The Rejection of Consequentializing

Consequentialists say we may always promote the good. Deontologists object: not if that means killing one to save five. “Consequentializers” reply: this act is wrong, but it is not for the best, since killing is worse than letting die. I argue that this reply undercuts the “compellingness” of consequentialism, which comes from an outcome-based view of action that collapses the distinction between killing and letting die.

Ignorance, Beneficence, and Rights

I argue that ignorance of who will die makes a difference to the ethics of killing. It follows that reasons are subject to ‘specificity’: it can be rational to respond more strongly to facts that provide us with reasons than to the fact that such reasons exist. In the case of killing and letting die, these reasons are distinctively particular: they turn on personal acquaintance. The theory of rights must be, in part, a theory of this relation.

Conceptual Clarity in Clinical Bioethical Analysis

Conceptual clarity is essential when engaging in dialogue to avoid unnecessary disagreement and to promote mutual understanding. In this issue devoted to clinical bioethics, the authors exemplify the virtue of careful conceptual analysis as they explore complex clinical questions regarding the essential nature of medicine, the boundaries of killing and letting die, the meaning of irreversibility in definitions of death, the argument for a right to try experimental medications, the ethical borders in complex medical billing, and the definition and modeling of complex disease states.

Giving Useful but Not Well-Understood Ideas Their Due

In this paper, I introduce the ideas to be discussed in the articles of this journal with reference to an imaginary case involving a pregnant woman declared dead on the basis of neurological criteria. I highlight the fact that although these ideas have proved useful for advancing certain claims in bioethical debates, their implications are not always well understood and may complicate our arguments. The ideas to be discussed are (1) an ethic internal to the profession of medicine; (2) the difference between killing and letting die; (3) the organism as a whole; and (4) the “lives” and interests of the dead.

Two Tragedies Argument: Two Mistakes

Most opposition to abortion turns on the claim that human fetuses are full moral agents from conception (or soon afterwards). Critics argue that antiabortion theorists act hypocritically when they neglect spontaneous abortions—valuing some fetal lives and not others. Many philosophers draw a distinction between killing and letting die, with the former being morally impermissible and latter acceptable. Henrick Friberg-Fernros appeals to this distinction with his Two Tragedies Argument, contending that anti-abortion theorists are justified in prioritising preventing induced abortions over spontaneous ones, as the former involves two tragedies—a death and a killing. However, induced abortion can involve either killing or letting die, and thus this view is incompatible with the traditional anti-abortion view. Furthermore, Friberg-Fernros appears to value preventing killing attempts more than preventing actual deaths.

Il fine vita e l’attribuzione di responsabilità morale / The end of life and the ascription of responsibility

L’odierno dibattito bioetico sulle questioni del fine vita sembra ancora caratterizzato da alcuni nodi problematici in merito alla responsabilità morale. Per esempio, certi approcci di stampo utilitaristico conferiscono a un medico che pratica l’eutanasia la medesima responsabilità morale attribuibile a chi non avvia o sospende dei trattamenti di sostegno vitale. Chiamiamo questo come l’argomento della “sempre uguale responsabilità”. La prospettiva opposta alla precedente riguardo all’attribuzione di responsabilità ritiene invece che vi sia una differenza morale assoluta tra uccidere e lasciar morire. Si definisca tale tesi nei seguenti termini: “mai la medesima responsabilità”. Dopo aver sottolineato come l’argomento della “sempre uguale responsabilità” equipari erroneamente all’eutanasia il non avvio o la sospensione dei trattamenti, l’articolo evidenzia le implicazioni sull’attribuzione di responsabilità derivanti sia dal rifiuto sia dalla difesa incondizionata della distinzione uccidere/lasciar morire. Nello specifico, mentre la tesi della “sempre uguale responsabilità” conduce a un’iper-responsabilizzazione del medico, l’altro argomento (“mai la medesima responsabilità”) ottiene l’effetto opposto, cioè de-responsabilizza l’agente morale. Richiamando altre distinzioni morali, il paper suggerisce quindi un approccio intermedio che distingue da un lato la causa dalle condizioni, dall’altro i doveri negativi da quelli positivi. Infine, attraverso la distinzione tra lasciar morire colpevole e lasciar morire per il bene del paziente, si rileva come in alcuni casi il lasciar morire sia moralmente equiparabile all’uccidere. Di conseguenza, affrontare le questioni del fine vita per attribuire la responsabilità significa confrontarsi con la complessità dell’agire morale, ma, per evitare approcci riduttivi, è necessario mantenere tutte le distinzioni appena menzionate. ---------- Nowadays the bioethical debate on end-of-life issues seems to still be characterized by some problematic interpretations of moral responsibility. For example, within certain utilitarian approaches, the same moral responsibility is ascribed to a physician who practices euthanasia and to another who withholds or withdraws life-sustaining treatments. Let’s call this point of view “the always equal argument”. An opposite approach to the ascription of responsibility emerges from the thesis that there is an absolute moral distinction between killing and letting die. Let’s call this thesis “the never equal argument”. After showing that the always equal argument erroneously describes the act of withholding or withdrawing treatments such as euthanasia, the paper addresses the implications that both a rejection and an unconditional defense of the killing/letting distinction could have in the ascription of responsibility. To specify, it is argued that while the always equal argument calls for an over-responsibility of the physician, the never equal argument leads the agent to take less responsibility for his actions. By referring to other moral distinctions, the paper then suggests an intermediate position that addresses the relevance of the distinctions between cause and conditions and between negative and positive duties. Finally, by the distinction between morally culpable letting die and letting die for the patient’s good, it is argued that in some cases letting die is morally equivalent to killing. Ascribing responsibility at the end of life thus means struggling with the complexity of moral acting, but maintaining all these distinctions is necessary to avoid reductive approaches.