in limiting the number of organ donations. (shrink)

The distinction between killing and letting die is too simple. A third category must also be recognized. Like killing, preventing a person from being saved is a species of doing harm; like killing, it infringes one of the victim's negative rights. Yet preventing a person from being saved is morally on a par with letting die, which infringes one of the victim's positive rights. It follows that we cannot explain the moral inequivalence of killing (...) and letting die by saying, as so many have, that negative rights are more stringent than positive rights. A more promising strategy is suggested at the end of the article. (shrink)

Judith Jarvis Thomson; Killing, Letting Die, and The Trolley Problem, The Monist, Volume 59, Issue 2, 1 April 1976, Pages 204–217, https://doi.org/10.5840/monis.

Bioethicists involved in end‐of‐life debates routinely distinguish between ‘killing’ and ‘letting die’. Meanwhile, previous work in cognitive science has revealed that when people characterize behaviour as either actively ‘doing’ or passively ‘allowing’, they do so not purely on descriptive grounds, but also as a function of the behaviour’s perceived morality. In the present report, we extend this line of research by examining how medical students and professionals (N = 184) and laypeople (N = 122) describe physicians’ behaviour in (...) end‐of‐life scenarios. We show that the distinction between ‘ending’ a patient’s life and ‘allowing’ it to end arises from morally motivated causal selection. That is, when a patient wishes to die, her illness is treated as the cause of death and the doctor is seen as merely allowing her life to end. In contrast, when a patient does not wish to die, the doctor’s behaviour is treated as the cause of death and, consequently, the doctor is described as ending the patient’s life. This effect emerged regardless of whether the doctor’s behaviour was omissive (as in withholding treatment) or commissive (as in applying a lethal injection). In other words, patient consent shapes causal selection in end‐of‐life situations, and in turn determines whether physicians are seen as ‘killing’ patients, or merely as ‘enabling’ their death. (shrink)

It is commonly held that killing is morally wrong and that the killers need to be punished, and in marginal cases where killing seems justifiable, we are advised to resort to the ethics of killing for general guidance. It is also commonly held that the notion of killing per se is accountable in terms of ‘causing death’, which is a metaphysical (or even physical) issue, having nothing to do with ethics. However, this dichotomy – between the (...) ethics of killing and the metaphysic of killing – is questionable and we claim that the notion of killing itself presumes a social norm, which generally involves ethical considerations. This explains why there has been much debate concerning the distinction between killing and letting die. According to the account of killing that shall be proposed in this article, the distinction is based on a social norm rather than a metaphysical reality. Likewise, there is no metaphysical ground for an active-killing/passive-killing distinction. With the help of a value-time diagram that captures a key feature of a genuine act of killing, six classic scenarios in the ethics of killing are analyzed within the same framework. The prominent feature of this approach is that no physical action is an act of killing before the imposition of a social norm. (shrink)

ABSTRACTI believe that there is no intrinsic moral difference between killing and letting die. That is, there is no difference that depends solely on the distinction between an act and an omission. I also believe that we can reasonably establish this thesis by appeal to the Bare Difference Argument. The form of this argument involves considering two imaginary cases in which there are no morally relevant differences present, save the bare difference that one is a case of (...) class='Hi'>killing and one a case of letting die. But in the pair of cases under consideration this bare difference makes no moral difference. Hence it cannot be that the bare difference between killing and letting die is in itself a morally important difference.Winston Nesbitt has recently argued that the Bare Difference Argument fails because “the examples produced typically possess a feature which makes their use in this context illegitimate, and that when modified to remove this feature, they provide support for the view which they were designed to undermine”. I argue that Nesbitt misunderstands the logic of the Bare Difference Argument and that accordingly his objections are mistaken. (shrink)

Disconnecting a patient from artificial life support, on their request, is often if not always a matter of letting them die, not killing them—and sometimes, permissibly doing so. Stopping a patient’s heart on request, by contrast, is a kind of killing, and rarely if ever a permissible one. The difference seems to be that procedures of the first kind remove an unwanted external support for bodily functioning, rather than intervening in the body itself. What should we say, (...) however, about cases at the boundary—procedures involving items that seem bodily in some respects, but not others? When, for instance, does deactivating an implanted device like a pacemaker count as killing, and when as letting die? Contra existing proposals, I argue that the boundaries of the body for this purpose are not drawn at the boundaries of the self, or (if this is different) the human organism. Nor should we determine when we are killing and when we are letting die by deferring to existing practices for distinguishing ongoing from completed treatment. Rather, I argue that whether something (organic or inorganic) counts as body part for purposes of this distinction depends on the results of a normative analysis of the particular character of our rights in it—particularly, whether and in what way these rights ought to be alienable. I conclude by arguing that there are likely good reasons to recognize distinctively “bodily” rights and restrictions in at least some implantable devices. (shrink)

ABSTRACTThere are a number of arguments that purport to show, in general terms, that there is no difference between killing and letting die. These are used to justify active euthanasia on the basis of the reasons given for allowing patients to die. I argue that the general and abstract arguments fail to take account of the complex and particular situations which are found in the care of those with terminal illness. When in such situations, there are perceptions and (...) intuitions available that do not easily find propositional form but lead most of those whose practice is in the care of the dying to resist active euthanasia. I make a plea for their intuitions to be heeded above the sterile voice of abstract premises and arguments by examining the completeness of the outline form of the pro‐euthanasia argument. In doing so, I make use of Nussbaum's discussion of moral perception and general claims to be found in the literature of moral particularism. (shrink)