The difference between 'active' and 'passive' euthanasia

The argument

The argument attacks a distinction on which much opposition to legalising euthanasia rests. Both active and passive euthanasia ultimately lead to the patient's death; the question is whether the difference in how they do so carries the moral weight placed on it. The claim is that it does not. There is, on this account, no ethical difference between letting a patient die and administering a lethal dose of drugs. Both occur under a physician's supervision, both are undertaken deliberately, both are expected to end in death, and both are chosen with that outcome in view. What separates them is the physical form of the act — withholding as against administering — and the argument holds that this describes technique rather than moral character. If an outcome is permissible when brought about by omission, the reasoning permitting it does not turn on the omission. The second strand is about consequences for the patient. Since passive euthanasia is already permitted in practice while active euthanasia is refused, the effect of maintaining the distinction is to determine not whether a patient dies but how long dying takes. Withdrawal of treatment can prolong suffering that a lethal dose would end quickly. That runs contrary to the whole idea of euthanasia, which is relief from incurable pain — so the distinction, applied within a system that already accepts the end, produces exactly the harm the practice exists to prevent. Together the two strands support legalisation. If the two methods are ethically equivalent, permitting one while prohibiting the other is arbitrary; and if the prohibition additionally extends suffering in the cases where it binds, it is worse than arbitrary. Euthanasia should be legal in its active form, because the objection to it collapses into a preference about method that costs patients time spent in pain.

Context

Euthanasia is traditionally divided on "passive" and "active" euthanasia, based on a role of a physician in the process. "Passive" euthanasia refers to the ending of a patient's life by the deliberate withholding of drugs or other life-sustaining treatment on part of a physician. "Active" euthanasia refers to an act of injecting a patient with a lethal dose of medication with the intention of ending the patient’s life, at the patient’s request.

Premises

Counter-arguments

Two different actions (or omissions of actions) resulting in the same outcome are not necessarily ethically identical since reasons for the decision and circumstances might differ. Actively causing a patient's death is not identical with discontinuation of treatment, since the former constitutes a deliberate act of an external agent in a patient's organism, while the latter lets a natural process, already in motion, to run its course.

Rejecting the premises

[Rejecting P3] There is no basis for treating an act of deliberate killing and an act of forgoing life-sustaining treatment as identical.