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An ethic consisting of specific duties, prescribed by moral rules |
that everyone can be expected to obey, must make a sharp moral |
distinction between acts and omissions. Take, for example, the |
rule: 'Do not kill.' If this rule is interpreted, as it has been in |
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Taking Life: Humans |
the Western tradition, as prohibiting only the taking of innocent |
human life, it is not too difficult to avoid overt acts in violation |
of it. Few of us are murderers. It is not so easy to avoid letting |
innocent humans die. Many people die because of insufficient |
food, or poor medical facilities. If we could assist some of them, |
but do not do so, we are letting them die. Taking the rule against |
killing to apply to omissions would make living in accordance |
with it a mark of saintliness or moral heroism, rather than a |
minimum required of every morally decent person. |
An ethic that judges acts according to whether they do or do |
not violate specific moral rules must, therefore, place moral |
weight on the distinction between acts and omissions. An ethic |
that judges acts by their consequences will not do so, for the |
consequences of an act and an omission will often be, in all |
significant respects, indistinguishable. For instance, omitting to |
give antibiotics to a child with pneumonia may have consequences |
no less fatal than giving the child a lethal injection. |
Which approach is right? I have argued for a consequentialist |
approach to ethics. The acts/omissions issue poses the choice |
between these two basic approaches in an unusually clear and |
direct way. What we need to do is imagine two parallel situations |
differing only in that in one a person performs an act |
resulting in the death of another human being, while in the |
other she omits to do something, with the same result. Here is |
a description of a relatively common situation, taken from an |
essay by Sir Gustav Nossal, an eminent Australian medical |
researcher: |
An old lady of 83 has been admitted [to a nursing home for the |
aged) because her increasing degree of mental confusion has |
made it impossible for her to stay in her own home, and there |
is no one willing and able to look after h~r. Over three years, |
her condition deteriorates. She loses the ability to speak, requires |
to be fed, and becomes incontinent. Finally, she cannot sit in an |
armchair any longer, and is confined permanently to bed. One |
day, she contracts pneumonia. |
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Pradical Ethics |
In a patient who was enjoying a reasonable quality of life, pneumonia |
would be routinely treated with antibiotics. Should this |
patient be given antibiotics? Nossal continues: |
The relatives are contacted, and the matron of the nursing home |
tells them that she and the doctor she uses most frequently have |
worked out a loose arrangement for cases of this type. With |
advanced senile dementia, they treat the first three infections |
with antibiotics, and after that, mindful of the adage that 'pneumonia |
is the old person's friend', they let nature take its course. |
The matron emphasises that if the relatives desire, all infections |
can be vigorously treated. The relatives agree with the rule of |
thumb. The patient dies of a urinary tract infection six months |
later. |
This patient died when she did as a result of a deliberate omission. |
Many people would think that this omission was welljustified. |
They might question whether it would not have been |
better to omit treatment even for the initial occurrence of pneumonia. |
There is, after all, no moral magic about the number |
three. Would it also have been justifiable, at the time of the |
omission, to give an injection that would bring about the patient's |
death in a peaceful way? |
Comparing these two possible ways of bringing about a patient's |
death at a particular time, is it reasonable to hold that |
the doctor who gives the injection is a murderer who deserves |
to go to jail, while the doctor who decides not to administer |
antibiotics is practising good and compassionate medicine? That |
may be what courts of law would say, but surely it is an untenable |
distinction. In both cases, the outcome is the death of |
the patient. In both cases, the doctor knows that this will be |
the result, and decides what she will do on the basis of this |
knowledge, because she judges this result to be better than the |
alternative. In both cases the doctor must take responsibility for |
her decision - it would not be correct for the doctor who decided |
not to provide antibiotics to say that she was not responsible |
for the patient's death because she did nothing. Doing nothing |
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Taking Life: Humans |
in this situation is itself a deliberate choice and one cannot |
escape responsibility for its consequences. |
One might say, of course, that the doctor who withholds |
antibiotics does not kill the patient, she merely allows the patient |
to die; but one must then answer the further question why |
killing is wrong, and letting die is not. The answer that most |
advocates of the distinction give is simply that there is a moral |
rule against killing innocent human beings and none against |
allowing them to die. This answer treats a conventionally accepted |
moral rule as if it were beyond questioning; it does not |
go on to ask whether we should have a moral rule against killing |
(but not against allowing to die). But we have already seen that |
the conventionally accepted principle of the sanctity of human |
life is untenable. The moral rules that prohibit killing, but accept |
'letting die' cannot be taken for granted either. |
Reflecting on these cases leads us to the conclusion that there |
is no intrinsic moral difference between killing and allowing to |
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