At issue in the first two readings is the distinction between killing and letting die. Rachels
tries to dissolve the distinction, whereas Foot wants to maintain it. This distinction is
likened to the distinction between active and passive euthanasia.
Doesn’t buy the distinction. It is no worse (morally) to kill than let die.
His ‘pain’ argument: if X is in pain (be it mental or physical), then why would the
medical institution allow only for ‘nature’ to take course as opposed to a doctor
expediting the process? This makes the suffering worse for the patient, which goes
against the purpose of medicine, Rachels argues.
He argues by analogy why he thinks the distinction between killing and letting die is a
bad one. It goes something like this: Both Jones and Smith have the potential to gain by
the death of a cousin. They both want this gain now, and plan to get rid of this cousin to
get it. Smith drowns the cousin in the tub whereas Jones, who had the same intent, did not
get the chance to do so because the cousin died before he could get there.
Rachels thinks that this analogy maps onto the active/passive distinction.
Smith: actively brings about the death. Jones: lets the kid die.
For Rachels, both cases are morally equivalent because what matters morally, he claims,
are intentions. Although Jones did not actually kill the child, he had the intent to do so
and let him die.
Note: Rachels assumes that intentions, not the consequences, are what matter morally. In
the example, the consequences are the same, but keep in mind that this assumption
transcends the example, and is at the core of Rachels’ ethical framework.
Both Jones and Smith are murderers because both have the same ‘sinister’ intent to kill
the child. Since both acts are morally equivalent, and since Rachels thinks that these
cases represent killing and letting die, he thinks that it follows that both killing and letting
die are morally equivalent. Thus, the distinction does not hold.
Rachels makes a further point. The American Medical Association is opposed to active
euthanasia, and he takes this to be a mistake. He denies the distinction, and here, what is
typically taken as ‘passive’ euthanasia is the same as active.
Passive euthanasia too is the intentional termination of life by another human (which is
the definition of active euthanasia). Therefore, his point is that passive euthanasia
collapses into active euthanasia because withholding treatment is itself an action.