In the light of Terri Schiavo's upcoming judicially-imposed starvation, I wanted to record some of my thoughts on euthanasia and related issues. Before looking at the issues, it's important first to get some terminology out of the way. Euthanasia (from the Greek for good death) can be either active or passive, voluntary or involuntary. Active euthanasia is usually defined in terms of whether the person doing the killing actively does something to initiate the death, whereas passive euthanasia involves no such action but merely allowing someone to die. Euthanasia is voluntary when the person being killed has consented to being killed, and involuntary euthanasia is against such consent. Some people will classify cases with no consent either way as non-voluntary (but not involuntary).
Putting your pet to sleep is non-voluntary, active euthanasia. Not taking your friend to the hospital because he requests not to be helped is voluntary, passive euthanasia. Killing everyone over 60 because they're too old for your tastes would be involuntary, active euthanasia (at least for most of the people killed). Watching someone drown to death who is calling for your help would be involuntary and passive. Killing a child born with Down's Syndrome is non-voluntary but active. Simply refusing to operate on such a child who has an easily operable intestinal blockage is passive, non-voluntary euthanasia.
The only cases that are legal in this country are the ones the medical community recognizes as voluntary and passive or non-voluntary (but with a legal guardian's consent) and passive. Voluntary, active assisted suicide is allowed in some states, but only a few have made that legal at this point. I'm not sure which those are, but I believe Oregon was the first to do so. There may be only one or two others.
The standard view is that active euthanasia is always wrong, but passive euthanasia is ok in cases when the person consents or when the legal guardians consent when the
victim beneficiary is someone unable to consent, e.g. the mentally retarded child whose parents decide that sort of mental disability is enough to make the child's life not worth living and therefore refuse to allow a simple operation. That such cases are allowed is important to the argument first popularized by the late philosopher James Rachels that the distinction between active and passive euthanasia doesn't hold up, and therefore since we allow passive euthanasia we're committed to allowing active.
I have three things to say about this argument. One is that Rachels is right in his main point. There is no moral distinction between active and passive euthanasia. Suppose you intend to kill someone and go through all the preparations to drown the person while swimming in a known location. Then you arrive to do the deed, and the victim is simply drowning to death already. You could save him, but why would you? You were going to kill him anyway. Does the fact that you didn't actively kill him make what happened less bad than if you had done the drowning? I say yes. Does it mean you're not at fault? Hardly. Passively allowing someone to die when you can do something about it is still wrong.
Of course, this isn't what Rachels wants. He wants to say that euthanasia isn't wrong in both cases. He thinks it's ok in both cases. The difference with euthanasia is the motivation. In my murder case, you would have had some evil intent. In euthanasia cases, you simply want to put someone out of their misery, and what can be more innocent than wanting your loved ones free from suffering? So Rachels argues that in cases with the same motivation, regardless of whether you physically move to do the deed, the moral issues have more to do with why you're doing it and with the final effect, which is of course death in both cases, than with how it's arrived at. If it's ok to refuse to operate on the retarded child, if the only reason is so the child will die, then why is it not ok to inject the child with a lethal poison that will allow a more painless death? I don't see the difference, morally speaking. I don't think it leads to the conclusion he takes it to, though, because he's assuming it's ok to kill Down's syndrome babies by not operating on their intestinal blockages, and I think that's morally horrendous.
The second point I want to make about Rachels' argument is that the difference between active and passive euthanasia is unhelpful to begin with when applied to the kinds of cases that are usually referred to as passive euthanasia. Passive euthanasia, as commonly defined, is somewhat rare. It involves failing to treat someone medically or failing to engage in some other, non-medical lifesaving technique. This happens when members of the Watchtower Society refuse blood transfusions or when the followers of Mary Baker Glover Patterson Eddy refuse any medical treatment whatsoever. It doesn't happen when you flip a switch, pull a plug from an outlet, or remove a feeding tube. What's being proposed for Terri Schiavo is in fact active euthanasia, regardless of what anyone wants to call it. I've just explained why the distinction between active and passive euthanasia doesn't do the work it's supposed to do. Still, those who want to pretend that it does need to recognize that most of the cases they're calling passive so as to make them legal are simply not passive.
Third, there is a moral distinction that can enter into euthanasia cases, but it's not the active-passive distinction. That distinction is found, of all places, in the A.M.A. statement that supporters of the active-passive distinction use as the basis of their view. The A.M.A. statement says nothing of active or passive killing, however. It simply says that euthanasia is presumed to be wrong except in cases where extreme measures would be required to save someone's life. This is because other moral principles might conflict with saving the person's life in these cases.
Such extreme measures might be something like initiating very expensive procedures to prolong someone's life. Some people think the expense of prolonging someone's life isn't always going to be worth it. If it took half the GNP of the U.S. to save someone, I think that would be a bit much. The act of saving the person would require causing harm to a great many others. Also, no one is justified in taking a heart out of a living person to save another's life. That's just wrong, and saving someone's life isn't an absolute requirement even if the action required to do so would otherwise be immoral. There may also be issues with religious beliefs, which explains why it could be ok to refuse treatment at the request of the patient. It may well be wrong to violate someone's religious beliefs even if that means the person dies.
I don't have a real problem with such cases of passive euthanasia. That's because some other moral principle interferes with a prima facie principle to save people's lives. That principle is true only if all other things are equal, and when other moral principles apply other things are not equal. There are many cases that don't seem so obviously ok that also don't seem to me to be absolutely clearly wrong. Maybe there are cases that are in some ways like Terri Schiavo's that are ok. I'm not prepared to take a view on that at this point. I do think there are a few features of her case that make it clearly wrong.
One is that it's at best non-voluntary. She didn't give her consent. There's no document demonstrating her consent, and the people who know her well offer conflicting testimony on whether she wanted to live under such conditions. Her parents and siblings say she would have wanted to be kept alive in such a state. Her husband says she wouldn't have. Which do you believe?
Now I'm not prepared to defend a view on this question for most cases like this. Her case has one feature that makes it clear to me. Her husband seems not to have her best interests in mind. He has been living with another woman for something like fifteen years. He has kids with this other woman. He can't divorce his wife without losing his life insurance policy on her. He can't collect that unless she dies. He can't therefore marry the woman he's living with whose kids he's fathered unless his wife dies without thereby forfeiting his life insurance money that he'd gain from Terri's death. If that's not enough to generate a real legal reason not to allow him to manage her affairs, he's even exhibited some further suspicious behavior, but you can read further on that on your own.
At the same time, there are some indications that she's not really even in the vegetative state that doctors claim she's in. I've seen some of the videos, and what she does seems more to me than what someone with no consciousness at all could do. She distinguishes between her parents and other people. That doesn't seem purely involuntary. She seems responsive to certain statements and not others, with some regularity. It's also not as if everyone diagnosed as being in a vegetative state has no hope of ever regaining consciousness, because we have someone this week who began communicating after having received such a diagnosis. The best attitude, I think, is one of caution against assuming that she's in such a state, and I don't think that would be enough to justify treating her as a non-person anyway, but that issue would take a post of its own (at the very least).
As for the issue of moral principles interfering, I just can't see it here. It's not as if her being on the feeding tube violates someone else's rights or costs some huge expense that would threaten the livelihood of lots of people. So I just can't see the one distinction that enters in here as relevant to her case. So what do I think is going on here? Michael Schiavo wants his wife killed, and the United States' judicial and medical system is shamefully going along with it. That's at least the moral equivalent of murder, even if it's not going to turn out to be legally murder.
Update: For more on Terri Schiavo and the background issues, see this roundup at Wittenberg Gate.