Rachels on Euthanasia

Rachels challenges the conventional view that passive euthanasia is permissible but active euthanasia is not.  This view is endorsed by the American Medical Association in a 1973 statement.  But Rachels holds that in some cases active euthanasia is morally preferable to passive euthanasia on utilitarian grounds. His most vivid example is the case of severe down’s syndrome babies born with intestinal obstructions.  Sometimes in such cases the baby is allowed to die.  Rachels argues that in such cases we find compelling moral grounds for preferring active euthanasia to passive euthanasia in the vastly greater degree of suffering involved in letting the baby die.  This utilitarian consideration is the first of four arguments that Rachels offers against the conventional view that passive euthanasia is morally acceptable but active euthanasia is not.

The second challenge that Rachels brings to bear on the conventional view is that the conventional view leads to life and death decisions being made on grounds that are irrelevant to whether or not a person’s life should continue.  The intestinal obstruction can be fixed.  Ordinarily an intestinal obstruction is not a life a death matter.  That it should be in the case of a baby that also has downs syndrome seems arbitrary.  The baby is allowed to die because of the downs syndrome, not the intestinal obstruction.  The presence or absence of an intestinal obstruction is irrelevant whether or not a life should continue given the downs syndrome. 

Is there a morally relevant difference between killing and letting die.  Brandt argues that there is none.  As evidence, he offers cases of Smith and Jones that differ only in one being a killing and the other a case of letting die.  Brandt argues that this difference makes no difference to our moral assessment of the situation. 

The cases:  Smith will inherit a large sum if his orphaned 6 year old cousin dies.  Smith drowns the child in the bath tub and makes it look like an accident.  The Jones case is just like the Smith case except that when Jones goes to drown his orphaned cousin, he finds that the child has just slipped in the bath and is about to drown.  Jones stands by and watches the child drown ready to assure it does not survive.

It seems that the actions of Smith and Jones are equally despicable.  It is hard to find reason for regard one as less wicked than the other.  But only Smith kills.  Jones just lets his cousin die.  If killing and letting die does not make a difference to our moral assessment of these cases, why should we think it makes a difference in other sorts of cases?  It might be that where the intention is bad, killing and letting dies are just as bad in all respects and yet that killing or letting die does matter to the permissibility of well intentioned actions.  Brandt’s argument does not rule this out.  But in light of Brandt’s cases, we require some account of why this difference matters to the permissibility of well intentioned acts but not ill intended acts.

Brandt goes on to argue that there is no morally significant difference between killing and letting die in the case of euthanasia:

“If a doctor lets a patient die, for humane reasons, he is in the same moral position as if he had given the patient a lethal injection for humane reasons.  If his decision was wrong – if, for example, the patient’s illness was in fact curable – the decision would be equally regrettable no matter which method was used to carry it out.  And if the doctor’s decision was the right one, the method used is not in itself important.”

Does this judgment presuppose utilitarianism?  Does it hold from deontological perspective as well?