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Sadly, there are people in very bad medical conditions who want to die. They are in pain, they are suffering, and they no longer find their quality of life to be at an acceptable level anymore.

When people like this are kept alive by machines or other medical treatments, can it be morally permissible to let them die?

Advocates of “passive euthanasia” argue that it can be. Their reasons, however, suggest that it can sometimes be not wrong to actively kill some patients, i.e., that “active euthanasia” can be permissible also.[1] This essay reviews these arguments.

Ferdinand Hodler, Ferdinand Hodler, “Valentine Godé-Darel on Her Sickbed,” 1914

1. Passive Euthanasia

Denying that passive euthanasia is ever morally permissible suggests that we must always do everything we can to try to keep someone alive, even if they are miserable, want to die, and say so. To many, that’s just cruel.[2]

Passive euthanasia can be directly supported by both consequentialist (or utilitarian) and Kantian ethics.[3]

For the consequentialist, the patient being out of their misery is a better consequence for them, and overall, than their staying alive: this decreases the total amount of pain and unhappiness in the world, and no other choice would produce more good, for them or overall.

For a Kantian, letting them die respects their autonomy or decisions about matters that profoundly affect their own lives: this respects them as “ends in themselves,” whereas forcing them to live treats them as a “mere means” toward our ends, not their own.

Passive euthanasia can also be supported by stating conditions when it can be OK to let someone die. We begin with an ‘if’ and develop a principle:

If . .

(a) someone is dying, and
(b) is in horrible pain and suffering, and
(c) that pain and suffering cannot be relieved, and
(d) that person wants to die and says so, and
(e) informed, thoughtful and caring people agree that the person would be better off no longer living . . ,

then it can be permissible to let that person die.[4]

Passive euthanasia, then, can be justified in a variety of ways.

2. Active Euthanasia

To see why active euthanasia might be permissible, we begin by reflecting on why passive euthanasia might be OK: it gets people out of their misery and respects what they want for their own lives.

We then observe that these goals can often be pursued more directly and immediately by, say, giving them an overdose of pain-killing medications. Letting people die can take a long time, and that time might be full of unwanted suffering. Killing people, when they want to be killed, achieves their goals, more quickly.

So, it seems that if passive euthanasia can be permissible, so can active.

3. Objections

There are many objections to this reasoning. Some concern euthanasia in general.

3.1. Some claim that pain can always be controlled and so there is never a need to euthanize anyone. However, this insistence that pain can always be made bearable is, sadly, not true.

3.2. Some argue that “miracles” are possible – there’s always a chance that someone recovers – and so euthanasia is wrong. But making important decisions on very unlikely chances is often unwise. Most interestingly though, euthanasia would never prevent a miracle, especially one of divine origins.

Further objections claim there are important differences between active and passive euthanasia, making passive permissible but active wrong.

3.3. Some argue that it’s always wrong to intentionally kill someone, so active euthanasia is wrong. In reply, while it’s, at least, nearly always wrong to kill people, this is arguably because people usually want to live and do not have lives full of pain. Perhaps killing can be justified when this is not the case.[5]

3.4. Some argue that allowing active euthanasia might put us on a “slippery slope” to murdering people who want to live. But this hasn’t happened where active euthanasia is allowed, since we do and would have safeguards to lessen this possibility, as we do with other things that might lead to bad results if misused.

3.5. Some argue that there are important moral differences between allowing something to happen and doing something or because killing someone and letting them die are profoundly different, and so passive and active euthanasia should be judged differently. But consider this case:

An aunt will inherit lots of money if her five-year-old nephew dies. She plans to drown him in the bathtub and make it look like an accident. He just started his bath; she’s on her way to the bathroom to drown him. She opens the bathroom door and is delighted to see that he has slipped in the bathtub and is drowning. She watches, ready to push him under if he steadies himself and saves his own life. But, as her luck would have it, he drowns; she never touches him throughout the ordeal. She inherits the money.[6]

If she claimed that she didn’t “do anything,” she did: she stood there, and doing nothing is doing something. And letting someone die can be as bad, or nearly as bad, and perhaps sometimes even worse than killing someone[7]: indeed, a way to kill someone is to let them die. So these distinctions are, at least, not clear.

3.6. A final concern is that especially if active euthanasia were allowed, some people could be wrongfully killed. This is possible: some people might wrongfully break (potentially good) rules. But we cannot ignore that if euthanasia is not allowed, it might be that some people could be wrongly kept alive. Which wrong is more likely? Which wrong is worse?

4. Conclusion

While death is, arguably, usually bad for the person who dies, the goal of euthanasia is to make this less bad: the word euthanasia means a “good death.” These issues are important, and not just for people currently facing hard choices about death. None of us knows what will happen to us: at any time, an accident or illness might force these issues upon us, and so we should engage them more deeply, now.[8]


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