James Rachels: Active and Passive Euthanasia

James Rachels: Active and Passive Euthanasia
Active euthanasia is the intentional termination of a patient's life by another person, for the sake of relieving the pain and suffering of the patient. Passive euthanasia is the cessation of medical assistance needed to prolong a patient's life, again performed for the sake of relieving pain and suffering. The conventional doctrine in medical ethics is that whereas passive euthanasia is sometimes morally permissible, active euthanasia never is. Rachels argues that the conventional doctrine faces serious objections, and cannot be correct.
Rachels raises two objections to the conventional doctrine. The first is that the purpose of euthanasia is to alleviate pain and suffering, and in many cases active euthanasia can serve this function much more efficiently than passive euthanasia. Thus, if a decision has been made to employ euthanasia, active euthanasia is preferable to passive euthanasia. Rachels's second objection is that the conventional doctrine leads to decisions about life and death being made on morally irrelevant grounds. For example, passive euthanasia is sometimes employed on infants born with Down's syndrome who would require a simple surgery to survive. Such infants are allowed to die not because they require surgery, but because they have Down's syndrome. The decision to euthanize such infants depends on the irrelevant fact that they require a simple operation.
The acceptance of the conventional doctrine is often grounded in the view that killing is intrinsically worse than letting die. Against this, Rachels imagines two cases that are exactly alike in every respect, except that one involves killing and the other involves letting die. In the first case, Smith drowns his young cousin to gain his inheritance. In the second case, Jones, like Smith, intends to kill his young cousin, but ends up (because of a slippery bath tub) merely watching him drown. Rachels claims that the two men behave equally wrongly, and that this shows there is no morally relevant distinction between killing and letting die. The distinction between killing and letting die thus cannot be used to support the conventional doctrine
-According to the conventional doctrine, active euthanasia is not morally permissible except in rare circumstances.