復旦研究生綜合英語2修訂版-Unit4省公開課金獎全國賽課一等獎微課獲獎課件

U8AdditionallnformationfortheTeacher’sReferenceTextActiveandPassiveEuthanasiaWarm-upActivitiesFurtherReadingWritingSkillsAdditionalWork1/190Warm-upActivities1.Trytogiveadefinitionofeuthanasia.2.Brainstormabouttheprosandconsofeuthanasia.3.Collectreferencestothisissueandtakedownnotes.4.Orderinformationandworkoutyourownopinion.Warm-up1.12/190JamesRachelswasanAmericanprofessorofmoralphilosophyandmedicalethicswhowasparticularlyconcernedwithethicalissues.BorninColumbus,Georgia,heearneddegreesatMercerUniversityandtheUniversityofCaliforniabeforejoiningtheUniversityofAlabama,BirminghamDepartmentofPhilosophyfacultyin1977.ThepopularityofhisgroundbreakingtextbookanthologyMoralProblems(1971),whichsold100,000copies,influencedAmericanuniversitiestomoveawayfrommoretraditionalphilosophicallyorientedundergraduatemoralphilosophycoursestowardmorepracticalundergraduatecoursesinethics.AIFTTR1.1AdditionallnformationfortheTeacher’sReference1.JamesRachels(1941-)3/190AIFTTR2.12.EuthanasiaEuthanasiaisapracticeofmercifullyendingaperson’slifeinordertoreleasethepersonfromanincurabledisease,intolerablesuffering,orundignifieddeath.ThewordeuthanasiaderivesfromtheGreekfor“gooddeath”andoriginallyreferredtointentionalmercykilling.Proponentsofeuthanasiabelievethatunnecessarilyprolonginglifeinterminallyillpatientscausessufferingtothepatientsandtheirfamilymembers.Manysocietiesnowpermitpassiveeuthanasia,whichallowsphysicianstowithholdorwithdrawlife-sustainingtreatmentwhendirectedtodosobythepatientoranauthorizedrepresentative.4/190AIFTTR2.2Euthanasiadiffersfromassistedsuicide,inwhichapatientvoluntarilybringsabouthisorherowndeathwiththeassistanceofanotherperson,typicallyaphysician.Inthiscase,theactisasuicide(intentionalself-inflicteddeath),becausethepatientactuallycauseshisorherowndeath.A.RelatedLaws

Aslawshaveevolvedfromtheirtraditionalreligiousunderpinnings,certainformsofeuthanasiahavebeenlegallyaccepted.Ingeneral,lawsattempttodrawalinebetweenpassiveeuthanasia(generallyassociatedwithallowingapersontodie)andactiveeuthanasia(generallyassociatedwithkillingaperson).Whilelawscommonlypermitpassiveeuthanasia,activeeuthanasiaistypicallyprohibited.5/190AIFTTR2.3LawsintheUnitedStatesandCanadamaintainthedistinctionbetweenpassiveandactiveeuthanasia.Whileactiveeuthanasiaisprohibited,courtsinbothcountrieshaveruledthatphysiciansshouldnotbelegallypunishediftheywithholdorwithdrawalife-sustainingtreatmentattherequestofapatientorthepatient’sauthorizedrepresentative.Thesedecisionsarebasedonincreasingacceptanceofthedoctrinethatpatientspossessarighttorefusetreatment.Untilthelate1970s,whetherornotpatientspossessedalegalrightofrefusalwashighlydisputed.Onefactorthatmayhavecontributedtogrowingacceptanceofthisrightistheabilitytokeepindividualsaliveforlongperiodsoftime—evenwhentheyarepermanentlyunconsciousorseverelybrain-damaged.Proponentsjets

6/190AIFTTR2.4oflegalizedeuthanasiabelievethatprolonginglifethroughtheuseofmoderntechnologicaladvances,suchasrespiratorsandkidneymachines,maycauseunwarrantedsufferingtothepatientandthefamily.Astechnologyhasadvanced,thelegalrightsofthepatienttoforgosuchtechnologicalinterventionhaveexpanded.EveryU.S.statehasadoptedlawsthatauthorizelegallycompetentindividualstomakeadvanceddirectives,oftenreferredtoaslivingwills.Suchdocumentsallowindividualstocontrolsomefeaturesofthetimeandmanneroftheirdeaths.Inparticular,thesedirectivesempowerandinstructdoctorstowithholdlife-supportsystemsiftheindividualsbecometerminallyill.Furthermore,thefederalPatientSelf-DeterminationAct,whichbecameeffectivein1991,requiresfederallycertifiedhealth-carebet7/190AIFTTR2.5facilitiestonotifycompetentadultpatientsoftheirrighttoacceptorrefusemedicaltreatment.Thefacilitiesmustalsoinformsuchpatientsoftheirrightsundertheapplicablestatelawtoformulateanadvanceddirective.PatientsinCanadahavesimilarrightstorefuselife-sustainingtreatmentsandformulateadvanceddirectives.Asofmid-1999,onlyoneU.S.state,Oregon,hadenactedalawallowingphysicianstoactivelyassistpatientswhowishtoendtheirlives.However,Oregon’slawconcernsassistedsuicideratherthanactiveeuthanasia.Itauthorizesphysicianstoprescribelethalamountsofmedicationthatpatientsthenadministerthemselves.Inresponsetomodernmedicaltechnology,physiciansandlawmakersareslowlydevelopingnewprofessionalandlegaldefinitionsofdeath.Additionally,expertsareformulatingrulestobat8/190AIFTTR2.6implementthesedefinitionsinclinicalsituations,forexample,whenprocuringorgansfortransplantation.Themajorityofstateshaveacceptedadefinitionofbraindeath—thepointwhencertainpartsofthebrainceasetofunction—asthetimewhenitislegaltoturnoffapatient’slife-supportsystem,withpermissionfromthefamily.In1995theNorthernTerritoryofAustraliabecamethefirstjurisdictiontoexplicitlylegalizevoluntaryactiveeuthanasia.However,thefederalparliamentofAustraliaoverturnedthelawin1997.InTheNetherlandsbecamethefirstcountrytolegalizeactiveeuthanasiaandassistedsuicide,formalizingmedicalpracticesthatthegovernmenthadtoleratedforyears.UndertheDutchlaw,euthanasiaisjustified(notlegallypunishable)ifthemust9/190AIFTTR2.7physicianfollowsstrictguidelines.Justifiedeuthanasiaoccursif(1)thepatientmakesavoluntary,informed,andstablerequest;(2)thepatientissufferingunbearablywithnoprospectofimprovement;(3)thephysicianconsultswithanotherphysician,whointurnconcurswiththedecisiontohelpthepatientdie;and(4)thephysicianperformingtheeuthanasiaprocedurecarefullyreviewsthepatient’scondition.Officialsestimatethatabout2percentofalldeathsinTheNetherlandseachyearoccurasaresultofeuthanasia.B.PrevalenceAlthoughestablishingtheactualprevalenceofactiveeuthanasiaisdifficult,studiessuggestthatthepracticeisnotcommonintheUnitedStates.Inastudypublishedin1998intheNewEnglandJournalofMedicine,onlyabout6percentofbasketball10/190physicianssurveyedreportedthattheyhadhelpedapatienthastenhisorherowndeathbyadministeringalethalinjectionorprescribingafataldoseofmedication.(Eighteenpercentoftherespondingphysiciansindicatedthattheyhadreceivedrequestsforsuchassistance.)However,one-fifthofthephysicianssurveyedindicatedthattheywouldbewillingtoassistpatientsifitwerelegaltodoso.NocomparabledataareavailableforCanada.However,in1998theCanadianMedicalAssociation(CMA)proposedthatastudyofeuthanasiaandphysician-assistedsuicidebeundertakenduetopoorinformationonthesubject.C.EthicalConcerns

Theissueofeuthanasiaraisesethicalquestionsforphysiciansandotherhealth-careproviders.TheethicalcodeofphysiciansintheAIFTTR2.811/190AIFTTR2.9UnitedStateshaslongbeenbasedinpartontheHippocraticOath,whichrequiresphysicianstodonoharm.However,medicalethicsarerefinedovertimeasdefinitionsofharmchange.Priortothe1970s,therightofpatientstorefuselife-sustainingtreatment(passiveeuthanasia)wascontroversial.Asaresultofvariouscourtcases,thisrightisnearlyuniversallyacknowledgedtoday,evenamongconservativebioethicists(seeMedicalEthics).Thecontroversyoveractiveeuthanasiaremainsintense,inpartbecauseofoppositionfromreligiousgroupsandmanymembersofthelegalandmedicalprofessions.Opponentsofvoluntaryactiveeuthanasiaemphasizethathealth-careprovidershaveprofessionalobligationsthatprohibitkilling.Theseopponentsmaintainthatactiveeuthanasiaisinconsistentwiththerolesofnursing,basketball12/190AIFTTR2.10caregiving,andhealing.Opponentsalsoarguethatpermittingphysicianstoengageinactiveeuthanasiacreatesintolerablerisksofabuseandmisuseofthepoweroverlifeanddeath.Theyacknowledgethatparticularinstancesofactiveeuthanasiamaysometimesbemorallyjustified.However,opponentsarguethatsanctioningthepracticeofkillingwould,onbalance,causemoreharmthanbenefit.Supportersofvoluntaryactiveeuthanasiamaintainthat,incertaincases,relieffromsuffering(ratherthanpreservinglife)shouldbetheprimaryobjectiveofhealth-careproviders.Theyarguethatsocietyisobligatedtoacknowledgetherightsofpatientsandtorespectthedecisionsofthosewhoelecteuthanasia.Supportersofactiveeuthanasiacontendthatsincesocietyhasmutual13/190AIFTTR2.11acknowledgedapatient’srighttopassiveeuthanasia(forexample,bylegallyrecognizingrefusaloflife-sustainingtreatment),activeeuthanasiashouldsimilarlybepermitted.Whenarguingonbehalfoflegalizingactiveeuthanasia,proponentsemphasizecircumstancesinwhichaconditionhasbecomeoverwhelminglyburdensomeforapatient,painmanagementforthepatientisinadequate,andonlyaphysicianseemscapableofbringingrelief.Theyalsopointoutthatalmostanyindividualfreedominvolvessomeriskofabuseandarguethatsuchriskscanbekepttoaminimumbyusingproperlegalsafeguards.14/190AIFTTR3.13.AmericanMedicalAssociationTheAmericanMedicalAssociation(AMA),foundedin1847andincorporated1897,isthelargestassociationofphysiciansandmedicalstudentsintheUnitedStates.Itisanonprofitprofessionalassociationofphysicians,includingallmedicalspecialties.TheAMA’spurposeistopromotetheartandscienceofmedicineforthebettermentofthepublichealth,toadvancetheinterestsofphysiciansandtheirpatients,topromotepublichealth,tolobbyforlegislationfavorabletophysiciansandpatients,toraisemoneyformedicaleducationandtoserveasanadvocatefortheadvancementoftheprofession.TheAssociationalsopublishestheJournaloftheAmericanMedicalAssociation(JAMA),whichhasthelargestcirculationofanyweeklymedicaljournalintheworld.TheAMAalsopublishesalistofPhysicianSpecialtyCodeswhichareastandardmethodintheU.S.foridentifyingphysicianandpracticespecialties.15/190TextActiveandPassiveEuthanasiaNotesIntroductiontotheAuthorandtheArticlePhrasesandExpressionsExercisesMainIdeaoftheText16/190MainIdeaoftheText1MainIdeaoftheText

Rachels’essay“ActiveandPassiveEuthanasia”firstappearedintheNewEnglandJournal

of

Medicinein1975.Init,Rachelsarguesthatkillingisnotmorallyworsethanlettingapersondieofnaturalcauses,whendoneforhumanitarianreasons.Therefore,activeeuthanasiaisnotanyworsethanpassiveeuthanasia,andincaseswhereapatientissparedneedlesspain,arguablybetter.17/190JamesRachels(1941–)wasanAmericanprofessorofmoralphilosophyandmedicalethicswhowasparticularlyconcernedwithethicalissues.BorninColumbus,Georgia,heearneddegreesatMercerUniversityandtheUniversityofCaliforniabeforejoiningtheUniversityofAlabama,BirminghamDepartmentofPhilosophyfacultyin1977.ThepopularityofhisgroundbreakingtextbookanthologyMoralProblems(1971),whichsold100,000copies,influencedAmericanuniversitiestomoveawayfrommoretraditionalphilosophicallyorientedundergraduatemoralphilosophycoursestowardmorepracticalundergraduatecoursesinethics.IntroductiontotheAuthorandthearticleIntroductiontotheAuthorandtheArticle18/190Rachels’essay“ActiveandPassiveEuthanasia”firstappearedintheNewEnglandJournalofMedicinein1975.Init,Rachelsarguesthatkillingisnotmorallyworsethanlettingapersondieofnaturalcauses,whendoneforhumanitarianreasons.Therefore,activeeuthanasiaisnotanyworsethanpassiveeuthanasia,andincaseswhereapatientissparedneedlesspain,arguablybetter.IntroductiontotheAuthorandthearticle19/190Part2_T1Thedistinctionbetweenactiveandpassiveeuthanasiaisthoughttobecrucialformedicalethics.Theideaisthatitispermissible,atleastinsomecases,towithholdtreatmentandallowapatienttodie,butitisneverpermissibletotakeanydirectactiondesignedtokillthepatient.Thisdoctrineseemstobeacceptedbymostdoctors,anditisendorsedinastatementadoptedbytheAmericanMedicalAssociationonDecember4,1973:JamesRachelsActiveandPassiveEuthanasiaText20/190Theintentionalterminationofthelifeofonehumanbeingbyanother—mercykilling—iscontrarytothatforwhichthemedicalprofessionstandsandiscontrarytothepolicyoftheAmericanMedicalAssociation.Thecessationoftheemploymentofextraordinarymeanstoprolongthelifeofthebodywhenthereisirrefutableevidencethatbiologicaldeathisimminentisthedecisionofthepatientand/orhisimmediatefamily.Theadviceandjudgmentofthephysicianshouldbefreelyavailabletothepatientand/orhisimmediatefamily.Part2_T221/190However,astrongcasecanbe

madeagainstthisdoctrine.InwhatfollowsIwillset

outsomeoftherelevantarguments,andurgedoctorstoreconsidertheirviewsonthismatter.Tobeginwithafamiliartypeofsituation,apatientwhoisdyingofincurablecancerofthethroatisinterriblepain,whichcannolongerbesatisfactorilyalleviated.Heiscertaintodiewithinafewdays,evenifpresenttreatmentiscontinued,buthedoesnotwanttogoonlivingforthosedayssincethepainisunbearable.Soheasksthedoctorforanendtoit,andhisfamilyjoinsintherequest.Part2_T322/190Supposethedoctoragreestowithholdtreatment,astheconventionaldoctrinesayshemay.Thejustificationforhisdoingsoisthatthepatientisinterribleagony,andsinceheisgoingtodieanyway,itwouldbewrongtoprolonghissufferingneedlessly.Butnownoticethis.Ifonesimplywithholdstreatment,itmaytakethepatientlongertodie,andsohemaysuffermorethanhewouldifmoredirectactionweretakenandalethalinjectiongiven.Thisfactprovidesastrongreasonforthinkingthat,oncetheinitialdecisionnottoprolonghisagonyhasbeenmade,activeeuthanasiaisactuallypreferabletopassiveeuthanasia,ratherthanthereverse.Tosayotherwiseistoendorsetheoptionthatleadstomoresufferingratherthanless,andiscontrarytothehumanitarian

impulsethatpromptsthedecisionnottoprolonghislifeinthefirstplace.Part2_T423/190Partofmypointisthattheprocessofbeing“allowedtodie”canberelativelyslowandpainful,whereasbeinggivenalethalinjectionisrelativelyquickandpainless.Letmegiveadifferentsortofexample.IntheUnitedStatesaboutonein600babiesisbornwithDown’ssyndrome.1Mostofthesebabiesareotherwisehealthy—thatis,withonlytheusualpediatriccare,theywillproceedtoanotherwisenormalinfancy.Some,however,arebornwithcongenital

defectssuchasintestinalobstruction

thatrequireoperationsiftheyaretolive.Sometimes,theparentsandthedoctorwilldecidenottooperate,andlettheinfantdie.AnthonyShawdescribeswhathappensthen:Part2_T524/190Part2_T6...Whensurgeryisdenied[thedoctor]musttrytokeeptheinfantfromsufferingwhilenaturalforcessapthebaby’slifeaway.Asasurgeonwhosenaturalinclinationistousethescalpeltofightoffdeath,standingbyandwatchingasalvageablebabydieisthemostemotionallyexhaustingexperienceIknow.Itiseasyataconference,inatheoreticaldiscussion,todecidethatsuchinfantsshouldbeallowedtodie.Itisaltogetherdifferenttostandbyinthenurseryandwatchasdehydrationandinfectionwitheratinybeingoverhoursanddays.Thisisaterribleordealformeandthehospitalstaff—muchworsesothanfortheparentswhoneverset

foot

inthenursery.25/190Part2_T7Icanunderstandwhysomepeopleareopposedtoalleuthanasiaandinsistthatsuchinfantsmustbeallowedtolive.IthinkIcanalsounderstandwhyotherpeoplefavordestroyingthesebabiesquicklyandpainlessly.Butwhyshouldanyonefavorletting“dehydrationandinfectionwitheratinybeingoverhoursanddays?”Thedoctrinethatsaysthatababymaybeallowedtodehydrateandwither,butmaynotbegivenaninjectionthatwouldenditslifewithoutsuffering,seemssopatently

cruelastorequirenofurtherrefutation.Thestronglanguageisnotintendedtooffend,butonlytoputthepointintheclearestpossibleway.Mysecondargumentisthattheconventionaldoctrineleadstodecisionsconcerninglifeanddeathmadeonirrelevantgrounds.26/190Part2_T8

ConsideragainthecaseoftheinfantswithDown’ssyndrome

whoneedoperationsforcongenitaldefectsunrelatedtothesyndrometolive.Sometimes,thereisnooperation,andthebabydies,butwhenthereisnosuchdefect,thebabyliveson.Now,anoperationsuchasthattoremoveanintestinalobstructionisnotprohibitively

difficult.Thereasonwhysuchoperationsarenotperformedinthesecasesis,clearly,thatthechildhasDowns’syndromeandtheparentsanddoctorjudgethatbecauseofthefactitisbetterforthechildtodie.27/190Butnoticethatthissituationisabsurd,nomatterwhatviewonetakesofthelivesandpotentialsofsuchbabies.Ifthelifeofsuchaninfantisworthpreserving,whatdoesitmatterifitneedsasimpleoperation?Or,ifonethinksitbetterthatsuchababyshouldnotliveon,whatdifferencedoesitmakethatithappenstohaveanunobstructedintestinaltract?Ineithercase,thematteroflifeanddeathisbeingdecidedonirrelevantgrounds.ItistheDown’ssyndrome,andnottheintestines,thatistheissue.Themattershouldbedecided,ifatall,onthatbasis,andnotbeallowedtodependontheessentiallyirrelevantquestionofwhethertheintestinaltractisblocked.Part2_T928/190Whatmakesthissituationpossible,ofcourse,istheideathatwhenthereisanintestinalblockage,onecan“l(fā)etthebabydie,”butwhenthereisnosuchdefectthereisnothingthatcanbedone,foronemustnot“kill”it.Thefactthatthisidealeadstosuchresultsasdecidinglifeordeathonirrelevantgroundsisanothergoodreasonwhythedoctrineshouldberejected.Onereasonwhysomanypeoplethinkthatthereisanimportantmoraldifferencebetweenactiveandpassiveeuthanasiaisthattheythinkkillingsomeoneismorallyworsethanlettingsomeonedie.Butisit?Iskilling,initself,worsethanlettingdie?Toinvestigatethisissue,twocasesmaybeconsideredthatareexactlyalikeexceptthatoneinvolveskillingwhereastheotherPart2_T1029/190Part2_T11involveslettingsomeonedie.Then,itcanbeaskedwhetherthisdifferencemakesanydifferencetothemoralassessments.Itisimportantthatthecasesbeexactlyalike,exceptforthisonedifference,sinceotherwiseonecannotbeconfidentthatitisthisdifferenceandnotsomeotherthataccountsforanyvariationintheassessmentsofthetwocases.So,letusconsiderthispairofcases:Inthefirst,Smithstandstogainalargeinheritanceifanythingshouldhappentohissix-year-oldcousin.Oneeveningwhilethechildistakinghisbath,Smithsneaksintothebathroomanddrownsthechild,andthenarrangesthingssothatitwilllooklikeanaccident.30/190Part2_T12Inthesecond,Jonesalsostandstogainifanythingshouldhappentohissix-year-oldcousin.LikeSmith,Jonessneaksinplanningtodrownthechildinhisbath.However,justasheentersthebathroomJonesseesthechildslipandhithishead,andfallfacedowninthewater.Jonesisdelighted;hestandsby,readytopushthechild’sheadbackunderifitisnecessary,butitisnotnecessary.Withonlyalittlethrashingabout,thechilddrownsallbyhimself,“accidentally,”asJoneswatchesanddoesnothing.NowSmithkilledthechild,whereasJones“merely”letthechilddie.Thatistheonlydifferencebetweenthem.Dideithermanbehavebetter,fromamoralpointofview?Ifthedifferencebetweenkillingandlettingdiewereinitselfamorallyimportant31/190Part2_T13matter,oneshouldsaythatJones’sbehaviorwaslessreprehensiblethanSmith’s.Butdoesonereallywanttosaythat?Ithinknot.Inthefirstplace,bothmenactedfromthesamemotive,personalgain,andbothhadexactlythesameendinviewwhentheyacted.ItmaybeinferredfromSmith’sconductthatheisabadman,althoughthatjudgmentmaybewithdrawnormodifiedifcertainfurtherfactsarelearnedabouthim—forexample,thatheismentallyderanged.ButwouldnottheverysamethingbeinferredaboutJonesfromhisconduct?Andwouldnotthesamefurtherconsiderationsalsoberelevanttoanymodificationofthisjudgment?Moreover,supposeJonespleaded,inhisowndefense,32/190“Afterall,Ididn’tdoanythingexceptjuststandthereandwatchthechilddrown.Ididn’tkillhim;Ionlylethimdie.”Again,iflettingdiewereinitselflessbadthankilling,thisdefenseshouldhaveatleastsomeweight.Butitdoesnot.Sucha“defense”canonlyberegardedasagrotesque

perversion

ofmoralreasoning.Morallyspeaking,itisnodefenseatall.Now,itmaybepointedout,quiteproperly,thatthecasesofeuthanasiawithwhichdoctorsareconcernedarenotlikethisatall.Theydonotinvolvepersonalgainorthedestructionofnormalhealthychildren.Doctorsareconcernedonlywithcasesinwhichthepatient’slifeisofnofurtherusetohim,orinwhichthepatient’slifehasbecomeorwillsoonbecomeaterribleburden.Part2_T1433/190Part2_T15However,thepointisthesameinthesecases:thebaredifferencebetweenkillingandlettingdiedoesnot,initself,makeamoraldifference.Ifadoctorletsapatientdie,forhumanereasons,heisinthesamemoralpositionasifhehadgiventhepatientalethalinjectionforhumanereasons.Ifhisdecisionwaswrong—if,forexample,thepatient’sillnesswasinfactcurable—thedecisionwouldbeequallyregrettablenomatterwhichmethodwasusedtocarryitout.Andifthedoctor’sdecisionistherightone,themethodusedisnotinitselfimportant.TheAMApolicystatementisolatesthecrucialissueverywell;thecrucialissueis“theintentionalterminationofthelifeofonehumanbeingbyanother.”Butafteridentifyingthisissue,and34/190Part2_T16forbidding“mercykilling,”thestatementgoesontodenythatthecessationoftreatmentistheintentionalterminationofalife.Thisiswherethemistakecomesin,forwhatisthecessationoftreatment,inthesecircumstances,ifitisnot“theintentionalterminationofthelifeofonehumanbeingbyanother?”O(jiān)fcourseitisexactlythat,andifitwerenot,therewouldbenopointtoit.Manypeoplewillfindthisjudgmenthardtoaccept.Onereason,Ithink,isthatitisveryeasytoconflatethequestionofwhetherkillingis,initself,worsethanlettingdie,withtheverydifferentquestionofwhethermostactualcasesofkillingaremorereprehensiblethanmostactualcasesoflettingdie.Mostactualcasesofkillingareclearlyterrible(think,forexample,ofallthe35/190Part2_T17murdersreportedinthenewspapers),andonehearsofsuchcaseseveryday.Ontheotherhand,onehardlyeverhearsofacaseoflettingdie,exceptfortheactionsofdoctorswhoaremotivatedbyhumanitarianreasons.Soonelearnstothinkofkillinginamuchworselightthanoflettingdie.Butthisdoesnotmeanthatthereissomethingaboutkillingthatmakesitinitselfworsethanlettingdie,foritisnotthebaredifferencebetweenkillingandlettingdiethatmakesthedifferenceinthesecases.Rather,theotherfactors—themurderer’smotiveofpersonalgain,forexample,contrastedwiththedoctor’shumanitarianmotivation—account

fordifferentreactionstothedifferentcases.36/190Part2_T18Ihavearguedthatkillingisnotinitselfanyworsethanlettingdie;ifmycontentionisright,itfollowsthatactiveeuthanasiaisnotanyworsethanpassiveeuthanasia.Whatargumentscanbegivenontheotherside?Themostcommon,Ibelieve,isthefollowing:“Theimportantdifferencebetweenactiveandpassiveeuthanasiaisthat:inpassiveeuthanasia,thedoctordoesnotdoanythingtobringaboutthepatient’sdeath.Thedoctordoesnothing,andthepatientdiesofwhateverillsalreadyafflicthim.Inactiveeuthanasia,however,thedoctordoessomethingtobringaboutthepatient’sdeath:hekillshim.Thedoctorwhogivesthepatientwithcanceralethalinjectionhashimselfcausedhispatient’sdeath;whereasifhemerelyceasestreatment,thecanceristhecauseofthedeath.”37/190Part2_T19Anumberofpointsneedtobemadehere.Thefirstisthatitisnotexactlycorrecttosaythatinpassiveeuthanasiathedoctordoesnothing,forhedoesdoonethingthatisveryimportant:heletsthepatientdie.“Lettingsomeonedie”iscertainlydifferent,insomerespects,fromothertypesofaction—mainlyinthatitisakindofactionthatonemayperformbywayofnotperformingcertainotheractions.Forexample,onemayletapatientdiebywayofnotgivingmedication,justasonemayinsultsomeonebywayofnotshakinghishand.Butforanypurposeofmoralassessment,itisatypeofactionnonetheless.Thedecisiontoletapatientdieissubjecttomoralappraisal

inthesamewaythatadecisiontokillhimwouldbesubjecttomoralappraisal:itmaybeassessedaswiseorunwise,38/190Part2_T20compassionateorsadistic,rightorwrong.Ifadoctordeliberatelyletapatientdiewhowassufferingfromaroutinelycurableillness,thedoctorwouldcertainlybetoblameforwhathehaddone,justashewouldbetoblameifhehadneedlesslykilledthepatient.Chargesagainsthimwouldthenbeappropriate.Ifso