Dr. Grey was depressed. One of his terminally ill patients was being kept on a life-support machine. Before she lost consciousness for the last time, she had repeatedly asked that the machine be switched off. But the hospital ethics committee had ruled that it would be wrong to take any action intended to shorten the life of a patient.
Grey disagreed with the committee and was disturbed that the wishes of the patient had been ignored. He also thought that holding off death with the machine was merely prolonging the agony of her friends and relations.
Grey stood looking mournfully at his patient. But then something odd happened. A hospital cleaner caught the power cable that led to the life-support machine and pulled it out from the socket. The machine emitted some warning bleeps. The cleaner, disturbed by the sound, looked at the nearby doctor for guidance.
"Don't worry," said Grey without hesitation. "Just carry on. It's all right."
And indeed for Grey it was now all right. For no one had taken any deliberate action to shorten the life of the patient. All he was doing by leaving the accidentally unplugged machine turned off was not taking any action to prolong it. He now had the result he desired without breaking the instructions of the ethics committee.
Source: Causing Death and Saving Lives by Jonathan Glover, 1977.
Baggini, J., The Pig That Wants to Be Eaten, 2005, p. 211.
As I said, I think the ethics committee is wrong to have such restrictive rules about voluntary euthanasia in the first place, and that is driving hospital staff to look for compassionate ways around the rules. By taking this fictional world as it is written, however, the thought experiment is asking us to look at something known as the "acts/omissions doctrine." The Oxford Dictionary of Philosophy explains that this is...:
"The doctrine that it makes an ethical difference whether an agent actively intervenes to bring about a result, or omits to act in circumstances in which it is foreseen that as a result of the omission the same result occurs. ... Critics reply that omissions can be as deliberate and immoral as commissions: if I am responsible for your food and fail to feed you, my omission is surely a killing. ‘Doing nothing’ can be a way of doing something, or in other words, absence of bodily movement can also constitute acting negligently, or deliberately, and depending on the context may be a way of deceiving, betraying, or killing. ... The question is whether the difference, if there is one, between acting and omitting to act can be described or defined in a way that bears general moral weight."
I could have addressed this topic before when I wrote a post about the thought experiment known as The Violinist, but I neglected to delve into that detail. If you recall, that experiment was a part of Judith Jarvis Thomson's paper called "A Defense Against Abortion," and it laid out the scenario of a man being hooked up to a famous violinist as a sort of human dialysis machine and he had to remain connected to the violinist for 9 months or the violinist would die. Critics of that thought experiment claimed that it wasn't a persuasive case for abortion because there is a moral difference between directly killing a fetus and indirectly letting someone die by unplugging a life support system. Those critics obviously hadn't read Thomson's original paper and only took the violinist experiment out of context because she actually did a thorough job of preemptively arguing against such concerns. That's partly why I didn't talk about this before. But now we're faced with the criticism that even unplugging the machine is too much of a direct act. These critics have moved the goalposts and now say that watching the plug get accidentally yanked out of the socket is okay, but really, where does such hair splitting end in the question of what is direct action vs. indirect inaction?
It's no surprise that the field of medical ethics has considered this issue in great detail, so we should consider their previous discussions. As seen above, the source for this week's thought experiment is a book by Jonathan Glover called Causing Death and Saving Lives. This book was reviewed in the Journal of Medical Ethics, where it was noted that one of Glover's chapters is "especially powerful" in arguing against "the doctrine that acts with bad consequences are always worse than omissions with the same consequences." But perhaps some of that power should be attributed to the philosopher James Rachels, who published a paper called "Active and Passive Euthanasia," in The New England Journal of Medicine two years earlier. Rachels' paper (excerpted in a BBC Ethics Guide) argued that:
"The distinction between acts and omissions is not as helpful as it looks. Consider these two cases:
- Smith will inherit a fortune if his 6 year old cousin dies. One evening Smith sneaks into the bathroom where the child is having his bath and drowns the boy. Smith then arranges the evidence so that it looks like an accident.
- Jones will inherit a fortune if his 6 year old cousin dies. One evening Jones sneaks into the bathroom where the child is having his bath. As he enters the bathroom he sees the boy fall over, hit his head on the side of the bath, and slide face-down under the water. Jones is delighted; he doesn't rescue the child but stands by the bath, and watches as the child drowns.
Nine years later, in an editorial in the Journal of Medical Ethics titled "Acts and Omissions: killing and letting die," we see that Rachels went even further and was still being discussed.
"Rachels supports his claim that the use of the kiling-letting die distinction can lead to cruelty by citing a paediatrician's account of what happens when it is decided to let a severely handicapped infant die. The doctor "must try to keep the infant from suffering while natural forces sap the baby's life away" — it is a "terrible ordeal" to stand by "and watch as dehydration and infection wither a tiny being over hours and days." Having quoted this harrowing account, Rachels writes, "The doctrine that says that a baby may be allowed to dehydrate and wither, but may not be given an injection that would end its life without suffering, seems so patently cruel as to require no further refutation.
One common argument in support of the doctrine is that in letting a patient die a doctor does not do anything to cause the patient's death — it is the disease process which causes the patient's death — it is nature taking its course. There are at least two problems with this line of argument. The first concerns the nature of action. While it may be arguable that if a person does not move he is not acting in the sense of being active (and even that claim is dubious), a person who intentionally takes no action may nonetheless be acting, in the morally important sense of human agency. The action he takes in that sense of action, and under one description, is intentionally to allow his patient to die. The fact that he did so by avoiding certain physical actions is not in itself morally exonerating — there are countless situations in which it is clearly morally reprehensible to take no action with the intention of allowing another person to die, particularly so if that person is one's patient."
Agreed. Such counterintuitive examples that seemingly exonerate cruelty or damn compassion are always possible to invent when faced with hairsplitting philosophers who insist on cleaving the past, present, or the future from its full context. As I described in my response to thought experiment 60:
"Deontological moral rules are not sufficient. Consequentialism shows that results matter too. And virtue ethics says intentions also count. Together, these three schools of thought make up the three main camps of moral philosophy. However, as is often the case with thorny philosophical issues, the best position on morality isn't an "either/or" decision from among these three choices, it's an "all/and" decision which considers the three of them. For any morally-considered human behaviour, there is an intention, an action, and a result. That's the way an event is described prior to, during, and after it occurs. It's the way the past, present, and future are bound together by causality yet allowed to be looked at separately across time. Virtue ethics concerns itself with the intention. Deontology focuses on the action. Consequentialism focuses on the result. But all three may be evaluated individually for moral purposes. ... We can hold all three of these judgments in our head at the same time and use them to guide future decisions accordingly with respect to blame, praise, imitation, or change."
In the case of this week's thought experiment, we see the confusion that occurs when such a holistic view of morality is not taken. The ethics committee imposed a deontological rule in which "it would be wrong to take any action intended to shorten the life of a patient." But by insisting upon the letter of this law, one action is deemed unvirtuous, while another inaction is deemed virtuous, even though both "actors" had the same (virtuous) intent and the same consequence was the result. Since that is an obvious contradiction, we see the breakdown in any morally meaningful hierarchy between acts and omissions. Either one could be more praise- or blame-worthy than the other when looked at in full context. The fact that people do hide behind such fallacious distinctions in real life examples such as this one is due to their need to find ways around faulty deontological rules. It would be far better to just abolish such strictures.