Euthanasia and the active-passive distinction.

Several surveys of the German population concerning the attitude towards euthanasia in patients with terminal illness yielded contradictory results, ranging from high acquisition to high refusal rates. After a critical discussion of the methodological concepts of these investigations, we present the results of a representative study of 1957 German persons (age range: 14 - 96 years) which was performed by the institute USUMA in February 2001. Four different types of euthanasia were included in the study: active, passive, and indirect euthanasia as well as physician's assisted suicide. The affirmative response categories were "declared will and unbearable pain", "declared will", "referred will", and "in the responsibility of the physician". Additionally, we asked to state the personal preference in the case of an own incurable illness. The resulting frequency distributions stress the autonomy of the patients (declared will) and the legal forms of professional euthanasia (passive and indirect euthanasia), independent from the degree of pain. The rank order of the hypothetic personal preferences was: passive euthanasia (26.1 %), active euthanasia (21.1 %), indirect euthanasia (13.1 %) and assisted suicide (6.2 %). For each category the hypothetic personal will to utilize euthanasia personally is markedly lower than the consent to legalize euthanasia in the society. This points to a diminished readiness of the population to seek for euthanasia. Persons aged 60 years and above deny all types of euthanasia significantly more often than younger persons. Persons with subjectively bad health status prefer the category "in the responsibility of the physician" more often than healthy subjects. The representative study proves that there is no polarized public opinion concerning euthanasia, rather there is a picture of high complexity.

In her article 'Active and Passive Euthanasia' (Philosophy 53, No. 204, April I978) Natalie Abrams argues that active euthanasia is preferable to passive euthanasia on the basis of a moral difference between acting and refraining in 'positive' cases where the outcome is desirable for the victim. She contends that in positive cases we intuitively feel an individual who merely allows a good thing to occur is not as praiseworthy as one who actually does something to bring it about, assuming identical motives and outcomes. Thus if Dick rescues his wife from a flaming building, we find him praiseworthy. But if Ernest's wife staggers out of a flaming building by herself before Ernest is able to find a way to go into the building to take her out, we do not believe him praiseworthy. Abrams then claims that euthanasia should be classified as a positive case, since it is performed only where the outcome is believed to be the more desirable outcome for the patient. Therefore a doctor who acts to bring about the death of a patient is more praiseworthy than one who merely allows the death to occur. There are a number of questionable points in Abrams's argument. For example, we may disagree that euthanasia should be classified as a positive case. Are there not cases in which death is mistakenly judged to be desirable for the patient? Also, one could argue that Ernest is just as praiseworthy as Dick, not for his inaction in allowing another to live but for his actions in attempting a rescue. After all, Ernest did not merely allow another to live. He took certain steps with the intention of bringing about the positive outcome. However, I will grant Abrams these points. Still, I believe her argument fails, because it is not true that given identical motives allowing a positive outcome to occur is never as praiseworthy as acting to bring about that outcome. Consider the following pairs of cases:

I argue that ‘classical liberalism’ does not sanction any easy permissiveness about suicide and active euthanasia. I will use liberal arguments to argue that the distinction between active and passive euthanasia is real and that assisted suicide is, at the very least, deeply troubling when viewed from an authentic liberal perspective. The usual argument for active euthanasia is a utilitarian, not a liberal argument, as recent calls to eliminate the conscientious objection rights of doctors who refuse participation in such procedures plainly demonstrate. The paper focuses on arguments in the public sphere (such as those articulated by James Rachels).

BackgroundDoctors are increasingly faced with end-of-life decisions. Little is known about how medical students approach euthanasia. The objective of this study was to evaluate, among medical students and residents, the view on euthanasia and its variants; correlate such a view with empathy and religiosity/spiritualism; and with the stages of medical training in Brazil.MethodsThis is an exploratory cross-sectional study using an online questionnaire to be filled out on a voluntary basis among medical students and residents, consisting of: socio-demographic data, an empathy questionnaire and questions with elaborate clinical cases that typify situations of the variants of euthanasia.ResultsFrom 1550 invitations, 273 volunteer participants responded (17.6%). The percentages of strong agreement/agreement on the concepts were: passive euthanasia (72.9%); active euthanasia (22.3%), orthothanasia (90.1%), dysthanasia (18.7%), assisted suicide (33%) and sedation (82.8%). Passive euthanasia, active euthanasia, dysthanasia and assisted suicide showed greater refusal with increasing length of medical training. Religious belief and degree of empathy did not significantly influence the opinion about the concepts. Strong agreement/agreement were: passive euthanasia (72.9%); active euthanasia (22.3%), orthothanasia (90.1%), dysthanasia (18.7%), assisted suicide (33%) and sedation (82.8%).ConclusionsPassive euthanasia, active euthanasia, dysthanasia and assisted suicide showed greater refusal with increasing length of medical training. The external validation of our findings relies on the distinct legal, cultural, and religious frameworks found across various countries.

Distinguishing Between Active and Passive Euthanasia

Debates about the moral dilemmas of euthanasia date back to ancient times. Many of the historical arguments used for and against the practice remain vu I id today. Indeed, any...

The legal consensus that has evolved through adjudication and legislation since the Karen Quinlan case in 1976 is founded on the premise that there is a bright line between passive euthanasia and active euthanasia. Indeed, the term passive euthanasia is often eschewed in favor of less emotionally-laden terminology such as "forgoing life-sustaining treatment" or "terminating life support" so as to further sever any possible connection with active euthanasia. Legal approval has been bestowed upon passive euthanasia under certain circumstances while active euthanasia is routinely condemned. This consensus was put to a test in 1990 when the United States Supreme Court ruled on the Cruzan case. However, the Court's narrow decision did not upset the consensus, and in the most significant appellate decisions handed down by state courts since Cruzan, there has been a reaffirmation--and possibly even an extension--of the consensus. Two other threats to the legal consensus about forgoing life-sustaining treatment have begun to manifest themselves: the increasing pressure for mercy killing and "futility" cases. Both of these challenge the fundamental premises on which the consensus is grounded.

The basic idea motivating this paper is that something can be done intentionally even when it is not done with the intention of doing it. An implication of this idea is that the distinction between doing what one intends and doing something as a foreseen avoidable consequence of doing what one intends cannot be used to exonerate agents for misdeeds.My immediate purpose here is to illustrate these points and show how they pertain to the morally relevant difference between active and passive euthanasia, and to the exoneration of God for the production of evil. In particular, I shall try to show, first, that the American Medical Association's recent attempt to distinguish between active and passive euthanasia is seriously defective. Second, I shall try to show that a popular version of the so-called Free Will Defense of God for Evil is also seriously defective.

BOOK REVIEWS ~43 I ask any interested reader to see whether Thomas says this. It is correct that Thomas uses intelligere in these passages but that does not mean that the operation is conception. The judicative function is an intelligere, as Julien Peghaire showed in Intellectus et Ratio (1986). For a recent review of this whole problem of the meaning of judgment in Aquinas, I would refer to Benoit Garceau, Judicium, vocabulaire, sources, doctrine de saint Thomas d'Aquin (Montreal-Paris, 1968). I would not accept all of Garceau's conclusions, but I think his survey of different interpretations is very complete. Doig does not list or use Garceau. The fact of the matter is that Doig approached his task with an obvious preconception. He is dead set against any suggestion that metaphysical esse is expressed or known in the judgment. Gilson and his associates are wrong on this point, in the view of Doig. Indeed, in the course of his discussion Doig disagrees with almost everyone in the Thomist establishment (Fabro, Forest, Geiger, Maritain, Marechal, Owens, Phelan, De Raeymaeker, Van Riet, and Van Steenberghen) except Charles Hart and Reginald Garrigou-Lagrange! What is important in Doig's mind is the concept of being, taken both essentially and existentially. His book should stand as an example of how not to interpret a philosophical classic. VERNON J. BoURKE St. Louis University St. Louis, Missouri Human Life: Some Moral Issues. By JoHN F. DEDEK. New York: Sheed & Ward, 197~. Pp. 180. $5.95. Dedek, professor of moral theology at St. Mary of the Lake Seminary in Mundelein, lllinois, offers a discussion of four moral issues profoundly affecting human life: abortion, genetic engineering, euthanasia, and war. His consideration of each of these questions is prefaced by a chapter on methodology, with attention centered on two principles: the sanctity of human life and the principle of double effect. Dedek contends that human life, although sacred and inviolable, is not an absolute value and that man's stewardship over human life implies a practical dominion, at least to the extent that man has the responsibility for making decisions regarding the termination of life. He then reviews some recent efforts at revising the principle of double effect and argues that the position taken by Bruno Schuller seems to be the most reasonable. For Schuller the principle of double effect does not rule out the direct intent to do something physically evil, e. g., killing a man, provided there is a proportionate reason which can serve as a "preference principle." In 244 BOOK REVIEWS such instances, Schuller and Dedek maintain, the evil intended and effected is only physical, not moral. After a chapter on the history of the attitudes of Catholic theologians toward abortion Dedek next surveys the views of contemporary moralists on this issue (e. g., Ramsey, Haring, Mangan) and offers his own view. He believes that the phenomenon of twinning makes it at least doubtful that human life is present until the end of the second or beginning of the third week of pregnancy. He then makes the tentative claim, justified by applying Schuller's preference principle, that " the purposeful destruction of a fetus is not a moral evil in the presence of a proportionate reason." Dedek, turning attention to problems posed by recent and proposed biomedical procedures, rejects artificial insemination by donor and cloning as too destructive of the human. He indicates, however, that artificial insemination by husband, artificial inovulation, the use of surrogate mothers, and artificial placentas may be morally permissible. The chapter on euthanasia gives readers a good survey of the views of men such as Ramsey, Fletcher, Ford, Healy, McFadden. Dedek argues that the distinction between active euthanasia (hastening death) and passive euthanasia (choosing not to use extraordinary means to prolong life) is valid. In a final chapter Dedek defends limited warfare as being morally justifiable, adopting for the most part arguments developed by Paul Ramsey. Dedek's work is an informative survey of current positions; the conclusions Dedek reaches are modestly proposed and defended by reasonable arguments. Nonetheless, in my opinion, Dedek's acceptance of Schuller's preference principle points to a trend current among many Catholic authors today (e. g...

Euthanasia comes from the Greek word “Thanatos” which means death and from the Greek word “eu” which means easy or good. Hence, euthanasia means good or easy death. For many, euthanasia is commonly thought of as mercy killing. The question of whether or not to choose to practice euthanasia is often looked upon as a medical decision. Physicians or other medical staffs are frequently asked to decide whether or not the patient's health has deteriorated to the point where further treatment is useless. The definition of death has not always been a major question in the area of euthanasia. When death was determined by the absence of spontaneous respiration and heart beat, one could rather easily define death and when it occurred. Active euthanasia involves the physician terminating a life. Such acts place the physician in jeopardy of being prosecuted for homicide. The decision to practice active or passive euthanasia is a moral decision as well.

This paper presents a philosophical defense of medical pessimism, often termed active euthanasia or “mercy killing,” by arguing that in specific clinical contexts, the moral distinction between active and passive euthanasia is untenable. The author critiques the Judeo-Christian and vitalist positions that prioritize the preservation of biological life at all costs, contending that such a stance can lead to an inhumane idolization of mere existence. Through an analysis of arguments from philosophers like James Rachels and within a framework informed by Kantian duty, the paper asserts that the intentional relief of unbearable, intractable suffering can constitute a moral imperative. The central thesis is that once a collective decision has been made that death is the preferable outcome to relentless suffering, the primary moral question shifts from “whether” to allow death to “how” to achieve it most compassionately. The paper concludes by proposing “potential for human relationship” as the key ethical criterion for preserving life, arguing that when this potential is irrevocably lost, the biological continuation of life no longer serves its human purpose, and a compassionate, responsible death becomes ethically permissible.

388 Japanese religious groups--143 Shinto, 157 Buddhist, 58 Christian and 30 others--were asked to answer questions regarding several forms of euthanasia and extraordinary treatment during the dying process. Passive euthanasia and indirect euthanasia were accepted by around 70% of the respondents. Active euthanasia was favored by less than 20% of them. Christians were less supportive of euthanasia than practitioners of other religions. Shinto and Buddhist corporations advocated "being natural," when medical treatment became futile at the terminal stage. Religionists' views may deepen the discussion of end-of-life issues.

Health care professionals frequently justify moral decisions by appealing to the acts and omissions distinction and the principle of double effect. These principles are often quoted and criticised in the nursing literature, particularly in relation to active and passive euthanasia. Authors are, however, inclined to acknowledge the fact that they are a philosophical minefield, but fall short of providing a substantial critical analysis. Those who uphold the acts and omissions distinction claim that we are morally less responsible for our omissions than for our acts. The principle of double effect suggests that there is a moral distinction between direct and indirect intention and that we are morally less responsible for that which we intend indirectly. This article offers an examination of these often quoted, but sometimes little understood, principles and it is hoped that it will serve as a basis for debate. Since the intention is to challenge assumptions which can lull us into believing that our moral decisions can be justified by appealing to principles such as these, it is necessary to examine them critically and to go beyond a superficial grasp of the implications of such distinctions. There is a tendency to appeal to the acts and omissions doctrine and the principle of double effect in life and death situations such as euthanasia, infanticide and abortion, but are they valuable tools which should be used in moral decision making, or are they so flawed that they can seriously mislead us when it comes to hard cases? The conclusion reached in this paper is that there is no significant moral difference between an act and an omission, particularly within the context of killing and letting die, and that the principle of double effect encourages hypocrisy rather than honesty.

This study aims to elaborate on the ethical and legal problems concerning passive euthanasia and Advance Directives (ADs) in Indonesia, focusing on the legal obscurity in current legislation, which causes uncertainties among families and medical practitioners. Although Indonesia’s Penal Code criminalizes active euthanasia, it remains silent on passive euthanasia, making healthcare providers vulnerable to the risk of prosecution when withholding or withdrawing futile treatments. Using a normative juridical approach, this research primarily analyzes Indonesian statutes and compares them with those of India, Saudi Arabia, and Iran. Despite provisions in health laws for patients to refuse treatment, the absence of explicit guidelines forces healthcare providers to operate with legal uncertainty. A comparative analysis of India’s legalization of passive euthanasia showcases how legislative clarity can align with ethical, medical, and societal needs. Insights from Islamic-majority countries like Saudi Arabia and Iran also reveal that Islamic jurisprudence, through the harm reduction principle, can be aligned with passive euthanasia within an ethical framework. Several particular reform recommendations are provided in this regard in the study, comprising amending the Penal Code to differentiate passive euthanasia and murder, establishing formal AD procedures, and introducing ethics committees and dual-approval oversight to maintain the ethical purity of the process. These reforms and public awareness initiatives would enhance the principle of patient autonomy and clarify misconceptions and legal responsibilities, providing overall improvement in an unattended aspect of medical care.

This paper offers a philosophical consideration and evaluation of several different criteria of moral standing, and discusses their implications for persistent vegetative state (PVS) individuals who were once competent. It is argued that the only criterion PVS individuals meet is that of being human, which is not the best test of moral standing. Accordingly it is, in principle, morally acceptable to perform passive or active euthanasia on PVS individuals or to use their bodies for research or for organ harvest. Nevertheless, the autonomous choices made by the persons the PVS individuals used to be can still impose moral obligations. Indeed, it is argued that the capacity for autonomy is a particularly appealing criterion of moral standing, and that the implications of this standard for PVS individuals confirm that appeal.