defense of rachels against killing and letting die

Jay Carlson:A Defense of Rachels and the Equivalency Thesis

The Difference thesis, a frequent member in many common sense conceptions of moral

reasoning, claims that allowing someone to die has a different moral status than actively bringing

about that person’s death, i.e. killing them. The intuitive pull of this thesis is that agents who

actively commit wrongdoing are usually judged to be more blameworthy than those who

passively allow wrongdoing to happen; for example, even though many WWII-era Germans

allowed the Nazis to commit various atrocities, the average German’s blameworthiness does not

rise to the level of the Nazi soldiers who perpetrated those atrocities. James Rachels, however,

claims that the Difference Thesis is false: there is no moral distinction between killing a person

and allowing them to die.

In this paper, I will defend Rachels from Philippa Foot’s advocacy for the Difference

Thesis. I will argue that Foot understands Rachels to be making a far stronger claim than I think

Rachels intended. On my reading of Rachels, he is arguing for a symmetry concerning the

permissibility of these two acts, not that there is never a morally relevant difference between

killing and letting die. I will also respond to other objections to Rachels’ position that arise.

Second, I will explore the findings of experimental philosophy studies on the questions of killing

and letting die, specifically with an eye towards what kinds of reasons people undergird the

intuitions they have about cases like Rachels’ Smith and Jones.

The immediate context in which Rachels confronts the Difference Thesis is the question

of the permissibility of euthanasia. Advocates of the Difference Thesis regarding euthanasia

claim that while actively ending some person P’s life by a lethal injection would constitute a

morally impermissible act, to refrain from resuscitating P if she went into cardiac arrest or to

discontinue life-sustaining treatment—i.e. to allow the patient to die—can be a morally

permissible act. The permissibility of allowing someone to die is of course qualified in several


ways—e.g. P is in the late stages of a terminal illness, she has an advance do-not-resuscitate

directive, and continuing treatment is judged to be no longer beneficial to P. These

qualifications notwithstanding, the key point for the Difference Thesis advocate is that while

there are some circumstances wherein allowing a patient to die is permissible, there are no

circumstances in which actively killing a patient is permissible. The American Medical

Association supports this asymmetry of the evaluative statuses of killing and letting die when it

claims that passive forms of euthanasia where one ceases to continue treatment is a permissible

option for physicians to use, but active euthanasia that involves the “intentional termination” of a

patient’s life is contrary to the ethos of the medical profession and thus is not justified under any

circumstances (Rachels 1975, 586).

Rachels argues against the Difference Thesis by imagining the cases of Smith and Jones,

both of whom wish to kill a young relative in order to receive an inheritance. Smith goes

through with his plan and actively drowns the child in the bathtub. Before Jones can commit a

similar deed, however, his targeted victim slips and falls unconscious in a bathtub and drowns.

Rachels argues that we would not judge Jones’ passively letting the child drown to be less

morally wrong than Smith’s active drowning; the mere fact that Jones was not the active agent in

the death of the child does not lessen his moral culpability. The acts of killing and letting die

were the only difference between the cases of Smith and Jones, and since that difference did not

render an intuitive difference in the moral evaluation of Smith and Jones, Rachels concludes that

the killing and letting die distinction does not “in itself make a moral difference” (Rachels 1975,

588).

Rachels also explains that the killing and letting die distinction has an initial intuitive pull

because we are accustomed to see acts of killing as accompanied by wicked motives to harm


someone, and acts of letting someone die—as in when a veterinarian puts down a beloved pet or

a doctor turns off the life support on a brain-dead patient—are usually accompanied by more

benevolent motives and intentions. Rachels claims that what determines our judgments about

these cases is not the activity or passivity of agent, but rather the “other factors” involved in the

case such as the motives and intentions of the agents in question (Rachels 1975, 588). The Smith

and Jones case are illustrative of the point that if we control for the motives of the active and

passive agent, then the intuitive impulse to judge the active agent differently than the passive

agent disappears.

The upshot of Rachels’ assertion there is no moral difference between killing and letting

die is that active and passive forms of euthanasia have the same moral status. Such a claim

would directly contradict the AMA’s policy that asserts just this very difference. But Rachels

also give an additional argument that the AMA’s stated policy of allowing some instances of

passive euthanasia but not permitting any instances of active euthanasia is incoherent. To refrain

from giving further treatment is an active choice to take a course of action, namely one that lets

the patient die. Insofar as this course of action is taken with full knowledge that it will result in

the death of the patient, then it even passive forms of euthanasia would constitute an “intentional

termination” of the patient that the AMA has deemed impermissible (Rachels 1975, 588). While

the AMA could still hold the impermissibility of active euthanasia, it could only consistently do

so if it deemed all passive forms of euthanasia impermissible as well. Since rejecting passive

forms of euthanasia would undermine the conventional medical and legal practices such as

advanced directives that are frequently utilized in end-of-life scenarios, the simpler route to

resolve this incoherence would seem to be to concede that there are some cases where active

euthanasia is permissible.


Philippa Foot defends the Difference Thesis by claiming that acts of killing and letting

die can be seen as violations of distinct rights. Killing another person is a violation of that

person’s negative right not to be interfered with without just cause (Foot 1978, 101), while

allowing someone to die is a failure to provide that person with what she needs to survive (Foot

1978, 100). The former kind of rights and duties are ones Foot calls duties to justice, while the

latter are rights and duties to charity (Foot 1978, 97). Foot connects this framework of rights and

duties to Rachels’ case of Smith and Jones by noting that that while Smith’s active drowning of

the child is judged to be wrong because it is a violation of the child’s right not to be interfered

with—and thus a violation of justice—Jones’ letting the child drown is a violation of his duty to

be charitable toward him (Foot 2002, 84). Thus, though Foot concedes that we have no reason to

think that either Smith or Jones’ action is worse than the other, this is only an accidental feature

of these particular cases that might not generalize over all instances of killing and letting die.

The crucial point for Foot is that their respective derelictions regards two different duties and

that these duties have different domains of applicability: “an act of charity is in question only

where something is not demanded by justice” (Foot 1978, 97). The negative duty to not interfere

with someone is more stringent duty than the positive duty to provide someone with a good or

service (Foot 1980, 160). The different scopes of these duties opens up the possibility that other

killing and letting die instances will not produce identical moral evaluation like the cases of

Smith and Jones do.

Foot develops two pairs of counterexamples to illustrate cases where doing and allowing

—and specifically killing and letting die—fail to have identical evaluations. Suppose that an

officer of a retreating army comes upon a mortally wounded soldier. The officer knows that

shooting the soldier will be to his benefit, as it would spare him the slow agony of death, as well


as possibly being taken prisoner by the approaching enemy. Nevertheless, the soldier insists that

he not be shot, but that he be left to die on his own time. Foot notes that even though it would be

the humane and charitable to shoot the soldier, in this case the officer has a duty not to shoot him

because it would violate that soldier’s right to not be interfered with. In more general terms,

active non-voluntary euthanasia is impermissible. But suppose that the officer came upon

another mortally wounded soldier who instead of requesting not be shot, asks that he be given a

drug that will temporarily extend his life (though not cure him of his injuries). Foot notes that

the temporary extension of the soldier’s life would only expose him to more of the harms of his

battle—continued pain, possibly being captured by the enemy, etc.—and would unlikely net him

any benefits (Foot 1978, 88). In this case Foot claims that if the officer failed to honor the

soldier’s request it would not constitute a dereliction of his duty to not interfere as was the case

in the soldier who asked not to be shot. To refrain from giving the soldier the life-extending

drug would not be a dereliction of the officer’s duty to charity either, as it is probably in the

soldier’s best interest that his death be swift and not drawn out. Thus, the officer is permitted to

not give the soldier the drug and allow him to die, that is, to practice passive non-voluntary

euthanasia. The second case Foot mentions to illustrate her point is a person drinking what is

known to be a harmful substance. It would be impermissibly paternalistic to coercively take the

bottle away from him, but it would be permissible to refrain from helping him retrieve the bottle

if it rolled away (Foot 1980, 88). These cases purport to demonstrate that there are times where

active interference is impermissible, but allowing something to happen in the same case is

permissible.

The conclusion Foot draws for cases of euthanasia is that instances of active

nonvoluntary euthanasia are always impermissible, but instances of passive nonvoluntary


euthanasia are not always impermissible. Indeed, Foot argues that it all combinations of

euthanasia save active non-voluntary are permissible in at least some cases (Foot 1978, 108).

Foot argues that the former kind of act infringes upon the negative rights of the patient to not be

interfered with against their will that the other kinds of act do not. On these grounds Foot

concludes that there is a morally relevant difference between an instance of killing and letting

die.

Having sketched the broad outlines of the debate, we can now proceed to some analysis

of the claims being made. How strong should we understand Rachels’ claim that killing is not

morally distinct from letting die? Foot understands Rachels to be making the claim that killing

and letting die are equally iniquitous (Foot 1978, 108). Foot seems to be in agreement with

Nelson on this point, who also takes Rachels to be making the claim that killing and letting are

“equally bad” (Nelson 1985, 43). But it does not seem to me that Rachels is claiming that all acts

of killing are morally equivalent in all aspects to all acts of letting die in the same situation.

Quite the opposite, in cases where allowing someone to die would subject the patient to greater

amounts of pain and suffering than a lethal injection would subject them to, Rachels is clear that,

all things considered actively, actively killing the patient is a morally superior option (Rachels

1975, 586). So I do not take Rachels to be claiming so broad of an equivalency between killing

and letting die that they are equal in full tally of morally salient features of the respective acts.

Nor do I think he has to. Recall that Rachels’ gloss on the AMA policy that is his initial

target is cashed out specifically in terms of permissibility: “…it is permissible to withhold

treatment…but it is never permissible to take any direct action designed to kill a patient”

(Rachels 1975, 586). I think the equivalency of killing and letting die that Rachels is interested

in is not an all things considered equivalency, but just the equivalency of permissibility of these


respective acts. In contrast to the Difference Thesis, I will call this principle Rachels wishes to

defend the Equivalence Thesis (E). How strong of a claim is the Equivalence Thesis? We could

express the AMA policy (A) Rachels is responding to formally as follows1:

A: (∀x) (∃y)((Ly ⇒Py) & (Kx ⇒ ~Px))

Where Lx=x is an act of letting die, Px=x is permissible, and Kx=x is an act of killing. If

Rachels were to contradict A, it seems he would need to claim that every case where letting die

is permitted is a case where killing is permitted as well:

E: (∀x)(∀y) ((Lx & Px)(Ky & Py))

On this reading, Rachels is claiming that whenever there is a case where allowing

someone to die is permissible, then that is a case where actively killing them is permissible as

well. A corollary to E via contraposition is that if there is a case where killing is impermissible,

then that is also a case where letting die is impermissible. Rachels illustrates this corollary by

stating that for a doctor to allow a patient to die because of a routine, easily corrected malady

would be just as impermissible as actively killing a patient in a similar case would be (Rachels

588).

Of course, the Equivalence Thesis as outlined is precisely what Foot wants to reject. She

wants to defend the claim that there are cases where letting die is permissible but killing is

impermissible; in cases of active non-voluntary euthanasia, some negative rights are infringed

upon that are not otherwise infringed in other cases. Citing the case of non-voluntary euthanasia

as an objection to Rachels’ is a peculiar move for two reasons. First, it seems that Rachels would

claim that this is simply a red herring as far as the euthanasia debate goes, since no serious

participant in discussions over the morality of euthanasia defends the permissibility of killing

1 Thanks to Chris Nagel for help with formalizing this section. All remaining errors, however, are my own.


someone who does not want to be killed. Nothing relevant to the euthanasia debate seems to

follow from the impermissibility of non-voluntary cases. Second, an important difference that is

not fully elucidated in Rachels’ discussion of the relevance of the Smith and Jones cases to

questions of euthanasia is that while Smith and Jones are acting with harmful intent, the

participants in euthanasia are almost by definition acting with the intent to benefit the patient.

This critical distinction of course is not lost on Foot: “…when we talk about euthanasia we are

talking about a death understood as a good or happy event for the one who dies” (Foot 1978, 86).

The import of the fact that euthanasia presumes that death is a benefit for the patient means that

the prima facie harm that accompanies death is either mitigated or removed entirely. If the harm

is removed, then perhaps the violation of the negative right to not be harmed seems removed as

well.

But this objection misses the mark, as the right formulated by Foot is not the right not to

be harmed, but the right not to be interfered with. The right Foot is referencing has less to do

with harms necessarily as they do with demarcating what one is in control of. In Nelson’s

language, the negative rights being discussed here are against being killed even if killing does

not constitute a harm for the recipient (Nelson 1985, 47).

Nevertheless, Foot’s cases calls into question the wider plausibility of the Equivalence

Thesis: is it true that active killing is permitted in every case where allowing to die is permitted?

It would surely count as a strike against the Equivalence Thesis if it only had purchase in cases

of euthanasia but not apply to a wider array of cases of killing and letting die. For instance,

under the Equivalence Thesis allowing a killing to happen would be as impermissible as

perpetrating the murder itself. Are all cases where killing is impermissible also cases where

letting someone die is impermissible as well? In the abstract this might not seem completely


implausible: it seems plausibly impermissible for one to have full knowledge of a murder taking

place and have a way to prevent or resist that murder—e.g. having access to police or emergency

services—and nevertheless fail to do anything about it. More problematic examples for the

Equivalence Thesis might be the case of famine relief or alleviation of third world hunger. One

could see this as a species of the argument that we’re letting people die all the time by indulging

ourselves in luxury goods with resources that could be put to more productive and beneficial

uses. On the Equivalence Thesis, there is no difference in permissibility between killing a

hungry child and knowing about such situations and failing to send money or resources to help

relieve such situations. For some who are sympathetic to the work of Peter Singer (Singer 1979)

this might be a bullet that is willing bitten, but for others it is hard to see how the mere failure to

send money would be on a moral par of, say, gunning a child down in cold blood. Several

options are available here. One might be that our knowledge of what specific situation needs

rectifying and how we can best contribute to relief efforts is not always clear. Corruption is a

frequent story about charities and there are frequently questions about well-intentioned resources

either being squandered, misused, or falling into the wrong hands.

Some might respond that the actual perpetration of the murder is morally worse than the

act of letting such an action happen, but this misses a crucial component of Equivalence Thesis

mentioned above. The claim of the Equivalence Thesis is only that there is an equivalence of

permissibility between killing and letting die in a given case. This is consistent with the

respective actions having morally salient differences when all things are considered; one act

might involve a greater infliction pain and suffering, for example. So long as killing is

permissible whenever letting die is permissible and letting die is impermissible whenever killing

is impermissible, the Equivalence Thesis is maintained. Another objection might be given to this


Equivalence Thesis specific to cases of euthanasia. If killing is permitted whenever letting die is

permitted, then that would seem to give license to actively killing patients with terminal illnesses

who have do-not-resuscitate directives. To this one would respond that both killing and letting

die are subject to the same qualifications to be permissible. Patients must consent, and the action

taken must be done with the intention to benefit and not harm the patient. It is quite clear that

someone who stalked around a hospital intentionally killing people who would be allowed to die

if they flat-lined or went unconscious would not meet these two conditions.

An intriguing final objection to the Equivalence Thesis comes from some studies of

experimental philosophy that tease out people’s intuitions on the putative distinction between

acts of commission and omission, the more category of killing and letting die. Several studies of

surveys that test these sorts of intuitions have shown that people do tend to show the sort of

intuitions that would be counter to the proposal Rachels would suggest and I have defended in

this paper. I want to suggest some reasons as to why this is the case, as well as some interesting

prospects for further development.

The 2003 study of Spranca, Minsk, and Baron provides one of the most thorough

explorations of subjects’ reflective judgments on the putative distinction between killing and

letting die. The opinions of the testers themselves on this question are sympathetic with Rachels,

that at least in cases of active and passive euthanasia, the distinction between killing and letting

die—or, more broadly for this study, acts of commission and omission—is largely irrelevant

(Spranca, Minsk, Baron 2003, 2). Their aim in this study is to present scenarios that would seem

to trigger a response similar to their own view. To this end, they presented scenarios that

attempted to control for the knowledge, intentions, and outcomes that are present in the

description of the cases.


In the first case, a tennis player, John, is having dinner with his rival the day before a

match. John knows that his opponent, Ivan, is allergic to Cayenne pepper and that the house

dressing has cayenne pepper, and that an allergic reaction would give him an advantage in the

game. The subjects were then presented with various scenarios where John either subtly

recommends the cayenne-laced dressing or, if Ivan orders it on his own, simply fails to inform

him of its cayenne content. The results confirmed that 65% of surveyed population judged the

acts of omission—e.g. failing to tell about the salad—as less bad than the parallel acts of

commission—e.g. recommending the tainted salad (Spranca, Minsk, Baron 2003, 9). The

phenomena of judging omissions as less morally wrong is identified by the testers as omission

bias, a heuristic whereby harmful commissions are judged as greater than corresponding

omissions (Spanca, Minsk, Baron 2003, 4). Of the subjects who judged the acts of omission as

less morally wrong than the commission one of the primary reasons offered as justification for

their judgments was that when John played a causal role in Ivan getting sick—by recommending

the salad dressing—the test subjects were more likely to judge John as morally responsible

(Spranca, Minsk, Baron 2003, 10).

The conclusisons the various surveys arrive at is that though there are normative reasons

to take the killing/letting die distinction as morally irrelevant, people nevertheless have beliefs to

the contrary, specifically in thinking that omissions are less bad then commissions. Some

ideological diagnoses by Spanca, Minsk, and Baron are presented as possible explanations for

why this is so. One option is that thinking acts of omissions are not as bad as acts of

commissions conveniently makes us feel less responsible or guilty for our failure to alleviate

problems we have not actually brought about (Spranca, Minsk, Baron 2003, 29). Another option

is that these intuitions are symptomatic of an omission bias that distorts the perceptions such that


omissions, when all other factors are held constant will generate an intuition that is more in favor

with the normative judgments the testers think is true (Spranca, Minsk, Baron 2003, 19). This

option, however, seems severely question begging against those who favor the Difference

Thesis, as the test subjects seem inclined to. These experiments are only asking about comparing

the moral worth of omissions and commissions. But this is far afield of the interpretation of

Rachels I find more fruitful, namely of evaluating killing and letting die in terms of

permissibility. This, to my knowledge has not been pursued in the literature as of yet.

I have argued that Rachels’ claim in “Active and Passive Euthanasia” should be

understood merely as a claim about the equivalency of permissibility. If understood in this way,

I think Rachels’ position can withstand the objections that are leveled against it.


Works Cited

Foot, Philippa. “Euthanasia.” Philosophy and Public Affairs. Vol. 6: 2 (1978): 85-112.

---“Killing, Letting Die, and Euthanasia: A Reply to Holly Smith Goldman.” Analysis. Vol.

41.3 (Jun 1981): 159-60

---“Killing and Letting Die.” Moral Dilemmas and Other Topics in Moral Philosophy. Oxford:

Clarendon Press, 2002. 78-87.

Nelson, William. “Positive Rights, Negative Rights and Property Rights.” Tulane Studies in Philosophy. 33 (1985):43-49.

Rachels, James. “Active and Passive Euthanasia.” New England Journal of Medicine. Vol. 292 (1975). Reprinted in Intervention and Reflection: Basic Studies in Bioethics. Ed. Ronald Munson. 9th Ed. 2012. 585-589.

Singer, P. (1979). Practical Ethics. Cambridge University Press.

Spranca, Mark, Elisa Minsk, and Jonathan Baron. "Omission and commission in judgment and choice." Journal of Experimental Social Psychology 27.1 (2003): 76-105.

defense of rachels against killing and letting die

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