Academic journal article The Hastings Center Report

Why Does Removing Machines Count as "Passive" Euthanasia?

Academic journal article The Hastings Center Report

Why Does Removing Machines Count as "Passive" Euthanasia?

Article excerpt

At least since the publication of James Rachels' well-known paper, the distinction between passive and active euthanasia has been criticized for depending on problematic conceptions of causation and on the belief that the sheer difference between killing and letting die is morally relevant.[1] In fact, most of the debate on the passive/active and killing/letting die dichotomies has focused on conceptual issues of ordinary notions of causation or on the social utility of retaining those ordinary notions. But both the passive/active distinction and its clinical application depend on other assumptions that have so far largely escaped the notice of ethicists. In looking at which actions actually count as "passive" and which actually count as "active," it is clear that the practice of euthanasia consistently revolves around notions of a "natural" death, the "natural" course of disease, and the contextual permissibility of "unplugging machines" and "withdrawing treatments." Subtly but crucially evident in these concerns is a conceptual reliance on a form of the nature/culture distinction--the distinction between the "natural" and the "artificial"--and on particular assumptions about the definition and moral relevance of technology. As with the traditional issues of causation, there are serious conceptual problems in these assumptions.

Intervention and "Natural" Death

The effects of the nature/culture distinction and the concept of "naturalness" in the ethical discourse on euthanasia can be located by examining another common term in medical discourse--"intervention." Consider these instances:

Death has always been inevitable, a "fact of life."

But where humans were once helpless onlookers

in the presence of death, we are now increasingly

able to intervene in the process, using technological

resources to direct or delay the inevitable.[2]

(emphasis added)

Consider, for example, the patient on a respirator

with I.V. lines whose heart stops beating to the

point that it cannot be started. Such a person is

surely dead, yet we would not bury him with the

respirator running and the I.V. lines in place. For

aesthetic reasons we would first remove the interventions

(p. 31). (emphasis added)

. . . for physicians and medical scientists intervene

in numerous ways in the lives of adult humans,

children, infants, fetuses, and laboratory mice.[3]

(emphasis added)

. . . human medical interventions have interrupted

the natural death process to such an extent that

very few illnesses can be said to

have a natural course.[4] (emphasis


Title of prominent medical ethics

textbook: "Intervention and Reflection:

Basic Issues in Medical

Ethics."[5] (emphasis added)

What is the conceptual and moral effect of characterizing some action as an intervention? In euthanasia discourse, using this term separates out certain actions and objects as ontologically distinct, giving those actions and objects a special status in relation to surrounding phenomena. If a respirator, for example, is considered an intervention, then it is somehow ontologically isolated--inserted, foreign, added--on-from that in which it intervenes. More importantly, however, is what intervention implies about the larger phenomena in which it occurs.

It makes sense to call something an intervention only if one perceives that the collection of phenomena before the intervention forms an identifiable process. In fact, calling something an intervention may be the constructive act by which preintervention phenomena come to be related (as calling something pathological often establishes what will be considered normal). These phenomena are viewed as being gathered together to form a socially and morally meaningful, addressable, coherent process. …

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