Moral difference between active and passive euthanasia

The Moral Distinction Between Active and Passive Euthanasia

The moral distinction between active and passive euthanasia has been the subject of several disputes in both the medical and modern worlds. Active euthanasia is defined as the act of a medical professional or another human that is directly intended to end the life of a patient. Passive euthanasia, on the other hand, refers to the condition in which a patient dies because physicians fail to do something necessary to keep the sick person alive or when they stop performing a process that is keeping the patient alive (Rachels 2007, p.64). Such actions that are regarded as passive euthanasia include the disconnection of a feeding tube, the discontinuation of life-extending prescriptions, switching of life-supporting machines, and the failure to conduct life-extending operations.

Research on Moral Distinctions between Killing and Letting Die

Research asserts that many people make a moral distinction between killing (active euthanasia) and letting die (passive euthanasia). The thinking behind this perception is that it is completely unacceptable to kill a patient deliberately while it is somewhat acceptable to withhold treatment and allow an ill person to die (Rachels 2007, p.65). Medical professionals who support this ideology assert that they do not have to deal with the moral obligations that tag along with active killing. Nonetheless, those who purport that there is no moral difference between commission (active euthanasia) and omission (passive euthanasia) claim that stopping a patient's treatment is in itself deliberate intention which is similar to making a decision to withhold certain treatments that would preserve or prolong life. This study suggests that there is no logical moral distinction between the act of commission and omission that would lead to a justification of the implementation of some actions of passive euthanasia while simultaneously prohibiting active euthanasia.

Requirements for the Existence of a Significant Moral Difference

First of all, it is important to understand the conditions under which a morally significant distinction between killing and letting die may be maintained. The first characteristic is that acts of commission must have some trait that is dissimilar to those acts of omission. Markedly, if there is no difference in these features, then there can be no morally significant difference. The second characteristic that must be fulfilled for there to be a crucial ethical distinction is that the inconsistency in the action traits must entail a substantial moral difference. Indeed, if there exists a variance in the characteristic of passive and active euthanasia acts and that a morally relevant alteration is present, then it proves the existence of a morally significant distinction between killing and letting die (Rachels 2007, p.65). Consequently, this research will verify that none of the reasons provided for the injunction of certain acts of active euthanasia meet the preset conditions and thus no morally significant difference can be maintained between commissions and omission.

Killing vs. Letting Die

The first argument that is presented by those who purport that there indeed exists a significant moral difference between the two types of euthanasia is that passive euthanasia is letting die while active euthanasia is killing. The ethical distinction that is provided by this group of critics is that it is condemned to directly take the life of someone under any instance while passive euthanasia is acceptable in some conditions (McLachlan 2008, p.636). This is not a relevant moral difference between the two acts of euthanasia. For instance, if two people stand to acquire some financial gains from the death of someone, one beneficiary may choose to kill the latter so that he or she can directly benefit from this death. On the other hand, the second heir may decide not to take any action if they found the predecessor in a situation that would end his or her life. The actions of the first beneficiary can be considered as active euthanasia while those of the second heir may be termed as passive euthanasia. Nonetheless, a moral evaluation of the doings of these two beneficiaries proves that they are both at fault for the death of the predecessor. Subsequently, it is evident that neither of the actions is more or less ethical than the other which suggests that there can be no significant moral difference between acts of commission and those of omission.

The Shift of Moral Responsibility

In the medical context, it is inferred that when a physician lets a patient die, he or she is not responsible for the disease but rather the disease. On the other hand, actions of active euthanasia, such as the injection of a lethal drug to cause death, render the medical practitioner directly responsible for the demise of the patient (Gert, & Culver 1986, p.29). This has been used as an argument for the existence of an ethical distinction between the two kinds of euthanasia. While this demonstrates a characteristic that is not shared by active and passive euthanasia; that is, the causes of the death, it fails to provide a definite ethical difference. Markedly cases of negligence by the medical practitioner which result in the death of a patient are considered to be part of passive euthanasia, but in such an instance, they represent cases of moral irresponsibility (Norcross 2003, p.453). Indeed, it is impossible to relieve the physician of the ethical responsibility to ensure that he or she does everything possible to save the life of the patient. Despite the fact that the doctor would not be termed as a direct causal factor for the death, such a practitioner is to blame for the death similarly as the physician who intentionally kills a patient. Therefore, there does not exist a significant moral distinction between active and passive euthanasia.

Miraculous Recoveries

Some scholars in the past have presented the argument that active euthanasia is immoral because doctors can never be sure of the diagnosis of any ill person. Notably, doctors in the history and the contemporary era have admitted to making mistakes in their profession, some of which could cost the life of a patient. Additionally, many physicians have witnessed the survival and comeback of people whom medical practitioners thought would not survive a particular malady or health condition (Hermsen 2002, p.519). The argument presented for the existence of a moral difference in the above instance is that active euthanasia denies patients the possibility of a miraculous recovery. Nonetheless, this proposition fails to present a logical, moral difference between commission and omission. Markedly, if doctors failed to provide medical treatment to patients by assuming that they cannot survive their current medical condition, they also deny ill person the chance of a miraculous recovery. This shows that there is not actual difference between these acts which fails the first condition of the existence of a crucial ethical distinction (Guedj, Gibert, Maudet, Sastre, Mullet, & Sorum 2005, p.315). The claim that more tragic deaths are associated with active rather than passive euthanasia is, therefore, misleading and does not represent any significant difference between killing and letting die in the medical profession.

The Case of Voluntary Passive Euthanasia

Another argument that has been offered in the defense of the existence of a significant moral distinction between active and passive euthanasia is that the permission of voluntary passive euthanasia by a competent adult patient is vindicated by the existence of a choice for the ill person to refuse treatment in which case the medical practitioner agrees or disagrees to this request (Harris 2003, p.12). Nonetheless, there is no universal law containing the right to be killed which would be used as a defense for active euthanasia. This is because this right would require the active participation of the physician in the death process which would represent killing and thus immoral. In this case, it would represent the existence of a right of the patients to force the doctor to violate his or her conscience which is indeed illogical. The climax of this proposition is that the ethical difference between commission and omission is that ill persons have the right to demand passive euthanasia from the doctors but physicians, on the other hand, do not have the right to directly cause death (Bishop 2006, p.222). While this may seem like a very convincing argument of the existence of a moral difference between active and passive euthanasia, closer evaluation reveals that it does not fulfill any of the two conditions provided earlier in the discussion for the existence of a moral distinction.

First, this argument fails to present a viable difference between active and passive euthanasia and, therefore, fails on the first condition. According to the proposition, the moral difference depends on the extent of the moral responsibility that is placed upon the medical practitioner. In this case, therefore, when it is the sole responsibility of the patient, it is more unassailable to term this as a matter of policy that in the instance when the responsibility is shared as in the case of active euthanasia (Miller, Fins, & Snyder 2000, p.473). However, it is imperative to acknowledge that since the burden of moral responsibility is merely shifted from the practitioner to the patient in voluntary passive euthanasia, then there is actually no real ethical distinction between commission and omission (Doyal 2001, p.1079). Interestingly, the only form of euthanasia that would not involve the cooperation of medical practitioners would be the one in which the patient dismisses him or herself from the hospital without the knowledge of the physicians. This, therefore reveals that this proposition fails the first condition, thus proving that there is no morally significant distinction between active and passive euthanasia.

Moreover, were there a succinct difference between commission and omission in this context, why is it then that only actions related to passive euthanasia are respected upon the patient's request. While the argument shows that a patient is justified to refuse treatment from a doctor, it fails to show why these two parties cannot come to a mutual agreement to have active euthanasia performed by the doctor instead (Doyal 2001, p.1083). In many countries around the world, there are rules regarding the concepts of sterilization and abortion. Basing the claim on the above argument, there is no valid reason for the ban on the existence of mutually agreed active euthanasia.

The Potential of Abuse

Those who are in support of the existence of a significant moral distinction between commission and omission claim that there is a greater possibility of the abuse of active euthanasia by medical practitioners than passive euthanasia. The suggestion by many scholars is that the main reason for the condemnation of commission is the lack of protection from when medical practitioners may decide to perform acts of active euthanasia because of their personal other than charitable motives (Dixon 1998, p.26). Evidently, this makes a significant moral consideration since the likelihood of abuse of medical procedures is relevant in the permission of particular actions. In the case that active euthanasia offers a motive for abuse, then it should not be allowed even when the patient requests especially if there are no means of reducing the threat of abuse of this action by physicians.

Despite the fact that this proposition meets the second condition of the existence of a significant moral distinction between the acts of killing and letting die, it fails to oblige to the first condition because in the same way that physicians would abuse active euthanasia, they can also cause unnecessary deaths by passive euthanasia. One form of abuse in passive euthanasia would involve the withholding of life supporting treatments from patients who may still want to fight through their illness (Dixon 1998, p.27). This would mark the worst form of abuse because it would cause the occurrence of avoidable deaths. Remarkably, an evaluation of the circumstances herein reveal that it is in fact easier to abuse passive euthanasia because it does not involve direct killing. For instance, in some nursing homes for the elderly, patients may be denied prescriptions that would help cure their bacterial infections such as pneumonia. When doctors choose to withhold such treatment without the consent of the patients, these ailing persons may die, thus representing an abuse of passive euthanasia (Harris 2003, p.14). The response for such actions across many countries in the world has been to develop means of reducing the abuse of passive euthanasia by means such as the provision of records of consent that should be signed by patients when they wish to have the physicians withhold treatment. Logically, commission is similar to omission in the sense that rather than prohibiting it, means of dealing or reducing the abuse of active euthanasia should be developed. If the real threats surrounding passive euthanasia have not led to its prohibition, then there are no grounds for the prohibition of active euthanasia. Consequently, this serves as evidence that there is no significant moral difference between active and passive euthanasia.


All in all, active euthanasia is the process by which a medical professional or any other individual commits an action whose intention is to end the life of a patient. On the other hand, passive euthanasia refers to the condition via which a patient dies because physicians fail to do something that is necessary to keep the sick person alive or when they halt the performance of a process that is keeping the patient alive. The study provides the conditions for the existence of a significant moral distinction between the two kinds of euthanasia. They include a real difference between the acts of commission and omission and the existence of a relevant moral discrepancy between the two actions. Nonetheless, killing vs. letting die, the shift of moral responsibility, miraculous recoveries, cases of voluntary passive euthanasia, and the potential of abuse are instances that do not meet the two conditions for the existence of a valid moral distinction. Consequently, no morally significant distinction between active and passive euthanasia can be maintained.


Bishop, J.P., 2006. Euthanasia, efficiency, and the historical distinction between killing a patient and allowing a patient to die. Journal of medical ethics, 32(4), pp.220-224.

Dixon, N., 1998. On the Difference between Physician‐Assisted Suicide and Active Euthanasia. Hastings center report, 28(5), pp.25-29.

Doyal, L., 2001. Why active euthanasia and physician assisted suicide should be legalised: If death is in a patient's best interest then death constitutes a moral good. BMJ: British Medical Journal, 323(7321), p.1079-1087.

Gert, B. and Culver, C.M., 1986. Distinguishing between active and passive euthanasia. Clinics in geriatric medicine, 2(1), pp.29-36.

Guedj, M., Gibert, M., Maudet, A., Sastre, M.M., Mullet, E. and Sorum, P.C., 2005. The acceptability of ending a patient’s life. Journal of medical ethics, 31(6), pp.311-317.

Harris, J., 2003. Consent and end of life decisions. Journal of medical ethics, 29(1), pp.10-15.

Hermsen, M.A., 2002. Euthanasia in palliative care journals. Journal of pain and symptom management, 23(6), pp.517-525.

McLachlan, H.V., 2008. The ethics of killing and letting die: active and passive euthanasia. Journal of medical ethics, 34(8), pp.636-638.

Miller, F.G., Fins, J.J. and Snyder, L., 2000. Assisted suicide compared with refusal of treatment: a valid distinction? Annals of internal medicine, 132(6), pp.470-475.

Norcross, A., 2003. Killing and letting die. A Companion to Applied Ethics, pp.452-454.

Rachels, J., 2007. Active and passive euthanasia. Bioethics: An Introduction to the History, Methods, and Practice, pp.64-69.

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