Definition of the problem: In order to discuss the normative aspects of euthanasia one has to clarify what is meant by active and passive euthanasia. Arguments and conclusion: Many theoreticians deny the possibility of distinguishing between the two by purely descriptive means, e.g. on the basis of theories of action or the differences between acting and omitting. On the contrary, such a purely descriptive distinction will be defended in this paper by summarizing and refining the theory (...) of Dieter Birnbacher, which he developed in his book Tun und Unterlassen. I will suggest a new definition of active and passive euthanasia. (shrink)

This paper is divided into three sections. The first presents some examples of the killing/letting die distinction. The second draws a further distinction between what I call negative and positive cases of acting or refraining. Here I argue that the moral significance of the acting/refraining distinction is different for positive and for negative cases. In the third section I apply the above distinction to euthanasia, and argue that mercy killing should be regarded as analogous to positive rather than negative (...) cases. On the basis of this, I then support active rather than passive euthanasia. (shrink)

In their account of passive euthanasia, Garrard and Wilkinson present arguments that might lead one to overlook significant moral differences between killing and letting die. To kill is not the same as to let die. Similarly, there are significant differences between active and passive euthanasia. Our moral duties differ with regard to them. We are, in general, obliged to refrain from killing each and everyone. We do not have a similar obligation to try to prevent (...) each and everyone from dying. In any case, to be morally obliged to persist in trying to prevent their deaths would be different from being morally obliged to refrain from killing all other people even if we had both obligations. (shrink)

As a new approach to the still unsettled problem of a morally significant difference between active and passive euthanasia, the meanings of the notion of killing are distinguished on the levels of causality, intention, and motivation. This distinction allows a thorough analysis and refutation of arguments for the equality of killing and letting die which are often put forward in the euthanasia debate. Moreover, an investigation into the structure of the physician's action on those three levels (...) yields substantial differences between the two ways of acting. As can be demonstrated, only a teleological notion of the organism is able to grasp the characteristic feature of active euthanasia. On this basis it is argued that an action against the organism as a whole must, on the interpersonal level, be at once directed against the patient as a person himself. (shrink)

The view that voluntary active euthanasia and physician-assisted suicide should be made available for terminal patients only is typically warranted by reference to the risks that the procedures are seen to involve. Though they would appear to involve similar risks, the commonly endorsed end-of-life practices referred to as passive euthanasia are available also for non-terminal patients. In this article, I assess whether there is good reason to believe that the risks in question would be bigger in (...) the case of voluntary active euthanasia and physician-assisted suicide than in that of passive euthanasia. I propose that there is not. On that basis, I suggest that limiting access to voluntary active euthanasia and physician-assisted suicide to terminal patients only is not consistent with accepting the existing practices of passive euthanasia. (shrink)

BackgroundEuthanasia can be thought of as being either active or passive; but the precise definition of “passive euthanasia” is not always clear. Though all passive euthanasia involves the withholding of life-sustaining treatment, there would appear to be some disagreement about whether all such withholding should be seen as passive euthanasia.Main textAt the core of the disagreement is the question of the importance of an intention to bring about death: must one intend to (...) bring about the death of the patient in order for withholding treatment to count as passive euthanasia, as some sources would indicate, or does withholding in which death is merely foreseen belong to that category? We may expect that this unclarity would be important in medical practice, in law, and in policy. The idea that withholding life-sustaining treatment is passive euthanasia is traced to James Rachels’s arguments, which lend themselves to the claim that passive euthanasia does not require intention to end life. Yet the argument here is that Rachels’s arguments are flawed, and we have good reasons to think that intention is important in understanding the moral nature of actions. As such, we should reject any understanding of passive euthanasia that does not pay attention to intent.Short conclusionJames Rachels’s work on active and passive euthanasia has been immensely influential; but this is an influence that we ought to resist. (shrink)

I consider four recently suggested difference between killing and letting die as they apply to active and passive euthanasia : taking vs. taking no action; intending vs. not intending the death of the person; the certainty of the result vs. leaving the situation open to other possible alternative events; and dying from unnatural vs. natural causes. The first three fail to constitute clear differences between killing and letting die, and "ex posteriori" cannot constitute morally significant differences. The (...) last constitutes a difference but is not morally significant. (shrink)

In order to discuss the normative aspects of euthanasia one has to clarify what is meant by active and passive euthanasia. Many philosophers deny the possibility of distinguishing the two by purely descriptive means, e.g. on the basis of theories of action or the differences between acting and omitting to act. Against this, such a purely descriptive distinction will be defended in this paper by discussing and refining the theory developed by Dieter Birnbacher in his “Tun (...) und Unterlassen”. On this basis I will suggest a new definition of active and passive euthanasia. (shrink)

The distinction between “passive” and “active” euthanasia, though problematic and highly criticized, retains a certain intuitive appeal. When a patient is allowed to die, nature appears simply to be taking its course. Yet when a patient is killed by, say, a lethal injection, humans appear to be causing his or her death. Guilt seems to follow naturally from the latter act while not from the former. Yet this view only holds up if age‐old and vague ideasabout “nature” (...) and “artifice” go unscrutinized. Once examined more closely the functional relevance of particular machines to particular bodies becomes evident. And the innocence and guilt less clear. (shrink)

There are 4 main arguments for euthanasia: (1) arguments appealing to consistency (e.g., from passive to active euthanasia); (2) the argument from respect for autonomy; (3) appeals to justice; and (4) the argument from interests (mercy or relief of suffering). I will argue that only the last is directly relevant to active euthanasia as a medical intervention, though arguments together from autonomy and justice can in practice (through the backdoor) provide a ground for voluntary (...) active medical euthanasia (AME). (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Active Euthanasia and Assisted SuicidePat Milmoe McCarrick (bio)Although the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in its 1983 report, Deciding to Forego Life-Sustaining Treatment, described the words and terms "euthanasia," "right to die," and "death with dignity" as slogans or code words—"empty rhetoric," (I, p. 24), the literature reviewed for this Scope Note continues to use these (...) terms. Therefore, to discuss the termination of a patient's life by a physician at the patient's request, the phrase active euthanasia is used, and the supplying of a means by a physician whereby a patient can end his or her life is referred to as assisted suicide.Euthanasia, either as the "good death" from classical Greek or "mercy killing" to end unbearable suffering in the dying, has long been a topic of interest in western civilization (III, Brody 1989). In recent years, public awareness of this discussion about control over the time of one's death has been informed by a series of well-publicized events. They include the November 1991 rejection by a vote of 54 percent to 46 percent of the Washington state Initiative 119, which would have allowed the option of requesting one's physician to "aid-in-dying" for adult patients in a "medically terminal condition" (V, Gross 1991); two medical journal articles describing physician's actions in helping bring death to two patients (V, Anonymous 1988; V, Quill 1991); Dr. Jack Kevorkian's assistance in the suicide of three women (V, Belkin 1990; V, Wilkerson 1991); and the best seller status of a how-to book on committing suicide with opiates obtained from a physician (III, Humphry 1991).For the most part, material included in the annotated bibliography in Scope Note 18 has been chosen from works published in the four years since "It's Over, Debbie" (V, Anonymous 1988) appeared in early January 1988 in the Journal of the American Medical Association.Dr. Edmund D. Pellegrino (V, 1991, pp. 3118-19) presented opposing views about active voluntary euthanasia as follows:Those who favor voluntary euthanasia argue that it is a beneficent and compassionate act; it respects autonomy by preserving the patient's control of the manner, method, [End Page 79] and timing of death; it takes the matter outside the reach of "medical power" (accessed in this Scope Note's bibliography at V, Fletcher 1973; V, Nowell-Smith 1989) and scrupulosity; and it prevents the injustice that allows some patients to choose death by refusal of life-support measures, while denying others the right to do so by active euthanasia....The opponents of active euthanasia argue that it undermines the value of, and respect for, all human life (V, Kass 1989; V, Coyle 1990; V, Singer 1990). They fear that guidelines cannot avoid sliding down the "slippery slope" to involuntary euthanasia and selective devaluation of the lives of the most vulnerable among us.... If euthanasia is legal, it is predicted that patients will feel subtle pressure to conform so as to relieve the economic and emotional burdens they impose on family and friends.Euthanasia, its opponents further argue, is socially destructive: it undermines trust in physicians, desensitizes society to killing, and imperils the ground already gained in legitimating passive euthanasia(IV, Wolf 1989).Physicians were not particularly involved with a patient's death until after World War II when participation grew in proportion to the growth of technology. Since the complex, life-sustaining equipment that could forestall death was located in a hospital, death itself became almost completely medicalized (V, Dagi 1991). For terminally ill persons who would like to die a painless death, either by their own hand or with assistance, physicians have almost a monopoly on obtaining strong drugs for distribution to patients (V, Abrams 1990).Active euthanasia for human beings is not legalized anywhere in the world (V, VonDrehle 1991). It is classified as homicide or murder in all fifty states and in Great Britain, Canada, Australia, and the Phillippines (V, Nerland 1989). Twentysix states in the United States prohibit assisted suicide by statute (V, Rosenblum 1990).In 1969 in the Netherlands, a physician named Jan Hendrik van... (shrink)

Ever since the debate concerning euthanasia was ignited, the distinction between active and passive euthanasia – or, letting die and killing – has been marked as one of its key issues. In this paper I will argue that a) the borderline between act and omission is an altogether blurry one, and it gets even vaguer when it comes to euthanasia, b) there is no morally significant difference between active and passive euthanasia, and (...) c) if there is any, it seems to favor active instead of passive euthanasia. Therefore, while the distinction between active and passive euthanasia might be meaningful in terms of description, if it is considered to be endowed with moral weight and used on purpose of justifying one type of euthanasia instead of the other, it becomes morally problematic and misleading. (shrink)

Essays discuss active and passive euthanasia, the right to die, and the care of the terminally ill.

In this paper, we critically reflect on the concept of Euthanasia as understood in the West and in Africa, and especially in sub-Saharan Africa. From the Western block, we rely on the contributions of Ronald Otremba and James Rachels. In our view, Otremba represents the Traditional Western view of euthanasia, which holds that life is sacrosanct and therefore ought not to be taken away for whatever reasons. Otremba’s defense of passive euthanasia over active euthanasia (...) stems from this understanding. Rachels, on the other hand, does not see any morally significant difference between active and passive euthanasia, for the simplereason that the result is the same - death. Next, as we examine the African view of euthanasia with special reference to Munyaradzi Mawere’s interpretation of the Shona position on it, we want to ascertain whether or not there is something that can be called African euthanasia, and if not, whether or not the understanding of euthanasia in Africa has Western roots. (shrink)

Social media plays a vital role in consumers’ purchasing decision making. There are still gaps in existing research on the relationship between divided dimensions of social media use and impulse buying, as well as the mediating and moderating effects therein. This study explored the mediation and moderation effects in the relationship between different social media usage patterns, emotional responses, and consumer impulse buying. Data from 479 college students who were social media users in China were analyzed using structural equation modeling. (...) The results showed that active and passive social media use were significantly and positively associated with users’ enjoyment, whereas passive social media use significantly increased depression. Both enjoyment and depression were significantly and positively associated with users’ impulse buying. Materialism positively moderated the relationship between enjoyment and impulsive consumption, while self-control significantly reduced the effect of depression on impulse buying. These findings that emotion mediated and personality traits moderated relationships between social media use and impulse buying expand impulsive purchase literature and provide insights for guiding college students’ healthy use of social media and rational consumption. (shrink)

A study of 78 parents of Down's syndrome children shows that, while most were in favour of abortion for a handicapped fetus, they were divided equally on whether euthanasia (no distinction made between active and passive euthanasia) was an acceptable practice. Only a third considered an average Down's syndrome child could be a suitable candidate for euthanasia. While parents argued that the degree of handicap of the child was the crucial factor in making this decision, (...) in fact the social class of the parents themselves was the only variable which was statistically significantly related to their opinions. Differences arose from the parents' lack of agreement on what constituted a sufficiently severe handicap. (shrink)

Many philosophers maintain that there is a distinction between acts that the agent plays an active role in producing, and acts that issue from the agent in a more passive fashion. According to the standard account, we can make sense of this distinction by maintaining that reflective or deliberative acts are paradigmatic cases of an agent’s playing an active role in the production of action. This chapter argues that this standard account is mistaken. Reflective or deliberative actions (...) will seem to be active only if we conflate three claims: that choice causes action, that motives do not determine choice, and that reflection suspends the effects of motives. The chapter argues that while and are true, is false. Further, is needed to support the claim that reflective acts are active. Given the falsity of, the chapter shows that reflective acts are not necessarily more active than unreflective ones. The chapter closes by suggesting a new model of agential activity. (shrink)

In the early modern period, many authors held that sensation or sensory reception is in some way passive and that perception is in some way active. The notion of a more passive and a more active aspect of perception is already present in Aristotle: the senses receive forms without matter more or less passively, but the “primary sense” also recognizes the salience of present objects. Ibn al-Haytham distinguished “pure sensation” from other aspects of sense perception, achieved (...) by “discernment, inference and recognition,” which included perception of properties such as size and distance as well as similarity, difference, and beauty. Descartes regarded light and color as experiences passively caused in the mind by bodily processes, but he also included distance, perceived through accommodation and convergence, as an immediately caused sensory idea. On the perception side, most theorists held that size and distance perception occurs through unnoticed psychological operations, whether mediated by judgment or associative processes. Association is, in a sense, passive, as it occurs through nonreflective habit formation. But such habits mark a contribution of the subject to perception and are in that way active. The decision of whether sensation and perception are active or passive is highly sensitive to what counts as activity and to what is included as sensation or perception. There is no simple formula, but the generalization that sensation is for the most part passive and perception for the most part active may stand as an imprecise summary of early modern thought on the topic. (shrink)

David Shaw presents a new argument to support the old claim that there is not a significant moral difference between killing and letting die and, by implication, between active and passive euthanasia. He concludes that doctors should not make a distinction between them. However, whether or not killing and letting die are morally equivalent is not as important a question as he suggests. One can justify legal distinctions on non-moral grounds. One might oppose physician- assisted suicide and (...) active euthanasia when performed by doctors on patients whether or not one is in favour of the legalisation of assisted suicide and active euthanasia. Furthermore, one can consider particular actions to be contrary to appropriate professional conduct even in the absence of legal and ethical objections to them. Someone who wants to die might want only a doctor to kill him or to help him to kill himself. However, we are not entitled to everything that we want in life or death. A doctor cannot always fittingly provide all that a patient wants or needs. It is appropriate that doctors provide their expert advice with regard to the performance of active euthanasia but they can and should do so while, qua doctors, they remain hors de combat. (shrink)

The distinction between active and passive mind has been discussed by recent Augustine scholars, mainly in connection to the question whether - and if so to what extent - the Augustinian mind could be said to be active given the doctrine of divine illumination. The doctrine has prompted some to emphasize the mainly passive nature of the human mind in attaining knowledge, while others have argued that the doctrine should not be so construed as to downplay (...) the role the human mind plays in cognition. Of the latter, some have emphasized the role of the act of judgment, others the mind’s act of discovering within itself the standards of “eternal reasons”, and still others the role of the “created” as well as the “uncreated” light. While framing the discussion of the active and passive mind in this way, does help us clarify Augustine’s epistemological views, and at the same time fails to bring out the specific conception of the “active” mind that Augustine himself had and wished to emphasize. I explain what this conception is, then show that the distinction is put in use in his philosophy with a view that recent commentators have not emphasized in their interpretation of this distinction, as regards the role of the mind’s activity as a condition for non-empirical as well as empirical cognition. (shrink)

This chapter contains sections titled: Important Concepts and Distinctions and Alternative Views A Brief Defense of Assisted Suicide and Voluntary Active Euthanasia Arguments for the View that Voluntary Active Euthanasia is Morally Wrong Should Assisted Suicide and Voluntary Active Euthanasia be Legal?

Definition of the problem: Concerning the debate on euthanasia, a widely held position is that it should be accepted in its so-called passive and indirect form, while so-called active euthanasia should be rejected. The problem, now, is that at least some of the usual arguments to defend this view are invalid. Arguments: Three kinds of failures are examinded: First, if taken seriously, some of the arguments against active euthanasia undermine the accepted passive and (...) indirect forms, too. For example, this is the case concerning the claim that the patient's decision can be manipulated. Second, the rejection of active euthanasia partly rests on empirical data unsuited for this task. Euthanasia in The Netherlands as evidence for the so-called slippery slopes is presented as an example. Third, some of the objections against active euthanasia rest on assumptions that contradict our empirical knowledge, e.g. in the field of motives of patients asking for euthanasia. Conclusion: Those who want to defend the view mentioned above have to present more conclusive arguments. (shrink)

The Groningen Protocol allows active euthanasia of severely ill newborns with unbearable suffering. Defenders of the protocol insist that the protocol refers to terminally ill infants and that quality of life should not be a factor in the decision to euthanize an infant. They also argue that there should be no ethical difference between active and passive euthanasia of these infants. However, nowhere in the protocol does it refer to terminally ill infants; on the contrary, (...) the developers of the protocol take into account the future quality of life of the infant. We also note how the Nazi Euthanasie Programm started with the premise that there is some life not worthy of living. Therefore, in our opinion, the protocol violates the traditional ethical codes of physicians and the moral values of the overwhelming majority of the citizens of the world. (shrink)

Newton published his deduction of universal gravity in Principia (first ed., 1687). To establish the universality (the particle-to-particle nature) of gravity, Newton must establish the additivity of mass. I call ‘additivity’ the property a body's quantity of matter has just in case, if gravitational force is proportional to that quantity, the force can be taken to be the sum of forces proportional to each particle's quantity of matter. Newton's argument for additivity is obscure. I analyze and assess manuscript versions of (...) Newton's initial argument within his initial deduction, dating from early 1685. Newton's strategy depends on distinguishing two quantities of matter, which I call ‘active’ and ‘passive’, by how they are measured. These measurement procedures frame conditions on the additivity of each quantity so measured. While Newton has direct evidence for the additivity of passive quantity of matter, he does not for that of the active quantity. Instead, he tries to infer the latter from the former via conceptual analyses of the third law of motion grounded largely on analogies to magnetic attractions. The conditions needed to establish passive additivity frustrate Newton's attempted inference to active additivity. (shrink)

Zusammenfassung. In der Auseinandersetzung um die Frage, ob aktive Sterbehilfe mit dem ärztlichen Ethos vereinbar ist, werden häufig deskriptive Unterscheidungen wie Tun vs. Unterlassen, aktiv vs. passiv oder auch intendieren vs. in Kauf nehmen benutzt, um eine kategorische moralische Differenz zwischen Töten und Sterbenlassen auszuweisen. Als zusätzliche Schwierigkeit erweist sich dabei zum einen, daß zentrale Begriffe zwischen einer deskriptiven und einer ethischen Bedeutung changieren, und zum anderen, daß die Kennzeichnung des Problems (z.B. Sterbehilfe) selbst ethisch nicht neutral ist. Nach der (...) Entwicklung einer ethisch neutralen Problemstellung werden kategorische Argumente gegen die ethische Zulässigkeit aktiver Sterbehilfe diskutiert und verworfen. Anschließend werden Begründungen diskutiert, die mittels intrinsischer oder extrinsischer Situationsmerkmale eine ethische Unzulässigkeit aktiver Sterbehilfe aufzuweisen versuchen. Dabei zeigt sich, daß graduelle ethische Unterschiede zwischen passiver, indirekt und direkt aktiver Sterbehilfe begründbar sind, die ein jeweils höheres Maß an Rechtfertigungsgründen erfordern. (shrink)

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). (shrink)

The moral issues involved in doctors assisting patients to die with dignity are of absolutely central concern to the medical profession, ethicists, and the public at large. The debate is fuelled by cases that extend far beyond passive euthanasia to the active consideration of killing by physicians. The need for a sophisticated but lucid exposition of the two sides of the argument is now urgent. This book supplies that need. Two prominent philosophers, Gerald Dworkin and R. G. (...) Frey present the case for legalization of physician-assisted suicide. One of the best-known ethicists in the US, Sissela Bok, argues the case against. (shrink)

Is it worse to kill someone than to let someone die? It seems obvious to common sense that it is worse. We allow people to die, for example, when we fail to contribute money to famine-relief efforts; but even if we feel somewhat guilty, we do not consider ourselves murderers. Nor do we feel like accessories to murder when we fail to give blood, sign an organ-donor card, or do any of the other things that could save lives. Common sense (...) tells us that, while we may not kill people, our duty to give them aid is much more limited. Some philosophers, however, have argued that common sense is wrong about this. They have defended the Equivalence Thesis, which says that killing and letting die are equally bad. This is a more specific version of the idea that there is no moral difference between making something happen and allowing it to happen. The Equivalence Thesis is a radical conception that would require changes in our ordinary moral beliefs. If it is true, then obviously our duty to give aid is much stronger than we commonly assume. But our views about other matters, such as euthanasia, will also be affected. Many people believe that “passive euthanasia”--allowing terminal patients to die, rather than pointlessly prolonging their lives--is sometimes permissible; but they also believe that killing patients is always wrong. If the Equivalence Thesis is true, this combination of beliefs is inconsistent. The idea behind the Equivalence Thesis is not that every individual case of letting die is equally as bad as every individual case of killing. Obviously, if we compare an ordinary murder--say, a man killing his wife out of jealousy--with the actions of a physician who humanely permits a suffering patient to die, the murder is much worse. Rather, the idea is that the difference between killing and letting die does not itself make a difference to the moral assessment of the actions. Other factors may still be important. (shrink)

This chapter takes a fresh look at 3d2 of Spinoza’s Ethics, an absolutely pivotal definition for the ethical theory that ensues. According to it, “we act when something happens, in us or outside us, of which we are the adequate cause,” whereas we are passive “when something happens in us, or something follows from our nature, of which we are only a partial cause.” The definition of activity has puzzled scholars: how can we be an adequate, i.e. complete, cause (...) of an effect outside us (which clearly involves other causal factors as well)? However, the definition of passivity is hardly unproblematic either: how can something follow from the patient’s nature so that the patient can nevertheless be considered only a partial cause? I begin by outlining 3d2 and situating it in the historical context formed by Descartes, Hobbes, and the Aristotelian tradition. Then I show that the existing interpretations do not solve the problem of activity and argue that unraveling the problem requires taking properly into account the distinction between immanent and transeunt causality. In relation to the definition of passivity, I argue that Spinoza’s geometry-inspired theory of essence constitution offers the key to understanding the nature of passions. (shrink)

Our examination explicates not only how Leibniz’s emphasis on force or power squares well with (and most probably largely stems from) his endorsement of certain central Aristotelian tenets, but also how the concept of force is incorporated into his mature idealist metaphysics. That metaphysics, in turn, generates some thorny problems with regard to the concept of passivity; and so we shall also ask whether and how Leibniz’s monadology, emphasizing the activity as much as it does, is able to encompass the (...) passivity of created substances. (shrink)

In 2002 the Netherlands and Belgium both adopted a law on euthanasia. In the Netherlands the law was a codification of a longstanding practice of condoning euthanasia. In Belgium it was a political novelty, without extended prior legal or medical discussion. The developments in the Netherlands and in Belgium will certainly give rise to debates in other countries. The Dutch example has already elicited international discussion. The Belgian policy is interesting because it shows that legalisation of euthanasia (...) can be enacted quite quickly in a country that has no longstanding tradition in this area. John Keown’s book is therefore timely. He has taken part in the debate on euthanasia for a decade and combines an analytic style with a thorough knowledge of the literature on euthanasia. Moreover, he takes a firm stand in the debate. The subtitle of the current book clearly shows Keown’s position. As a critique of legislation of euthanasia, his book is a challenge to the developments in the Netherlands and Belgium.In the first part of the book, Keown tries to clear away common confusions and misunderstandings in the debate by developing clear definitions. Euthanasia is defined as an intentional termination of life. Keown distinguishes between active euthanasia and termination of treatment with the intention to terminate life, or passive euthanasia . Euthanasia is either at the patient’s request, that is voluntary euthanasia , or without the patient’s request, that is non-voluntary euthanasia . Keown distinguishes between euthanasia and medical interventions that foresee the shortening of the patient’s life, but do not primarily aim to bring this about, with reference to the intention of the physician. According to Keown, intentions and foresights are different states of mind, which are morally distinct. …. (shrink)

It has recently been suggested by Shaw (2007) that the distinction between voluntary active euthanasia, such as giving a patient a lethal overdose with the intention of ending that patient's life, and voluntary passive euthanasia, such as removing a patient from a ventilator, is much less obvious than is commonly acknowledged in the literature. This is argued by suggesting a new perspective that more accurately reflects the moral features of end-of-life situations. The argument is simply that (...) if we consider the body of a mentally competent patient who wants to die, a kind of ‘unwarranted’ life support, then the distinction collapses. We argue that all Shaw has provided is a perspective that makes the conclusion that there is little distinction between voluntary active euthanasia and voluntary passive euthanasia only seemingly more palatable. In doing so he has yet to convince us that this perspective is superior to other perspectives and thus more accurately reflects the moral features of the situations pertaining to this issue. (shrink)

This article deals with the euthanasia debate in light of new life-sustaining technologies such as the left ventricular assist device (LVAD). The question arises: does the switching off of a LVAD by a doctor upon the request of a patient amount to active or passive euthanasia, i.e. to ‘killing’ or to ‘letting die’? The answer hinges on whether the device is to be regarded as a proper part of the patient's body or as something external. We (...) usually regard the switching off of an internal device as killing, whereas the deactivation of an external device is seen as ‘letting die’. The case is notoriously difficult to decide for hybrid devices such as LVADs, which are partly inside and partly outside the patient's body. Additionally, on a methodological level, I will argue that the ‘ontological’ arguments from analogy given for both sides are problematic. Given the impasse facing the ontological arguments, complementary phenomenological arguments deserve closer inspection. In particular, we should consider whether phenomenologically the LVAD is perceived as a body part or as an external device. I will support the thesis that the deactivation of a LVAD is to be regarded as passive euthanasia if the device is not perceived by the patient as a part of the body proper. (shrink)