moral taxonomy and rachels' thesis

North American Philosophical Publications

Moral Taxonomy and Rachels' ThesisAuthor(s): D. W. HaslettSource: Public Affairs Quarterly, Vol. 10, No. 4 (Oct., 1996), pp. 291-306Published by: University of Illinois Press on behalf of North American Philosophical PublicationsStable URL: http://www.jstor.org/stable/40435962 .

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Public Affairs Quarterly Volume 10, Number 4, October 1996

MORAL TAXONOMY AND RACHELS' THESIS

D. W. Haslett

philosophy articles have ever been more widely anthologized in textbooks than James Rachels' classic article "Active and Passive

Euthanasia."1 And for good reason. This article presents and defends an important thesis in a manner that is rarely equaled for clarity and the ability to stimulate both students and instructors alike. To under- stand Rachels' thesis, one must start with the difference between active and passive euthanasia. Passive euthanasia is discontinuing means of keeping patients alive - that is, discontinuing treatment for terminal patients - and letting them die. Active euthanasia, on the other hand, is killing terminal patients by, say, a painless injection. So the difference between active and passive euthanasia boils down to no more than that the former is killing, and the latter is letting die. But while, with proper consent, passive euthanasia is generally considered morally permissible, active euthanasia is almost universally condemned as murder, no matter how much a patient may beg for it. Rachels argues that, in permitting passive euthanasia, which is often slow and agonizing, while rejecting active euthanasia, which is quick and painless, we are making a huge mistake, the effect of which is to force innumerable dying people to suffer needlessly, and sometimes unbearably. For Ra- chels' thesis is, quite simply, that, to whatever extent passive euthanasia is morally justified, active euthanasia must be also.

In defense of this thesis, Rachels asks us to compare two hypothetical cases. In the first case, Smith sneaks into the bathroom while his six-year old cousin is taking a bath, pushes his head under water and drowns him making it look like an accident so that Smith can thereby inherit his cousin's fortune. In the second case, another person, Jones, intends to do the same thing to his six-year old cousin so as to inherit his fortune, but as he sneaks into the bathroom, his cousin accidentally falls, bumps his head, and is drowning in the tub of water. Rachels writes that "Jones is delighted; he stands by, ready to push the child's head back under if necessary, but it is not necessary. With only a little thrashing about, the

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child drowns all by himself, 'accidentally/ as Jones watches and does nothing."2 Now, as Rachels correctly points out, we tend to view what occurred in each of these two cases to be equally reprehensible, and they are identical in every respect except the one involves killing, and the other, letting die. What this shows, Rachels claims, "is that the bare difference between killing and letting die does not, in itself, make a moral difference."3 But since the only difference between active and passive euthanasia is that one is killing and the other is letting die, if the difference between killing and letting die is not morally relevant, then it follows that, to the extent that passive euthanasia is morally permissible, active euthanasia must be also, which is precisely the thesis Rachels is defending.

In this paper I shall try to show, through an investigation into moral taxonomy, that Rachels' defense is flawed, that the bare difference between killing and letting die is indeed morally relevant. Yet I shall conclude by arguing that Rachels' thesis nevertheless is correct, but for reasons other than those Rachels himself gives.

But one of the premises upon which my argument depends cannot be defended within the parameters of this paper. So let me make this premise known from the start. It is, simply, that the general point of morality, the reason societies have codes of morality in the first place, is overall well-being, which is to be calculated by giving each person's well-being equal consideration.4 If then the general point of morality is overall well- being, it follows that the most justified code of morality is that code which will be most successful in bringing it about. Although any attempt to defend this premise is far beyond the scope of this paper, I have attempted to defend it elsewhere,5 and, in any case, it is, I think, a premise with which many people already, more or less, agree.

I. Moral Taxonomy

Let us begin by performing a kind of thought experiment. Let us suppose that we must draw up, from scratch, a code of morality for our society. Whatever code we draw up will, we may assume, actually be adopted (that is, backed by social pressure) in our society; people will come to "internalize" it, teach it to their children, criticize deviations from it, and so on. But suppose, finally, that, in drawing up this code, we must do so as if our goal were, and were only, that of drawing up the general kind of moral code likely, once adopted, to bring about more overall well-being than would any other kind of moral code. Being thus concerned only about what kind of moral code, in general outline, is likely to maximize overall well-being, we shall not, therefore, be concerned about the details of this code, only with its general taxonomy.



MORAL TAXONOMY AND RACHELS' THESIS 293

First of all, if we want a code that will likely maximize overall well- being, we do not want an act utilitarian code - that is, we do not want a code that requires everyone always to do that which maximizes overall well-being. What maximizes overall well-being would, typically, be ex- tremely difficult to know, and people's opinions about what maximized overall well-being would differ widely, without anyone's being able to know for sure what anyone else's opinion really was (after all, another's opinion about what maximized overall well-being might be to lie about his or her opinion). Thus, if everyone were always to do what (they believed) maximized overall well-being, then no one could be very con- fident about what anyone else would end up doing, cooperative behavior would become next to impossible; and, in short, well-being would be far from maximized.6

So, rather than its requiring that each person always pursue overall well-being, our code must instead provide ample room for each person to pursue his or her own well-being. John Stuart Mill explained why in his famous arguments against paternalism in either law or morality. As Mill pointed out, although there are, of course, exceptions, generally speaking people know more about themselves, and thus what will be most conducive to their own well-being, than they know about others or others know about them.7 So if, as a general rule, people are left free to pursue their own well-being, more overall well-being is likely to result than if people are not left free, but must instead always pursue the well-being of others or have their well-being decided for them by others.

Notice, however, that certain ways of pursuing one's own well-being are much more conducive to overall well-being than certain other ways. Take, for example, the person, during primitive times, who pursues his own well-being by what libertarians like to call original acquisition, that is, by appropriating some land that does not belong to anyone, clearing it, and building a homestead where none existed before. Or take the busi- nessperson, today, who pursues her own well-being by producing a product so useful and well-made that she makes a fortune for herself. Both of the above are pursuing their own well-being positively, that is, in such a way that not only do they benefit themselves, but they also benefit others, thereby probably increasing overall well-being. In the first case, a homestead is built that, after the original occupant leaves, can probably be used by others to make them better off as well, while, in the second case, a product is being produced that may make the lives of many thou- sands a little better than otherwise. On the other hand, people may instead pursue their own well-being in ways not positive; that is, in ways not likely to increase overall well-being. Take, for example, Brutal, who pursues his own well-being by killing the person who built the homestead, or driving him off, thereby appropriating it for himself. Brutal's




increase in well-being will be offset by a corresponding decrease in the original occupant's well-being. Similarly, take Shady who drives her competitors out of business not by making a better product, but by deceptive business practices. Shady not only thereby fails to benefit the public, but may seriously harm the public by producing a product that is inferior to that of those whom she has, through her deceptive practices, driven out of business. The point of these examples is that, if we want a morality that maximizes overall well-being, we shall want it to allow people to pursue their own well-being only in ways likely to be "positive." Thus we shall want our morality to prohibit people from increasing their own well-being by killing others, assaulting them, forcibly taking what others have, raping them, deceiving them, and so on. In other words, we shall want a morality according to which people are (to use the language of morals) "obligated" to not do these things, and have a "right" to not have these things done to them. An obligation to not do something to someone is known as a "negative" obligation. These obligations (or duties) will take the form of moral norms, or principles, such as "Do not kill," "Do not assault," "Do not steal," "Do not rape," and "Do not deceive." Of course there will be a limited number of exceptions built into these norms, such as, in the case of "Do not kill," an exception for self-defense, but we need not be concerned about details, only general taxonomy.

For purposes of my argument later, however, I must point out one exception that we will not want built into these norms, and one that we will want built into them. The exception that we will not want is an exception for cases where what would otherwise be prohibited happens to have the best overall consequences in the case at hand. As a result of people's incomplete knowledge, false beliefs, and rationalizations about what had the best consequences, such an exception would inevitably bring about far more mischief than good (cf., the mischief from an act utilitarian code). So our code of morality must insist that moral agents adhere to all obligations regardless of the overall consequences in the particular case at hand.8

The exception that we will want built into the norms of our code is an exception for cases of consent. According to this exception, if a norm gives P a right that X not be done to him by Q, then P, through genuine consent, can waive his right, thereby making it morally permissible for Q to do X to P. For example, by means of this exception, what would ordinarily be a prohibited assault upon a person becomes morally permissible through his consenting to play tackle football. For consent to be genuine, the consenting party must be: (1) in a normal state of mind; (2) free from coercion; and (3) aware of certain information relevant to the consent.9 An exception for cases of genuine consent will give people more freedom to pursue their own well-being than they would have with-




out such an exception. But we will want this exception for consent to be qualified in one respect. We will want there to be an irrebuttable presumption against the genuineness of any consent from certain classes of people to certain kinds of things. For example, we will want there to be an irrebuttable presumption against the genuineness of any consent from a mere child to sex from an adult. If morality allowed people to come to their own conclusions in each particular case about whether a child's consent to sex met all the conditions necessary for being genuine, more often than not people's conclusions would be mistaken. Thus it is more conducive to overall well-being if, instead, morality simply imposes an irrebuttable presumption against any such consent being genuine.

So far then we have introduced, into our morality, "negative" obligations - that is, obligations to not do certain (generally) harmful acts to others - and, correlated with these negative obligations, are the "negative" rights of others to not have these certain acts done to them. But our morality is incomplete. If it really is to succeed in maximizing overall well-being, it must not just discourage harmful acts, but must also encour- age beneficial ones. Should we then introduce into it a general obligation to benefit others? Such an obligation would be "positive," in that it would require that we do something for others - namely, benefit them - and correlated with it would be a "positive" right on the part of others that we do this for them.

Before we investigate further whether to admit into our code a general positive obligation to benefit others, let us look first at two types of specific positive obligations that, I suggest, we will want to admit for rather obvious reasons. The first is an obligation to benefit those whom we have wrongly put into a position of needing our benefit. If, for example, in teasing our nervous friend by rocking the rowboat in which we are fishing, we go too far and negligently knock him overboard, this should create in us a positive obligation to do what we can to save him from drowning. The second kind of positive obligation we will want to admit into the code is an obligation to fulfill the normal expectations of whatever "special relationships" we have voluntarily, or semi- voluntarily, en- tered into with others. For example, the doctor / patient relationship, lawyer / client relationship, and, in general, promisor / promisee relationship should create, on the part of the doctor, lawyer, or promisor, an obligation to do, for the patient, client, or promisee, whatever necessary to fulfill the normal expectations brought about by the special relationship in question.

But now let us return to the crucial question of whether we want to admit into our code a general obligation to benefit others. I say that, if our goal is to maximize overall well-being, we do not want to admit such an obligation. Remember that an obligation must be adhered to; adher-




enee is not discretionary. But if we are given no discretion about whether or not to adhere to an obligation, then, at the very least, the obligation must be made relatively clear. Vagueness in obligations is hardly conducive to overall well-being. It leaves people confused, tentative, and inse- cure. But can a general obligation to benefit others, such as the starving people throughout the world, be made clear enough? The first problem is that of where to draw the line. Must one give 5 percent, 10 percent, 25 percent, or 50 percent of one's income to benefit others, or perhaps, as Peter Singer seems to hold,10 as much of one's income as one can give without leaving oneself as bad off as those whom one is benefiting? Singer's rather extreme suggestion can be rejected right off. An obligation to benefit all the way to the point where one is no better off than those whom one is benefiting would leave people with little scope to pursue that which they know best - namely, their own well-being. And, as we have seen, any code of morality that fails to provide people with ample scope for pursuing their own well-being will fail to maximize overall well-being. But then where should we draw the line? There appears to be no rational place - that is, nonarbitrary place - at which to draw the line, and obligations for which no rational lines appear possible are ones about which we have good reason to be suspicious.

There are still more problems with admitting into our code a general obligation to benefit others. As we have seen, if we have a moral obligation to do, or refrain from doing, something, then certain others have a right that we do, or refrain from doing, it. I know there are philosophers who have argued that obligations need not necessarily have rights correlated with them.11 But be that as it may, I do not think we want to admit any moral obligations into our code of morality that have no rights correlated with them, any more than we want to admit any moral rights into our code that have no obligations correlated with them. An obligation to do, or refrain from doing, something, that is not "owed" to anyone - in other words, that is not correlated with any rights of anyone to have the thing done, or not done - is empty and meaningless, just as a right to something is empty and meaningless if there is no one with any obligation to do, or not do, it.

But if we are not going to admit any obligations into our code that have no rights correlated with them, this raises the question of what rights would be correlated with a general obligation to benefit others? Take, for example, those starving in Bangladesh. It would seem that a general obligation to benefit others would have to include benefiting these starving people through, say, our financial contributions. But then if we rec- ognize a right to be benefited on the part of those whom we are obligated to benefit, this would mean that the starving people in Bangladesh have a right to our financial contributions. But what if we felt that our contribu-




tions would do more good going, instead, to a fund devoted to cancer research? Or what if we felt that what would help others most is for all our money, at present, to go toward medical school expenses, since, were we to succeed in becoming a physician, we would, in the long run, do more good than if we gave it to the starving now? The point is that there are innumerable ways in which we might use our resources for the good of others, and how could those in need of our help ever really know for sure if we were using our resources in just that way which satisfied their "right" to be helped? How would we ourselves know? In short, unless a general obligation to benefit others could be made much more clear, and I do not see how, benefiting others in general would appear not to be suitable for being made into an obligation.

But surely that should not be the end of it. Surely for a code of morality to be as conducive as possible to overall well-being, it must offer some kind of encouragement for people to help others who are in great need. What we need is encouragement that falls short of an obligation; encouragement that does not give anyone a right to our help and, therefore, leaves it up to us, in each individual case, whether or not to provide it, encouragement that does not preclude us from act utilitarian- like calculations as to how our limited resources might be used so as to result in the best overall consequences, encouragement that still leaves ample scope for us to pursue our own well-being as well. What we need, in short, is to admit benefiting others into our code, not as obligation, but as a value.12 Better yet, we should admit it as a family of related values, ones such as generosity, compassion, charity, kindness, and so on. Moral values may be used to evaluate different kinds of "things," the two most common being acts and people. Giving a thousand dollars to a charity, for example, will normally deserve to be labeled a "generous act," while someone who regularly performs generous acts (or who, perhaps, performs one super-generous act) will deserve to be called a "generous person." But we need focus here only on the use of values for evaluating acts. Since values do not, like obligations, delineate acts that we must do (or not do), values therefore need not be specified as precisely as obligations. In general, our moral code will, I suggest, be most conducive to overall well-being if - aside from the two positive obligations mentioned above - our code puts benefits into the category of good values, thereby reserving the category of obligations largely for prohibitions against harms. In any given case in which we could benefit others in general, our morality will thus allow us to pursue our own best interests instead (although we will not be particularly praiseworthy for doing so). And, in pursuing our own best interests, we need not, of course, take what has the best overall consequences into account. On the other hand, if we do choose to exemplify good values through benefiting others, then what has




the best overall consequences may, and should, be taken into account. Finally, we will want to admit a number of other values into the code in addition to those having to do directly with benefiting others - values such as industriousness, courage, and determination - and, for delineating that which is bad, we will also want to admit ¿//¿values into our code as well - disvalues such as selfishness, laziness, and cruelty. Moreover, the category of values will also include virtues, ideals, and so on. But, once again, we are interested only in the code's most general taxonomy, and need not, therefore, pursue these matters in any greater detail.

The hypothetical code of morality arrived at here through our thought experiment should seem familiar, for its general taxonomy is, I suggest, very much the same as that of the code which already exists in our society. Just as does our hypothetical code, our society's current code of morality consists, essentially, of two kinds of moral criteria: obligations and values. Obligations delineate that which we must not do to others (or what we must do for them), and correlated with obligations are the rights of others not to have these things done to them (or to have them done for them). And, just as in our hypothetical code, most obligations in our society's current code prohibit us from doing certain harms, as opposed to requiring us to perform benefits. The job of encouraging us to perform benefits generally falls within the realm of values instead. Thus, just as does our hypothetical code, our society's current code takes seriously the distinction between harming and failing to benefit, as well as related distinctions, such as that between killing and letting die. According to both codes, it is a far more serious matter to kill ten starving people by sending them a poisoned cake, then to let ten starving people die by deliberately failing to contribute to a charity that would have used our contribution to save their lives. This is because, generally speaking, harming and failing to benefit fall, for good reasons, under two entirely different parts of both codes, and thus have entirely different moral statuses. Let us turn now to what we should conclude, from this examination of moral taxonomy, about the truth of Rachels' thesis.

II. Rachels' Thesis

As will be recalled, Rachels' thesis is that, to whatever extent passive euthanasia is morally justified, active euthanasia is also. And, as we saw, the cornerstone of his defense of this thesis is that "the bare difference between killing and letting die does not, in itself, make a moral difference." But, as our thought experiment into moral taxonomy has sug- gested, for a moral code to treat harms differently, in general, from benefits makes perfectly good sense. In particular, it makes perfectly good sense for killing people (a harm) to fall within the realm of what we




are obligated not to do, thereby precluding discretion, and for not letting people die (a benefit) to fall within the realm of values, thereby allowing for discretion.13 If morality grants discretion about whether to do something (e.g., let the starving die), then, in most cases at least, doing it cannot appropriately be morally condemned with the same degree of in- tensity as we condemn doing what is prohibited (e.g., killing the starving). So, contrary to what Rachels claims, the difference between killing and letting die is, in fact, morally relevant, which means that the cornerstone of his defense fails.

But, Rachels might ask, if the bare difference between killing and letting die is, as I claim, morally relevant, then how can I explain our moral intuitions in the bathtub cases, our moral intuitions that Jones, in letting his cousin die, did what was just a heinous as what Smith did, in killing his cousin? I must grant that most people's moral intuitions about these cases , including my own, do indeed seem to run counter to what I claim. For an explanation of these intuitions, we must go back to the reason why morality should, and does, view benefiting others as, in most cases, falling within the realm of values, not obligations. Normally, as we saw, it is virtually impossible to know whether a moral agent really is doing just that alternative which does the most good in the particular circumstances at hand. Take, for example, the case of a person who fails to give money to life-saving charities. Do we really know that he is not doing as much, or more, good through the alternative use to which he is putting his money? Say that his alternative use is to start a business that will not only contribute much to the well-being of the community, but will enable him to give far more to chanties over his lifetime than he would have been able to give had he given now. The point is that, in the typical case of failing to perform a certain benefit, B, at a certain time - such as failing to give to life-saving charities now - either an alternative activity, A, or an alternative time for doing B, may well, for all we know, end up doing as much, or more, good. That is why (aside from the two kinds of exceptions mentioned above) morality wisely leaves whether, and how, to benefit others, in any given case, to the agent's discretion. But even though letting die, being thus discretionary, does have a different moral status than killing, there is no reason why it should not be viewed as being, in just the right circumstances, just as heinous as killing. And Rachels' bathtub case - where all Jones needs to do to save a drowning child is take his hand and flick him out of the water - is an example of just the right circumstances. Contrary to most other circumstances, here it is painfully obvious that, at the moment, no alternative - such as, say, that of Jones' scratching his head instead - is likely to do even remotely as much good, and this good can be done by no one else but Jones, and by Jones at this instant only. In short, contrary to most




other circumstances, the circumstances in this particular case are stripped of any (reasonable) ambiguity whatsoever. That is why, contrary to most other circumstances, we intuitively view letting die here as being just as heinous as killing.14

But then if, in these circumstances "striped of any ambiguity," letting die actually is just as heinous as killing, does this not show that the "bare" difference between them is not morally relevant after all? Not really, for consider now the following variations of Rachels' bathtub cases. For simplicity, let us assume that none of the people in any of these cases has any special relationship obligations to any others. Case One. Jones, walking through the woods, comes upon Portly, unconscious, drowning in a puddle of water, and all Jones needs to do to save him is kick him out. This case is the one most similar to Rachels' letting-die bathtub case, and if Jones were to just walk past and let Portly die, then we would view it as being just as heinous as Jones letting his Cousin die in the bathtub. Case Two. Jones, walking through the woods, comes upon Portly, unconscious, drowning in a puddle of water, and five other people, unconscious, drowning in another puddle. Jones is halfway between each puddle, and has time only to reach one of the puddles before the occupants drown. No one will consider it improper if, to save the five people, Jones lets Portly die. Case Three. Jones, walking through the woods, comes upon Portly stuck firmly in the only entrance to a cave and, looking through a crack, Jones sees five people behind Portly in the cave unconscious, drowning in a puddle. Portly will eventually be able to free himself from the entrance, but not in time for Jones to save the five drowning people. The only way Jones can possibly reach them in time is to do so by killing Portly. Now clearly his killing Portly is morally prohibited, even for the sake of saving these five people. If he were to do so, his humanitarian motives might significantly mitigate the severity of our condemnation of Jones himself, but it would not significantly mitigate the severity of our condemnation of his act, which, in spite of its good consequences, we would still condemn as wrong and, like any other murder, heinous.15 Jones may, without our condemning it, let Portly die to save the five, but he may not kill Portly to save them.16 What this suggests is that the extent of our condemnation in cases of letting die is more sensitive to the overall consequences of doing so than in cases of killing. This makes sense, given that, for good reasons, our morality typically prohibits our taking overall consequences into account in cases of killing and other matters of obligation, but encourages us to do so in cases of letting die and other matters of value. So if the bad consequences of letting die are clear-cut enough, our condemnation of doing so will approach the severity of our condemnation of killing in similar circumstances - which explains our severe condemnation of letting die in the bathtub case. But, as the Portly




cases suggest, the converse is not true. No matter how clear-cut good consequences of killing may be, our condemnation of doing so will never approach the mildness of our condemnation, if there be any at all, of letting die in similar circumstances. Unfortunately, Rachels' defense of his thesis requires not that, in clear-cut cases with bad consequences, our condemnation of letting die be as severe as our condemnation of killing (which it is). Rather, his defense requires that, in clear-cut cases with good consequences, our condemnation of killing be as mild as our condemnation, if there be any at all, of letting die (which, for good reason, it is not).

Let us now take stock. I have argued that Rachels' defense of his thesis fails because the bare difference between killing and letting die is, in fact, morally relevant. Moreover, this thesis cannot be saved by trying to justify an exception, to be built into the obligation not to kill, for just those cases (such as cases of euthanasia) in which killing has the best overall consequences. As our investigation into moral taxonomy has ahown, no such exception can be j stified. But, as our investigation has also shown, one exception to our obligations that can be justified is an exception for cases of consent. According to this exception, doing what otherwise would contravene an obligation becomes morally permissible if the person to whom the obligation was owed genuinely consents to its being done. I will conclude by trying to show that Rachels' thesis can be saved if defended by appeal to this exception for consent.

The first thing is to recall about the exception for consent is that it is not applicable across the board; there is an irrebuttable presumption against there ever being genuine consent from certain classes of people to certain kinds of things. One such irrebuttable presumption which any justifiable code of morality must surely include is an irrebuttable presumption against the genuineness of any consent from a healthy person to being killed. Even though, occasionally, such consent might in fact be genuine; nevertheless the mischief resulting from attempting to deter- mine, on a case by case basis, the genuineness of a healthy person's consent to be killed would, for obvious reasons, far outweigh any good. Likewise, for those cases which, through a special relationship or otherwise, we have incurred an obligation not to let a person die, a justifiable code of morality will include an irrebuttable presumption against the genuineness of any consent from that person to being allowed to die. For example, a child cannot, merely by consent, relieve her parents of their (special relationship) obligation not to deliberately let her die. Similarity, a patient whose life can easily be saved through standard medical procedures cannot, merely by his consenting to being allowed to die, relieve his physician of her (special relationship) obligation to save his life through these procedures. As long as she remains his physician, she




retains an obligation not to let him, an easily curable patient, simply die, even if he instructs her to do so. (He can, I assume, always fire the physician, but as long as she remains his physician, she retains the obligation to do her best to save him.)

Now, as it so happens, in cases where a patient is, say, suffering im- mensely, and nothing further can be done to save him, our current morality suspends this irrebuttable presumption against consent to being allowed to die, thereby paving the way for passive euthanasia. So genuine consent from the patient himself, or, when the patient is permanently incapable of consenting, genuine consent from the immediate family, is usually considered morally sufficient for discontinuing "extraordinary means" of keeping a terminal patient alive.17 It is not my purpose here to justify the suspension, in these circumstances, of this irrebuttable presumption against being able to consent to being allowed to die, although I do think it is justified. Instead my purpose is to point out that, if the suspension of the irrebuttable presumption against being able to consent to being allowed to die is, indeed, justified in these circumstances, then the suspension of the irrefutable presumption against being able to consent to being killed should, in these very same circumstances, be justified as well.

In fact, the argument for suspending the irrebuttable presumption is actually stronger in the case of killing than in the case of letting die. This is because the good that results from suspending the irrebuttable presumption in the case of killing, thereby paving the way for active euthanasia, goes beyond even the good that results from suspending it in the case of letting die, thereby merely paving the way for passive euthanasia. Among the good results in both cases are (1) a conservation of scarce medical services desperately needed for purposes far more important than forcing terminal patients to remain alive against their will,18 and (2) a quicker end in the intense suffering that terminal patients and, to a lesser extent, their families, must often endure. Both of these good results are achieved to an even greater extent by suspending the irrebuttable presumption in the case of killing (thereby allowing for an even more quick and pain free death) than by doing so in the case of letting die.

Moreover, the only potential bad results of allowing the practice of euthanasia - that is, the only ones not grounded merely on supersti- tion - are, for the most part, applicable to both active and passive versions. The first, and most serious, potential bad result of allowing the practice of euthanasia is that it might all too often take place without consent that is genuine. But I suspect that this result can, for the most part, be avoided by implementing certain safeguards to help assure that any consent is genuine. The second potential bad result of allowing the practice of euthanasia is that of its occurring in cases in which the patient




is mistakenly diagnosed as being terminal. In any such cases, lives will then be lost that would otherwise not have been. There is, I suppose, a slightly higher chance of this happening in cases of active euthanasia19 but, for either active or passive cases, with proper precautions, such as requiring more than just one competent, medical opinion, the chances of this happening can be kept well within acceptable bounds. Indeed, the chances of people dying who would not otherwise have died can be kept much lower with either passive or active euthanasia than they can with automobiles, and we certainly do not think that we must prohibit automobiles. The third and, I believe, final, potential bad result is that euthanasia will serve as an "entering wedge" for the eventual acceptance of clearly wrong, "nazi-like" practices, such as letting babies and elderly people die, or killing them, merely if they become an inconvenience.20 If the entering wedge were a problem at all, it would be a problem for both the active and passive versions of euthanasia. But extensive worry over the so-called entering wedge here really does, I think, smack a bit of paranoia. Entering wedges are, after all, only a problem in those cases in which, as between what is morally acceptable and what is not, reasonably clear lines cannot be drawn. For both active and passive euthanasia, there is no reason why clear lines cannot be drawn.

I conclude, therefore, that Rachels was right all along: to the extent that passive euthanasia is morally justified, active euthanasia must be also. But this is not a consequence, as Rachels argues, of there being no morally relevant difference between killing and letting die. There is a relevant difference. It is instead a consequence of there being no morally relevant difference between a certain two applications of the exception for consent - namely, its application to our obligation not to kill, and its application to our obligation to not let die in cases of special relationships.21

University of Delaware Received April 29, 1996

NOTES

1 . James Rachels, "Active and Passive Euthanasia," The New England Journal of Medicine, vol. 292 (1975), pp. 78-80. This article is reprinted, among many other places, in Morality and Moral Controversies, 4th ed., edited by John Arthur (Engle- wood Cliffs, NJ: Prentice-Hall, 1996); Social and Personal Ethics, 2nd ed., edited by William H. Shaw (Belmont, CA: Wadsworth, 1996); and Killing and Letting Die, 2nd ed., edited by Bonnie Steinbock and Alastair Norcross (New York: Fordham University Press, 1994). My page references here to Rachels' article are from the latter anthology, which includes a number of other articles relevant to the issues raised in this paper.

2. Ibid., p. 115.




3. Ibid., p. 116. Rachels defends, in greater detail, this claim about letting die being morally equivalent to killing in "Killing and Starving to Death," Philosophy 54 (1979), pp. 1 59-7 1 . Although the distinction between killing and letting die is not entirely clear in all cases, it is clear enough for my purposes here. For one attempt at further clarification of this much debated distinction, see Jeff McMahan, "Killing, Letting Die, and Withdrawing Aid," Ethics, vol. 103 (1993), pp. 250-79; reprinted in Killing and Letting Die, pp. 383-420.

4. What giving each person's well-being "equal consideration" in our calculations means is that equal degrees of well-being, with equal probabilities of occurring, are to be given equal weight, no matter whose well-being it might be. My argument in this paper does not depend, incidentally, upon which of the main alternative accounts of what constitutes "well-being" happens to be correct.

5. D. W. Haslett, Capitalism with Morality (Oxford: Clarendon Press, 1994), ch. 1; and Equal Consideration, (Newark, DE: University of Delaware Press; London and Toronto: Associated University Presses, 1986).

6. See Capitalism with Morality; sec. 1.6. This objection to act utilitarianism is spelled out most fully in G. J. Warnock, The Object of Morality (London, Methuen, 1971).

7. John Stuart Mill, On Liberty, 1859, many editions. 8. It is important that an exception for what has the best overall consequences not be

mistaken for an exception for genuine, life-or-death emergencies, an exception which, I assume, moral obligations will indeed have built into them. This exception for genuine emergencies must be carefully formulated, however, with clear boundaries, so as to assure that it does not simply collapse into a vague exception for that which has the best overall consequences. And it might well be formulated even to allow, in life-or-death emergency situations, killing an innocent person if, and only if, doing so is necessary for preventing an imminent disaster that the person to be killed would himself have died in anyway (as in the famous case of the fat man who is hopelessly stuck in the only exit from a cave in which, behind him, five people, who happen to have some dynamite, are trapped, and, if they do not get out quickly, the rising tide will drown them all, including even the fat man, since he is facing in). But details about the formulation of this exception for emergencies need not delay us here.

9. Of what information, exactly, the party must be aware in order for his or her consent to be genuine is fine tuning we need not pursue here.

10. Peter Singer, "Famine, Affluence, and Morality," Philosophy & Public Affairs, vol. 1 (Spring, 1972).

1 1 . For example, Joel Feinberg, "The Nature and Value of Rights," The Journal of Value Inquiry, vol. 4 (1970), pp. 243-57.

12. Cf. J. O. Urmson, "Saints and Heroes," in Essays in Moral Philosophy, ed. by A. I. Melden, (Seattle: University of Washington Press, 1958), pp. 198-216.

1 3. Of course killing a person is not always a harm for that person, anymore than not letting a person die is always a benefit. In the case of a terminally ill patient who is suffering, for example, killing him may well not be a harm, but a benefit. Our obligation not to kill is based on the fact that, typically, to kill is to harm. Moreover, our morality does not, for good reasons, countenance an exception to this obligation for the atypical case in which it is a benefit. Any moral code that permitted people to kill whenever they happened to think that, in the case at hand, doing so was beneficial, or had the best consequences, would, obviously, be a disaster.




14. If Jones let his cousin die in the tub so that he could inherit his fortune, not to use for his own selfish purposes, as Rachels hypothesizes, but to use solely for purposes of feeding the starving people throughout the world, then this, I suggest, might mitigate somewhat how severely we would condemn him, but only somewhat. After all, gratitude is (for good reason) also a value, and Jones would hardly be showing gratitude to his cousin for his having named Jones his sole heir. And the so called "family values" of solidarity with family members come into play here as well. Moreover, it is not at all clear but that Jones' cousin, if Jones had saved him, would have used his fortune to do at least as much, or perhaps even more, good than Jones will do by using it to aid the starving. So I think that, even in this case, Jones' failure to save his cousin remains rather heinous.

15. Rachels and I both agree that an act which is otherwise morally prohibited does not become permissible merely because accompanied by good intentions. For Rachels' defense of this view, see "More Important Distinctions and a Defense of Active Eutha- nasia," in Killing and Letting Die, Ibid. See also, Alastair Norcross, "Introduction to the Second Edition, in Killing and Letting Die, pp. 6-9.

16. At this point, those who are familiar with the literature will perhaps bring up the famous runaway trolley case as a counterexample to my position that, if faced with a choice between killing one and letting five die, one may not, morally speaking, choose to kill the one for the sake of saving the five (or for some other good consequences). In the original version of the runaway trolley case, set out by Philippa Foot in "The Problem of Abortion and the Doctrine of the Double Effect," Oxford Review, vol. 5 (1967), reprinted in Killing and Letting Die, pp. 266-79, a trolley driver had to choose between either (1) letting his trolley, whose brakes had failed, continue on the track straight ahead, which would then kill five people stuck on that track, or (2) redirecting the trolley onto a side track, which would then kill only one person who was stuck on that track. As Philippa Foot correctly points out, since the driver is in control of the trolley (even though to a limited extent), this is a case where he must choose between either killing five or killing one. Naturally (other things being equal) it is better to choose killing one. Judith Jarvis Thomson, however, asks us to consider a variation of the case in which the trolley driver has died, and Frank, a passenger, takes his place. See "Killing, Letting Die, and the Trolley Problem," The Monist, vol 59 (1976). Thom- son claims that, although, if the original driver had chosen to let the trolley continue straight ahead, he would have, just as Foot says, killed the five, if Frank chooses to let the trolley continue straight ahead, he will merely have let them die. I disagree. Anyone who takes over control from the original driver, even if only remote control from a tower, becomes, in effect, the driver, and is therefore faced with the very same choice as the original driver - either kill five or kill one. Thus the runaway trolley case is really not a counterexample to my claim.

17. See, for example, the American Medical Association statement, reprinted in "Active and Passive Euthanasia," pp. 112-13. Thomas D. Sullivan, in "Active and Passive Euthanasia: An Impertinent Distinction?", found in Killing and Letting Die, pp. 131-38, argues that the AMA's position on euthanasia does not depend upon the distinction between passive and active euthanasia, as Rachels claims, but upon the distinction between using "ordinary" and using "extraordinary" means of keeping a patient alive; and that the AMA does not condone passive euthanasia, only the with- drawal of "extraordinary means." In "More Impertinent Distinctions and a Defense of Active Euthanasia," ibid., Rachels replies that the distinction between "ordinary" and "extraordinary" means of keeping a patient alive cannot be formulated in such a way as




to help decide when treatment should be withdrawn, and that, therefore, the only reasonable way to interpret the AMA's position remains in terms of the distinction between passive euthanasia (which, in certain circumstances, the AMA allows) and active euthanasia (which it prohibits in all circumstances). I do not have space to go into this debate here; let me simply state that I find Rachels' reply to be convincing.

18. Over a quarter of the 1990 US Medicare budget, or approximately twenty billion dollars, went to maintain patients in their last year of life, most of that in their last month. Thomas Harper, "Rights, Reforms, and the Health Care Crisis: Problems and Prospects," in Rights to Health Care, ed. by Thomas J. Bole, III, and William B. Bondeson, pp. 135-68, (Dordrecht: Kluwer Academic Publishers, 1991).

19. On this point see, Tom L. Beauchamp, "A Reply to Rachels on Active and Passive Euthanasia," in Contemporary Moral Problems, 4th ed., ed. by James E. White, (St. Paul. MN: West Publishing Co., 1994), pp. 163-70.

20. See Beauchamp, Ibid. 21.1 have benefited from comments by Erik Haslett on an earlier version of this essay.



moral taxonomy and rachels' thesis

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