{"agent_id":"rachels","agent_name":"James Rachels","slug":"active-and-passive-euthanasia","label":"Active and passive euthanasia: is there a morally significant difference between killing a patient and letting a patient die, or is the *Equivalence Thesis* — that if passive euthanasia is sometimes permissible, active euthanasia must sometimes be permissible too — the precise conclusion the *Bare Difference Argument* establishes against the AMA's 1973 doctrinal distinction?","topic":"Active and passive euthanasia","question":"Is there a morally significant difference between killing a patient and letting a patient die, or is the *Equivalence Thesis* — that if passive euthanasia is sometimes permissible, active euthanasia must sometimes be permissible too — the precise conclusion the *Bare Difference Argument* establishes against the AMA's 1973 doctrinal distinction?","position":"The *Equivalence Thesis* is the conclusion that there is no moral difference between active and passive euthanasia *as such* — that the bare difference between killing a patient and letting a patient die does not, in itself, make a difference to the morality of actions concerning life and death. The *Bare Difference Argument* establishes the conclusion through the Smith/Jones drowning thought experiment: Smith stands to gain a large inheritance and drowns his six-year-old cousin in the bath; Jones stands to gain the same and enters the bathroom planning the same drowning, but sees the child slip and fall face-down in the water and stands by ready to push the head under if necessary while the child drowns \"accidentally.\" Smith killed; Jones let die. The cases are exactly alike in motive, foreseeable outcome, and moral reprehensibility. If the bare difference between killing and letting die were itself morally significant, Jones's behavior would be less reprehensible than Smith's; it is not. The argument generalizes: the bare difference is not morally significant in itself. Where killing and letting die differ in moral assessment, they differ because of further factors — the actor's motive (personal gain vs humanitarian concern), the victim's situation (healthy child vs terminal patient in unrelievable pain), the consequences for the rest of the world — not because of the bare killing/letting-die distinction. In medical contexts where humanitarian motivation, the patient's unrelievable suffering, and the patient's request align, the bare difference between active and passive euthanasia carries no moral weight. If passive euthanasia is sometimes permissible — and the AMA's 1973 statement allows that it is — active euthanasia is sometimes permissible too.","paragraphs":[[{"t":"The *Equivalence Thesis* is the conclusion that there is no moral difference between active and passive euthanasia *as such* — that the bare difference between killing a patient and letting a patient die does not, in itself, make a difference to the morality of actions concerning life and death.","n":[1]},{"t":"The *Bare Difference Argument* establishes the conclusion through the Smith/Jones drowning thought experiment: Smith stands to gain a large inheritance and drowns his six-year-old cousin in the bath; Jones stands to gain the same and enters the bathroom planning the same drowning, but sees the child slip and fall face-down in the water and stands by ready to push the head under if necessary while the child drowns \"accidentally.\" Smith killed; Jones let die.","n":[2,3,4]}],[{"t":"The cases are exactly alike in motive, foreseeable outcome, and moral reprehensibility.","n":[]},{"t":"If the bare difference between killing and letting die were itself morally significant, Jones's behavior would be less reprehensible than Smith's; it is not.","n":[]},{"t":"The argument generalizes: the bare difference is not morally significant in itself.","n":[]},{"t":"Where killing and letting die differ in moral assessment, they differ because of further factors — the actor's motive (personal gain vs humanitarian concern), the victim's situation (healthy child vs terminal patient in unrelievable pain), the consequences for the rest of the world — not because of the bare killing/letting-die distinction.","n":[]}],[{"t":"In medical contexts where humanitarian motivation, the patient's unrelievable suffering, and the patient's request align, the bare difference between active and passive euthanasia carries no moral weight.","n":[]},{"t":"If passive euthanasia is sometimes permissible — and the AMA's 1973 statement allows that it is — active euthanasia is sometimes permissible too.","n":[5]}]],"texts":"Primary works: 'Active and Passive Euthanasia' in *The New England Journal of Medicine* 292 (9 January 1975), pp. 78-80 — the canonical short version; 'Euthanasia, Killing, and Letting Die' in John Ladd ed. *Ethical Issues Relating to Life and Death* (Oxford 1979), pp. 146-163 — the long developed version with the *Bare Difference Argument*, the Smith/Jones drowning thought experiment, the *Jack Palance Argument*, and the *No Relevant Difference Argument*; *The End of Life: Euthanasia and Morality* (Oxford 1986) Chapters 6-8 — 'Debunking irrelevant distinctions,' 'Active and passive euthanasia' (with engagement of Judith Jarvis Thomson's objection and the *Compromise View*), and 'Further reflections on killing and letting die'; *Can Ethics Provide Answers?* (Rowman & Littlefield 1997) Chapter 4 'Active and Passive Euthanasia' (the NEJM short version reprinted, lightly revised) and Chapter 5 'Killing, Letting Die, and the Value of Life' (1993). Reception: the AMA 1973 policy statement Rachels engages directly; Paul Ramsey's *The Patient as Person* and *Ethics at the Edges of Life* defending the killing/letting-die distinction; Anthony Shaw on the surgical-decision setting (cited in the NEJM 1975 paper); J. Russell Elkinton's *Villanova Law Review* (1968) 'cause of death' argument; Judith Jarvis Thomson's objection (engaged in *End of Life* Ch 7, 'Thomson's objection'); the bioethics literature on the Doctrine of Doing and Allowing (Frances Kamm, Warren Quinn, Jeff McMahan); the contemporary debate over physician-assisted suicide and active-euthanasia legalization that the original argument continues to inform.","works":["Primary works: 'Active and Passive Euthanasia' in *The New England Journal of Medicine* 292 (9 January 1975), pp. 78-80 — the canonical short version","'Euthanasia, Killing, and Letting Die' in John Ladd ed. *Ethical Issues Relating to Life and Death* (Oxford 1979), pp. 146-163 — the long developed version with the *Bare Difference Argument*, the Smith/Jones drowning thought experiment, the *Jack Palance Argument*, and the *No Relevant Difference Argument*","*The End of Life: Euthanasia and Morality* (Oxford 1986) Chapters 6-8 — 'Debunking irrelevant distinctions,' 'Active and passive euthanasia' (with engagement of Judith Jarvis Thomson's objection and the *Compromise View*), and 'Further reflections on killing and letting die'","*Can Ethics Provide Answers?* (Rowman & Littlefield 1997) Chapter 4 'Active and Passive Euthanasia' (the NEJM short version reprinted, lightly revised) and Chapter 5 'Killing, Letting Die, and the Value of Life' (1993)"],"reception":"the AMA 1973 policy statement Rachels engages directly; Paul Ramsey's *The Patient as Person* and *Ethics at the Edges of Life* defending the killing/letting-die distinction; Anthony Shaw on the surgical-decision setting (cited in the NEJM 1975 paper); J. Russell Elkinton's *Villanova Law Review* (1968) 'cause of death' argument; Judith Jarvis Thomson's objection (engaged in *End of Life* Ch 7, 'Thomson's objection'); the bioethics literature on the Doctrine of Doing and Allowing (Frances Kamm, Warren Quinn, Jeff McMahan); the contemporary debate over physician-assisted suicide and active-euthanasia legalization that the original argument continues to inform.","status":"The *Equivalence Thesis* has been the focus of sustained philosophical attention since the 1975 NEJM publication — defended by Peter Singer, Helga Kuhse, Jeff McMahan, and the bioethics-utilitarian tradition; attacked by Paul Ramsey and the sanctity-of-life Christian tradition; engaged with by Judith Jarvis Thomson on technical grounds; and revisited by the Doctrine-of-Doing-and-Allowing literature (Frances Kamm, Warren Quinn) that argues for a more refined version of the killing/letting-die distinction the Equivalence Thesis denies. The position is firm and was never softened across the authorship: the 1975 NEJM short version, the 1979 Ladd long version, the 1986 *End of Life* Chapters 7-8, and the 1997 *Can Ethics Provide Answers?* reprints all carry the same argument with increasing refinement. The contested ground is whether the Smith/Jones cases are genuinely \"exactly alike except for the bare difference\" (Frances Kamm in particular argues they are not), and whether the philosophical-conceptual analysis of the killing/letting-die distinction reaches into the medical-ethics setting in the way the argument requires. The position defends the analysis as published with engagement of the canonical objections by name.","era":"1941-2003","discipline":"Philosophy","refs":[{"n":1,"work":"The End of Life - Euthanasia and Morality","page":"pp. 123–124","canonical":"","quote":"Thus, it seems that when we are careful not to smuggle in any further differences which prejudice the issue, the bare difference between killing and letting die does not itself make any difference to the morality of actions concerning life and death. I will call this the 'Bare Difference Argument'.","label":"The End of Life - Euthanasia and Morality, pp. 123–124"},{"n":2,"work":"The End of Life - Euthanasia and Morality","page":"p. 123","canonical":"","quote":"However, just as he enters the bathroom Jones sees the child slip, hit his head, and fall face-down in the water. Jones is delighted; he stands by, ready to push the child's head back under if necessary, but it is not necessary. With only a little thrashing about, the child drowns all by himself, 'accidentally', as Jones watches and does nothing. No one is the wiser, and Jones gets his inheritance.","label":"The End of Life - Euthanasia and Morality, p. 123"},{"n":3,"work":"Can Ethics Provide Answers","page":"p. 82","canonical":"","quote":"In the first case, Smith stands to gain a large inheritance if anything should happen to his six-year-old cousin. One evening while the child is taking his bath, Smith sneaks into the bathroom, drowns the child, and arranges things so that it will look like an accident. In the second, Jones also stands to gain if anything should happen to his six-year-old cousin.","label":"Can Ethics Provide Answers, p. 82"},{"n":4,"work":"Ethical Issues Relating to Life and Death (1979) - contains Rachels Euthanasia Killing and Letting Die","page":"pp. 9–10","canonical":"","quote":"Like Smith, Jones sneaks in planning to drown the child in his bath. However, just as he enters the bathroom Jones sees the child slip, hit his head, and fall face down in the water. Jones is delighted; he stands by, ready to push the child's head back under if it is necessary, but it is not necessary.","label":"Ethical Issues Relating to Life and Death (1979) - contains Rachels Euthanasia Killing and Letting Die, pp. 9–10"},{"n":5,"work":"Ethical Issues Relating to Life and Death (1979) - contains Rachels Euthanasia Killing and Letting Die","page":"pp. 8–9","canonical":"","quote":"If a doctor deliberately let a patient die who was suffering from a routinely curable illness, then he would be to blame for what he did, just as he would be to blame if he had needlessly killed the patient. It would be no defense at all for him to insist that, really, he didn't \"do anything\" but just stand there. We would all know that he did do something very serious indeed, for he let the patient die.","label":"Ethical Issues Relating to Life and Death (1979) - contains Rachels Euthanasia Killing and Letting Die, pp. 8–9"}],"answer":null,"siblings":[{"slug":"biographical-life-vs-biological-life","label":"Biographical life vs biological life: is the moral rule against killing the protection of biological functioning (the traditional sanctity-of-life view) or the protection of *lives* in the biographical sense — the sum of a person's aspirations, decisions, activities, projects, and human relationships — that some humans (Mrs Florian, Quinlan, Baby Jane Doe) do not have and that some non-human animals do?"},{"slug":"moral-individualism-and-the-critique-of-speciesism","label":"Moral individualism and the critique of speciesism: does the bare fact that one is a member of the human species entitle one to special moral consideration, or does *moral individualism* — the position that how an individual should be treated depends on his or her own particular characteristics rather than on group-membership — replace the discredited doctrine of human dignity once Darwinism has removed its metaphysical supports?"},{"slug":"cultural-relativism","label":"Cultural relativism: does the existence of moral disagreement across cultures entail that there is no objective moral truth, or is the *Cultural Differences Argument* invalid — with the apparent disagreement masking shared underlying values that any functioning culture must hold?"},{"slug":"ethical-egoism","label":"Ethical egoism: do the *Two Arguments Against Ethical Egoism* in *Elements* Chapter 5 and *Legacy of Socrates* Chapter 10 successfully refute the position that one ought always to act in one's own self-interest, given that the documented late-life qualification (Stuart's *Legacy* preface: in the 1990s Jim said he had lost confidence in the argument because he had changed his mind about the role of intuitions in moral theory) is treated as authorship-internal tension rather than retraction?"}]}