Should a patient with terminal cancer who is in tremendous pain be allowed to stop treatment and die? Many people think that allowing this patient to die is not morally wrong, but, at the same time, they condemn the administration of a powerful drug to the patient which would cause death and ease suffering. Allowing someone to die by withholding treatment is passive euthanasia. Active euthanasia, on the other hand, is taking deliberate action to kill a patient. James Rachels, in "Active and Passive Euthanasia," claims that an act of killing, in itself, has to be either morally worse, better, or equivalent to an act of letting someone die, in itself. He maintains that everyone will agree that killing is not morally better than letting die, and thus killing is either morally equivalent or worse. Now assume, for a moment, that killing is worse. If it were the case that killing is always worse than letting die, then there would be no instance where killing is equivalent to letting die in a barely different situation. But, as will be shown, there is a case, the Smith and Jones case, where killing is equivalent, so it cannot be assumed that killing is worse than letting die. Thus, in this argument, Rachels maintains that an act of killing, in itself, is morally equivalent to an act letting die, in itself, and he calls this the Equivalence Thesis. In order for Rachel's argument to be substantiated, the Smith and Jones case must be thoroughly investigated.
Rachels presents the Smith and Jones cases as a pair of stories that will be briefly retold here. Smith will gain a large inheritance if his six-year old cousin were to die. One night when his young cousin is taking a bath, Smith goes into the bathroom and drowns the child. In a highly similar scenario, Jones too stands to gain a large inheritance if anything were to happen to his six-year old cousin. So Jones sneaks into the bathroom one evening while his cousin is taking a bath, planning to drown the boy. However, Jones finds that the boy has slipped into the bath and is already drowning. Jones does not save his cousin; instead he stands by and watches the boy, prepared to push his head back under the water if need be, but the boy drowns to death by himself with no help from Jones. These two situations are presented to be the same in every way, except that Jones 'merely' lets his cousin die while Smith actively kills his cousin.
The Smith and Jones case is an example a 'bare difference' argument. The application of this technique involves examining a pair of cases that differ in only one respect. Thus, in the Smith and Jones case, this one distinction is that Smith actively kills his six-year old cousin while Jones passively lets his six-year old cousin die. Other differences in the story, such as Smith and Jones having different names, are not relevant to the bare difference argument because they could, for instance, have had the exact same name without changing the situation, and thus this 'difference' is merely intended to aid the reader in differentiating the situations. Rachels intends to make the reader question whether or not the case of killing, in itself, is truly worse than letting die, in itself, by using the bare difference scenario. If letting die, in itself, is not deemed to be worse than killing and from the Smith and Jones case killing cannot be deemed to be worse, in itself, than letting die, it must be the case that killing and letting die are morally equivalent.
Rachels uses the Smith and Jones case in order to substantiate his claim for the Equivalence Thesis, which says that it is logically possible for killing to be morally equivalent to letting die in certain situations. He reasons that his readers will consider the two barely different cases to be equivalent, or equally morally bad, because both Jones and Smith have the same intent to kill their young cousin if need be. Due to sheer luck (on Jones' part), Jones does not have to go through with the actual murder, which Smith carries out. Since Jones intends to kill his cousin and does not save him when it was clearly within his power, the reader is to conclude that Jones is just as bad as Smith, or that Smith, at very least, did not act worse than Jones. Once the reader concludes that the two acts in this case are indeed morally equivalent, the remainder of Rachels' argument resumes: since no one would consider killing to be better than letting die and since the Smith and Jones case presents an example where killing is not worse than letting die, the two acts must be morally equivalent because there are no other moral possibilities. Thus, the Smith and Jones case helps to substantiate the central argument for Rachels' Equivalence Thesis. The implications of this Equivalence Thesis to euthanasia are that in any case where it is morally permissible to allow an individual to die from disease, it would also be morally acceptable to administer a dose of a drug that would actively kill that person.
I find Rachels' argument to be persuasive and I do think that euthanasia should be a legal option for patients suffering from pain due to disease. I think in many cases of morality intentions play a huge role in determining whether something is right or wrong. So even though death and killing are always unfavorable, the intent in euthanasia is not exactly death itself, but to escape from pain. Death is unfortunately the only way to achieve the intended result for some people. My main concern with legal euthanasia is that family members could influence or hasten the patient's choice of euthanasia in order to achieve their own ends- like coming into inheritance faster, or avoiding further costly hospital bills. I'm not sure that family influence could ever be completely avoided unless the patient completely avoided contact with them, which could in itself cause one to choose euthanasia due to loneliness. Overall though I think it is wrong to force someone who wants to die to remain living in pain.
Rachels, James. "Active and Passive Euthanasia" in What's Wrong: Applied Ethicists and Their Critics, ed. David Boonin and Graham Oddie (New York: Oxford University Press, 2010), 46-50.