In his paper, James Rachels argues against the conventional doctrine that is against doctors taking action that leads to a patient’s death. Further, he claims that taking such action leads to more suffering of the patient than if they were on medication until their time to die. If the patient chooses to continue with medication until they die, they might live longer, but the cause of death will be the disease and not an action by the doctor because failing to give the patient medication is a contributory action. Rachels suggest that instead of discontinuing medication, active euthanasia would be a better alternative. He also points out that there lacks a moral distinction between active and passive euthanasia and therefore there is a form of consistency in deciding to discontinue medication and not proceeding to active euthanasia. Through a critical analysis of Rachels’ perspective, it is clear that intentions supersede moral judgments as per the active/passive dichotomy which in fact is a mere distinction with no difference.
Rachels establishes that active and passive euthanasia serves the same purpose of ending the patient’s life. He gives examples where he demonstrates that killing and letting someone die is morally wrong in a similar manner. Rachels gives a situation where a doctor withholds treatment for a patient with a life-threatening treatable disease. The physician commits murder by withholding treatment. Accordingly, Rachels concludes that doctors must either make a choice to torture or kill their patients. The physician who decides to prolong his patient’s life prolongs suffering, and if they choose to terminate medication, they are committing murder. Both acts are intentional, and the motive is to end the life of the patient.
In a bid to show the distinction between the two, Rachels presents his main argument based on the equivalence thesis. The implication is that in the case where passive euthanasia is allowed active euthanasia should be allowed too. He gives examples of two case scenarios where the motivations and the ends are similar, but the means are different. Smith and Jones intend to murder their cousins for inheritance, but one lets their cousin die while the other is actively involved in their cousin’s death. Smith who killed his six-year-old cousin drowns the child while Jones watches as his cousin die. None of the two men behaved better because they acted on the grounds of personal gain. The case scenarios are equal morally, but their distinction is ethically irrelevant. Rachels derives his conclusion about the absurdity of active and negative euthanasia from the example. If letting a patient die is accepted then killing them should be allowed too.
The AMA supports the standard view that distinguishes between passive and active Euthanasia and allows passive euthanasia while simultaneously prohibiting active euthanasia. Rachels’ argues against the conventional view and maintains that the decision of whether to pursue extraordinary means in critical patients solely lies in the hands of the patient and the family and not the physician. The responsibility of the doctor is to provide freely available advice for the patient and their family. The ultimate goal in Rachels paper is to establish that there is no moral distinction between euthanasia in its active or passive form and if passive euthanasia is accepted, active euthanasia should be permitted and preferred as well.
In the critical evaluation of Rachels’ views, it is important to note that the distinction between the active and passive dichotomy is irrelevant since they are formulated as omission and commission. He uses the bare difference argument to defend his equivalence concept. The distinction in his view only serves to force a viewpoint. The distinction between killing and letting die is irrelevant to the issue of mercy killing. It is relevant when a physician intentionally withholds treating a patient so that they die when the disease is in fact curable. In such a case, if the doctor continues treating the patient, they will live. In euthanasia, the distinction is irrelevant because the doctors do not have an intent of killing the patient but they have to choose because the only eventuality for the patient is death. In the medical practice, the act of letting a patient die while they can be saved is unacceptable and amounts to negligence. The distinction by Rachels misrepresents the decision of withholding or terminating extraordinary treatment and equates it to letting a patient die. Doctors can only save a life if the patient is within a range of recovery. When they can do nothing about it, the doctor cannot help because they will eventually die such as the case of cancer. What doctors can do is to assist the patient in reducing their suffering as they wait to die.
Rachels gives an argument against the standard view of euthanasia that seeks to differentiate between euthanasia in its active and passive form. He actively attacks the perspective of the American Medical Association. The AMA statement he refers to does not seek to distinguish between active and passive euthanasia. It prohibits killing by medical professionals that is intentional for terminal patients and instead opts to allow the cessation of medication that is extraordinary. Rachels notes down four arguments against the AMA, and he states that it is the basis of the distinction. He uses four cases to show the absurdity of the difference he claims the AMA has made. It is also the basis upon which he proves that active euthanasia should also be allowed. His position on the issue is reinforced on a mercy argument. Rachels argument is invalid because the statement, the termination of medication is not based on suffering and it does not consider which technique leads to less suffering. On the contrary, pain and suffering should be the basis upon which to decide on passive euthanasia and not the morality of it. With modern technology, painkillers can help a patient with pain and thus there is no need to inflict death on the patient by choice.
In his paper, James Rachels seeks to justify the permitting of active euthanasia as much as active euthanasia is allowed. Active and passive euthanasia serve the same purpose of ending the life of the patient, and they should both be an option. He uses an equivalence thesis to establish between the two forms of euthanasia. He argues that the AMA statement concerning the two gives a distinction. However, the difference on which his claim is based on is irrelevant to the topic at hand. Doctors should not decide on the life of their patients. In essence, the subject of euthanasia should revolve around the wellbeing of the patient and not the intent of the doctor, which will determine the continuing or termination of medication.
