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Euthanasia is based on the idea of compassion and is the committing of an act or the omission of an act that will result in death. Active euthanasia in an act that directly causes death. Passive euthanasia is the non-performance of an act that causes death. The American Medical Association's rules allow a physician to practice passive euthanasia but not active euthanasia. In James Rachel's paper "Active and Passive Euthanasia", Rachel's arguments concerning active and passive euthanasia disagree with the American Medical Association's view. The main premise of Rachel's paper is there are no moral differences in passive and active euthanasia. Therefore, in a situation where passive euthanasia is acceptable, active euthanasia should be acceptable.
Rachel's first argument is that passive euthanasia is not more moral than active euthanasia, and may actually be considered less moral. This is based on the premise that the decision of euthanasia for the patient has been made. Rachel does not argue the morality of euthanasia, only the type. Rachel states that active euthanasia, having a quicker outcome of death, causes less pain and suffering. Passive euthanasia can be slower and more painful and therefore crueler to the patient, thus leaving active euthanasia the more humane and moral choice.
The second argument is based on Rachel's assumption that passive euthanasia decisions may be based on irrelevant grounds and leads to decisions that are not made based on equal logic. The example Rachel gives is the withholding of food from a baby born with Down's syndrome and an intestinal obstruction. Rachel states that the Down's syndrome should be irrelevant when making a decision of euthanasia for the baby. Some parents will chose passive euthanasia, and the withholding of life saving surgery, based on their logic of a diminished quality of life for the child because of the Down's syndrome. Other parents will choose to have the surgery for their baby based on their concept of quality of life.
Rachel questions whether letting someone die is worse than killing someone or is there no difference in the morality of active and passive euthanasia. The example given discusses whether there is a difference in the morality in watching a child drown in a bathtub and not helping save the child (passive) or holding the child's head under the water in the bathtub and causing the child to drown (active). If the withholding of help to a dying patient is acceptable according to The American Medical Association, then Rachel states the person watching the child drown should have a defense they played no role in the drowning of the child, they only omitted giving help. Rachel disagrees with the American Medical Association and says this is not a defense, thus concluding there are no moral differences in withholding help and actively participating in the death.
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One of the weaknesses of Rachel's argument is that his basic premise is based on an incorrect argument. He argues that there is no moral difference in letting someone die and in performing active euthanasia. Active euthanasia is the participation in the killing of the patient. The active act of killing someone is worse than permitting the patient to die. Therefore there are more moral conflicts in the active act versus the passive omission. Rachel would argue against this weakness with the child drowning in the tub example. Both the behaviors in the drowning example were reprehensible and one is not worse that the other.
Another weakness in Rachel's arguments is that the cause of death is not an issue. With active euthanasia, the doctor is actually killing the patient. In passive euthanasia, the disease is killing the patient. Rachel's rebuttal would be the cause of death is not as important as the good done by the euthanasia. The active killing of the patient by the physician is not wrong if the outcome is better for the patient than the traditional American Medical Association's approach of passivity.
After the decision is made to participate in euthanasia, Rachel reasons that active euthanasia should be as acceptable, if not more so, that passive euthanasia. The patient should be able to determine the method of euthanasia and not the physician. Rachel makes a case that if the American Medical Society permits passive euthanasia, then active euthanasia should be permitted as well. There are weaknesses in Rachel's reasoning that lend support to the American Medical Society's position that physicians may only participate in euthanasia by omission. Intent cannot be separated from the act. Our culture holds human life as sacred and considers the intentional killing of a person, except in defense of another human life, as wrong. The consequences of active participation in the death have more serious consequences as seen by the incarceration of Dr. Kevorkian for his participation in active euthanasia. Our society is still examining the morality of euthanasia. In general, if someone accepts the idea of euthanasia, passive euthanasia is generally acceptable for our society.
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