EuthanasiaFactSheet

HelgaKuhse,BIOETHICSNEWS,July1992BACKGROUNDBRIEFING*(fromBIOETHICSNEWSVol.11No.4July1992
page40)
HelgaKuhsePhDDirector,CentreforHumanBioethics,MonashUniversity,Clayton,Victoria

Introduction
'Euthanasia'isacompoundoftwoGreekwordseuandthanatosmeaning,literally,'agooddeath'.Today,'euthanasia'is
generallyunderstoodtomeanthebringingaboutofagooddeath'mercykilling,'whereoneperson,A,endsthelifeof
anotherperson,B,forthesakeofB.
Thisunderstandingofeuthanasiaemphasizestwoimportantfeaturesofactsofeuthanasia.First,thateuthanasia
involvesthedeliberatetakingofaperson'slifeand,second,thatlifeistakenforthesakeofthepersonwhoselifeitis
typicallybecausesheorheissufferingfromanincurableorterminaldisease.Thisdistinguisheseuthanasiafrommost
otherformsoftakinglife.
Everysocietyknowntoussubscribestosomeprincipleorprinciplesprohibitingthetakingoflife.Buttherearegreat
variationsbetweenculturaltraditionsastowhenthetakingoflifeisconsideredwrong.Ifweturntotherootsofour
Westerntradition,wefindthatinGreekandRomantimessuchpracticesasinfanticide,suicideandeuthanasiawere
widelyaccepted.MosthistoriansofWesternmoralsagreethatJudaismandtheriseofChristianitycontributedgreatlyto
thegeneralfeelingthathumanlifehassanctityandmustnotdeliberatelybetaken.Totakeaninnocenthumanlifeis,in
thesetraditions,tousurptherightofGodtogiveandtakelife.IthasalsobeenseenbyinfluentialChristianwritersasa
violationofnaturallaw.
Thisviewoftheabsoluteinviolabilityofinnocenthumanliferemainedvirtuallyunchallengeduntilthesixteenthcentury
whenSirThomasMorepublishedhisUtopia.Inthisbook,Moreportrayseuthanasiaforthedesperatelyillasoneofthe
importantinstitutionsofanimaginaryidealcommunity.Insubsequentcenturies,Britishphilosophers(notablyDavid
Hume,JeremyBenthamandJohnStuartMill)challengedthereligiousbasisofmoralityandtheabsoluteprohibitionof
suicide,euthanasiaandinfanticide.ThegreateighteenthcenturyGermanphilosopherImmanuelKant,ontheother
hand,whilstbelievingthatmoraltruthswerefoundedonreasonratherthanreligion,nonethelessthoughtthat'man
cannothave,thepowertodisposeofhislife'(Kant,1986,p.148).
Mercyforahopelesslyillandsufferingpatientand,inthecaseofvoluntaryeuthanasia,respectforautonomy,havebeen
theprimaryreasonsgivenbythosewhohavearguedforthemoralpermissibilityofeuthanasia.Today,thereis
widespreadpopularsupportforsomeformsofeuthanasiaandmanycontemporaryphilosophershavearguedthat
euthanasiaismorallydefensible.
Officialreligiousopposition(forexample,fromtheRomanCatholicChurch)does,however,remainunchanged,and
activeeuthanasiaremainsacrimeineverynationotherthantheNetherlands.There,aseriesofcourtcases,beginning
in1973,haveestablishedtheconditionsunderwhichdoctors,andonlydoctors,maypractiseeuthanasia:thedecisionto
diemustbethevoluntaryandconsidereddecisionofaninformedpatienttheremustbephysicalormentalsuffering
whichthesuffererfindsunbearablethereisnootherreasonable(i.e.acceptabletothepatient)solutiontoimprovethe
situationthedoctormustconsultanotherseniorprofessional.
Beforelookingmorecloselyattheargumentsforandagainsteuthanasia,itwillbenecessarytodrawsomedistinctions.
Euthanasiacantakethreeforms:itcanbevoluntary,nonvoluntaryandinvoluntary.

Voluntary,nonvoluntaryandinvoluntaryeuthanasia
Thefollowingcaseisanexampleofvoluntaryeuthanasia:MaryF.wasdyingfromaprogressivelydebilitatingdisease.
Shehadreachedthestagewhereshewasalmosttotallyparalysedand,periodically,neededarespiratortokeepher
alive.Shewassufferingconsiderabledistress.Knowingthattherewasnohopeandthatthingswouldgetworse.MaryF.
wantedtodie.Sheaskedherdoctortogiveheralethalinjectiontoendherlife.Afterconsultationwithherfamilyand
membersofthehealthcareteam,Dr.fi.administeredtheaskedforlethalInjection,andMaryF.died.
ThecaseofMaryF.isaclearcaseofvoluntaryeuthanasiathatis,euthanasiacarriedoutbyAattherequestofB.There
isacloseconnectionbetweenvoluntaryeuthanasiaandassistedsuicide,whereonepersonwillassistanothertoend
herlifeforexample,whenAobtainsthedrugsthatwillallowBtosuicide.Euthanasiacanbevoluntaryevenifthe
personisnolongercompetenttoassertherwishtodiewhenherlifeisended.Youmightwishtohaveyourlifeended
shouldyoueverfindyourselfinasituationwhere,whilstsufferingfromadistressingandincurablecondition,illnessor
accidenthaverobbedyouofallyourrationalfaculties,andyouarenolongerabletodecidebetweenlifeanddeath.If,
whilststillcompetent,youexpressedtheconsideredwishtodiewheninasituationsuchasthis,thenthepersonwho
endsyourlifeintheappropriatecircumstancesactsuponyourrequestandperformsanactofvoluntaryeuthanasia.
Euthanasiaisnonvoluntarywhenthepersonwhoselifeisendedcannotchoosebetweenlifeanddeathforherselffor
example,becausesheisahopelesslyillorhandicappednewborninfant,orbecauseillnessoraccidenthaverendereda
formerlycompetentpersonpermanentlyincompetent,withoutthatpersonhavingpreviouslyindicatedwhethershewould
orwouldnotlikeeuthanasiaundercertaincircumstances.
EuthanasiaisinvoluntarywhenItisperformedonapersonwhowouldhavebeenabletogiveorwithholdconsenttoher
owndeath,buthasnotgivenconsenteitherbecauseshewasnotasked,orbecauseshewasaskedbutwithheld
consent,wantingtogoonliving.Whilstclearcasesofinvoluntaryeuthanasiawouldberelativelyrare(forexample,
whereAshootsBwithoutB'sconsent,tosaveherfromfallingintothehandsofasadistictorturer),ithasbeenarguedthat
somewidelyacceptedmedicalpractices(suchastheadministrationofincreasinglylargedosesofpainkillingdrugsthat
willeventuallycausethepatient'sdeath,ortheunconsentedtowithholdingoflifesustainingtreatment)amountto
involuntaryeuthanasia.

Activeandpassiveeuthanasia
Sofar,wehavedefined'euthanasia'looselyas'mercykilling',whereAbringsaboutthedeathofB,forthesakeofB.
Thereare,however,twodifferentwaysinwhichAcanbringB'sdeathabout:AcankillBby,say,administeringalethal
injection:orAcanallowBtodiebywithholdingorWithdrawinglifesustainingtreatment.
Casesofthefirstkindaretypicallyreferredtoas'active'or'positive'euthanasia,whereascasesofthesecondkindare
oftenreferredtoas'passive'or'negative'euthanasia.Allthreekindsofeuthanasialistedpreviouslyvoluntary,non
voluntaryandinvoluntaryeuthanasiacaneitherbepassiveoractive.
IfwechangetheabovecaseofMaryF.,butslightly,itbecomesoneofpassivevoluntaryeuthanasia:
MaryF.wasdyingfromaprogressivelydebilitatingdisease.Shehadreachedthestagewhereshewasalmosttotally
paralysedandperiodicallyneededarespiratortokeepheralive.Shewassufferingconsiderabledistress.Knowingthat
therewasnohopeandthatthingswouldgetworse,MaryF.wantedtodie.Sheaskedherdoctortoensurethatshe
wouldnotbeputonarespiratorwhenherbreathingwouldfailnext.ThedoctoragreedwithMary'swishes,instructedthe
nursingstaffaccordingly,andMarydiedeighthourslater,fromrespiratoryfailure.
Thereisawidespreadagreementthatomissionsaswellasactionscanconstituteeuthanasia.TheRomanCatholic
Church,initsDeclarationonEuthanasia,forexample,defineseuthanasiaas'anactionoromissionwhichofitselforby

intentioncausesdeath'(1980,p.6.).Philosophicaldisagreementdoes,however,ariseoverwhichactionsandomissions
amounttoeuthanasia.Thusitissometimesdeniedthatadoctorpractises(nonvoluntarypassive)euthanasiawhenshe
refrainsfromresuscitatingaseverelyhandicappednewborninfant,orthatadoctorengagesineuthanasiaofanykind
whensheadministersincreasinglylargedosesofapainkillingdrugthatsheknowswilleventuallyresultinthepatient's
death.Otherwritersholdthatwheneveranagentdeliberatelyandknowinglyengagesinanactionoranomissionthat
resultsinthepatient'sforeseendeath,shehasperformedactiveorpassiveeuthanasia.Inspiteofthegreatdiversityof
viewsonthismatter,debatesoneuthanasiahavetimeandagainfocusedoncertainthemes:
Doesitmakeamoraldifferencewhetherdeathisactively(orpositively)broughtabout,ratherthanoccurringbecause
lifesustainingtreatmentiswithheldorwithdrawn?
Mustallavailablelifesustainingmeansalwaysbeused,oraretherecertain'extraordinary'or'disproportionate'means
thatneednotbeemployed?
Doesitmakeamoraldifferencewhetherthepatient'sdeathisdirectlyintended,orwhetheritcomesaboutasamerely
foreseenconsequenceoftheagent'sactionoromission?
Thefollowingisabriefsketchofthesedebates.

Actionsandomissions/Killingandlettingdie
Toshootsomeoneisanaction:tofailtohelpthevictimofashootingisanomission.IfAshootsBandBdies,Ahaskilled
B.IfCdoesnothingtosaveB'slife,CletsBdie.
ButnotallactionsoromissionsthatresultInaperson'sdeathareofcentralinterestintheeuthanasiadebate.The
euthanasiadebateisconcernedwithintentionalactionsandomissions,thatis,withdeathsthataredeliberatelyand
knowinglybroughtaboutinasituationwheretheagentcouldhavedoneotherwisethatis,whereAcouldhaverefrained
fromkillingB,andwhereCcouldhavesavedB'slife.
Therearesomeproblemsindistinguishingbetweenkillingandlettingdie,orbetweenactiveandpassiveeuthanasia.If
thekilling/lettingdiedistinctionweretorestsimplyonthedistinctionbetweenactionsandomissions,thentheagentwho,
say,turnsoffthemachinethatsustainsB'slife,killsB,whereastheagentwhorefrainsfromputtingContoalife
sustainingmachineinthefirstplace,merelyallowsCtodie.
Thatkillingandlettingdieshouldbedistinguishedinthiswayhasstruckmanywritersasimplausible,andattemptshave
beenmadetodrawthedistinctionInsomeotherway.Oneplausiblesuggestionisthatweunderstandkillingasinitiating
acourseofeventsthatleadstodeathandallowingtodieasnotinterveninginacourseofeventsthatleadstodeath.
Accordingtothisscheme,theadministrationofalethalInjectionwouldbeacaseofkillingwhereasnotputtingapatient
onarespirator,ortakingheroff,wouldbeaninstanceoflettingdie.Inthefirstcase,thepatientdiesbecauseofevents
setintrainbytheagent.Inthesecondcase,thepatientdiesbecausetheagentdoesnotinterveneinacourseofevents
(e.g.alifethreateningdisease)alreadyintrainthatisnotoftheagent'smaking.
Isthedistinctionbetweenkillingandlettingdie,orbetweenactiveandpassiveeuthanasia,morallysignificant?Iskillinga
person.alwaysmorallyworsethanlettingapersondie?
Variousreasonshavebeenproposedwhythisshouldbeso.Oneofthemoreplausibleonesisthatanagentwhokills
causesdeath,whereasanagentwholetsdiemerelyallowsnaturetotakeitscourse.Thisdistinctionbetween'making
happen'and'lettinghappen',ithasbeenargued,isamorallyimportantoneinsofarasitsetslimitstoanagent'sduties

andresponsibilitiestosavelives.Whilstitrequireslittleornoefforttorefrainfromkillinganyone,itusuallyrequireseffort
tosaveaperson.Ifkillingandlettingdieweremorallyonapar,sotheargumentgoes,thenwewouldbejustas
responsibleforthedeathsofthosewhomwefailtosaveasweareforthedeathsofthosewhomwekillandfailingtoaid
starvingAfricanswouldbethemoralequivalentofsendingthempoisonedfood.(SeeFoot,1980,p.1612.)This,the
argumentcontinues,isabsurd:wearemore,ordifferently,responsibleforthedeathsofthosewhomwekillthanweare
forthedeathsofthosewhomwefailtosave.Thus,tokillapersonis,otherthingsbeingequal,worsethanallowinga
persontodie.
Butevenifamorallyrelevantdistinctioncansometimesbedrawnbetweenkillingandlettingdie,thisdoesnot,ofcourse,
meanthatsuchadistinctionalwaysprevails.Sometimesatleastweareasresponsibleforouromissionsaswearefor
ouractions.Aparentwhodoesnotfeedherinfant,oradoctorwhorefrainsfromgivinginsulintoanotherwisehealthy
diabetic,willnotbeabsolvedofmoralresponsibilitybymerelypointingoutthatthepersoninherchargediedasa
consequenceofwhatsheomittedtodo.
Moreover,whentheargumentaboutthemoralsignificanceofthekilling/lettingdiedistinctionisraisedinthecontextof
theeuthanasiadebate,anadditionalfactorneedstobeconsidered.Tokillsomeone,ordeliberatelytoletsomeonedie,
isgenerallyabadthingbecauseitdeprivesthatpersonofherlife.Undernormalcircumstancespersonsvaluetheirlives,
andtocontinuetoliveisintheirbestinterest.Thisisdifferentwhenquestionsofeuthanasiaareatissue,Incasesof
euthanasia,deathnotcontinuedlifeisintheperson'sbestinterest.Thismeansthatanagentwhokills,oranagent
wholetsdie,isnotharmingbutbenefitingthepersonwhoselifeitis.Thishasledwritersinthefieldtosuggest:ifweare,
indeed,moreresponsibleforouractionsthanforouromissions,thenAwhokillsCInthecontextofeuthanasiawill,other
thingsbeingequal,beactingmorallybetterthanBwholetsCdieforApositivelybenefitsC,whereasBmerelyallows
benefitstobefallC.

Ordinaryandextraordinarymeans
Powerfulmedicaltechnologiesallowdoctorstosustainthelivesofmanypatientswho,onlyadecadeortwoago,would
havediedbecausethemeanswerenotavailabletoavertdeath.Withthisanoldquestionisraisedwithrenewed
urgency:mustdoctorsalwaysdoeverythingpossibletotrytosaveapatient'slife?Musttheyengagein'heroic'effortsto
addanotherfewweeks,days,orhourstothelifeofaterminallyillandsufferingcancerpatient?Mustactivetreatment
alwaysbeinstigatedwithregardtobabiesbornsodefectivethattheirshortlifewillbefilledwithlittlemorethan
continuoussuffering?
Mostwritersinthefieldagreethattherearetimeswhenlifesustainingtreatmentshouldbewithheldandapatient
allowedtodie.Thisviewissharedevenbythosewhoregardeuthanasiaortheintentionalterminationoflifeasalways
wrong.Itraisesthepressingneedforcriteriatodistinguishbetweenpermissibleandimpermissibleomissionsoflife
sustainingmeans.
Traditionally,thisdistinctionhasbeendrawnintermsofsocalledordinaryandextraordinarymeansoftreatment.The
distinctionhasalonghistoryandwasemployedbytheRomanCatholicChurchtodealwiththeproblemofsurgeryprior
tothedevelopmentofantisepsisandanaesthesia.Ifapatientrefusedordinarymeansforexample,foodsuchrefusal
wasregardedassuicide,ortheintentionalterminationoflife.Refusalofextraordinarymeans(painfulorriskysurgery,for
example)ontheotherhand,wasnotregardedastheintentionalterminationoflife.
Today,thedistinctionbetweenlifesustainingmeansthatareregardedasordinaryandobligatoryandthosethatarenot
isoftenexpressedintermsof'proportionate'and'disproportionate'meansoftreatment.Ameansis'proportionate'Ifit
offersareasonablehopeofbenefittothepatient:itis'disproportionate'ifItdoesnot.(SeeSacredCongregationforthe
DoctrineoftheFaith,198O,pp.910.)Understoodinthisway,thedistinctionbetweenproportionateanddisproportionate

meansisclearlymorallysignificant.Butitisnot,ofcourse,adistinctionbetweenmeansoftreatment,consideredsimply
asmeansoftreatment.Rather,itisadistinctionbetweentheproportionateordisproportionatebenefitsdifferentpatients
arelikelytoderivefromaparticulartreatment.Thesametreatmentcanthusbeproportionateordisproportionate,
dependingonthepatient'smedicalconditionandonthequalityandquantityoflifethepatientislikelytogainfromits
employment.Apainfulandinvasiveoperation,forexample,mightbean'ordinary'orproportionate'meansifperformed
onanotherwisehealthy20yearoldwhoislikelytogainalifetimeitmightwellbeconsidered'extraordinary'or
'disproportionate'ifperformedonanelderlypatient,whoisalsosufferingfromsomeotherseriousdebilitatingdisease.
Evenatreatmentassimpleasacourseofantibioticsorphysiotherapyissometimesjudgedtobeextraordinaryandnon
obligatorytreatment.(SeeLinacreCentreWorkingParty,1982,pp.468.)
Thisunderstandingofordinaryandextraordinarymeanssuggeststhatanagentwhorefrainsfromusingextraordinary
meansoftreatmentengagesinpassiveeuthanasia:AwithholdspotentiallylifesustainingtreatmentfromB,forthesake
ofB.Noteveryoneagrees,however,thatthediscontinuationofextraordinaryordisproportionatetreatmentisacaseof
passiveeuthanasia.'Euthanasia',Itisoftenargued,involvesthedeliberateorintentionalterminationoflife.Administering
alethalinjection,orwithholdingordinarylifesustainingmeans,arecasesoftheintentionalterminationoflife
withholdingextraordinarymeansandallowingthepatienttodie,isnot.
Thequestionthenbecomes:whatdoesthedoctor'do'whenshewithholdsdisproportionatelifesustainingtreatmentfrom
B,foreseeingthatBwilldieasaconsequence?Andhowcanthismodeofbringingthepatient'sdeathabout(orof
allowingthepatient'sdeathtooccur)bedistinguished,intermsoftheagent'sintention,fromthewithholdingofordinary
careontheonehand,andtheadministrationofalethalinjectionontheother?
Thisbringsustothethirdmajorthemeonwhichthedebateabouteuthanasiahasfocused:thedistinctionbetween
deathsthataredirectlyintendedanddeathsthataremerelyforeseen.

Intendingdeathandforeseeingthatdeathwilloccur
IfAadministersalethalinjectiontoBtoendB'ssuffering,AhasintentionallyterminatedB'slife.Thiscaseis
uncontroversial,buthasAalsointentionallyterminatedB'slifewhensheseekstoalleviate8'spainbyIncreasinglylarge
dosesofdrugs('pyramidpainkilling')thatsheknowswilleventuallybringaboutB'sdeath?AndhasAterminatedB'slife
intentionallywhensheturnsofftherespiratorthatsustainsB'slife,knowingthatBwilldieasaconsequence?
Thosewhowanttoholdthatthefirstcaseis,butthesecondandthirdcaseisnot,acaseofeuthanasiaortheintentional
terminationoflife,havesoughttodrawadistinctionbetweenthesecasesintermsofdirectlyintendedresults,and
foreseenbutnonintendedconsequences.Reflectingontheadministrationofincreasinglylargeandpotentiallylethal
dosesofpainkillingdrugs,theVatican'sDeclarationonEuthanasiathusholdsthat'pyramidpainkilling'isacceptable
because,inthiscase,'deathisinnowayintendedorsought,eveniftheriskofitisreasonablytaken'(p.9).Inother
words,evenifAforeseesthatBwilldieasaconsequenceofwhatAdoes,B'sdeathisonlyforeseenandnotdirectly
intended.Thedirectintentionistokillthepain,notthepatient.
Thisdistinctionbetweenintendedresultsandforeseenbutnonintendedfurtherconsequencesisformalizedinthe
PrincipleofDoubleEffect(PDE)ThePDElistsanumberofconditionsunderwhichanagentmay'allowor'permit'a
consequence(suchasaperson'sdeath)tooccur,althoughthatconsequencemustnotbeintendedbytheagent.
ThomasAquinas,withwhomthePDEissaidtohaveitsorigin,appliedthedistinctionbetweendirectlyintendedand
merelyforeseenconsequencestoactionsofselfdefence.Ifapersonisattackedandkillstheattacker,herintentionisto
defendherself,nottokilltheattacker(SummaTheologiae,II,ii).
Twomainquestionshavebeenraisedregardingtheintention/foresightdistinction:

Canacleardistinctionalwaysbedrawnbetweenthoseconsequencesthatanagentdirectlyintendsandthosethatshe
merelyforesees?
Isthedistinction,totheextentthatitcanbedrawn,morallyrelevantinitself?
Considerthefirstpointinthelightofthefollowingfrequentlycitedexample:Apartyofexplorersistrappedinacave,in
whosenarrowopeningaratherfatmemberofthepartyislodged,andthewatersarerising.Ifamemberoftheparty
explodesachargeofdynamitenexttothefatman,shouldwesaythatheintendedthefatman'sdeathorthathemerely
foresawitasaconsequenceofeitherfreeingtheparty,removingthefatman'sbodyfromtheopening,orblowinghimto
atoms?
Ifonewantstoholdthatthefatman'sdeathwasclearlyintended,inwhatwaythenisthiscasedifferentfromtheone
whereadoctorcanadministerincreasinglylargedosesofapainkillingdrugthatwillforeseeablybringaboutthe
patient'sdeath,withoutthatdoctorbeingsaidtohaveintendedthepatient'sdeath?
Thereareseriousphilosophicalproblemsinanysystematicapplicationoftheintention/foresightdistinction,andthe
literatureisrepletewithcriticismsandrefutations.NancyDavisdiscussessomeofthisliteratureinthecontextof
deontologicalethics(wherethedistinctioniscrucial)inArticle17,"contemporarydeontology"[inP.Singer(ed.)A
CompaniontoEthics].Assumingthatthedifficultiescanbeovercome,thenextquestionpresentsitself:isthedistinction
betweendirectlyintendedresultsandmerelyforeseenconsequencesmorallyrelevantinitself?Doesitmatter,morally,
whetheradoctorwhenadministeringwhatshebelievestobealethaldrugmerelyintendstorelievethepatient'spain,or
whethershedirectlyintendstoendthepatient'slife?
Hereadistinctionissometimesdrawnbetweenthegoodnessandbadnessofagents:thatitisthemarkofagoodagent
thatshenotdirectlyintendthedeathofanotherperson.Butevenifadistinctionbetweenthegoodnessandbadnessof
agentscansometimesbedrawninthisway,itisofcoursenotclearthatitcanbeappliedtoeuthanasiacases.Inall
euthanasiacases,AseekstobenefitB,thusactingasagoodagentwould.Onlyifitisassumedthatthereisarulewhich
says'Agoodagentmustneverdirectlyintendthedeathofaninnocent',doestheattempttodrawthedistinctionmake
senseandthatrulethenlacksarationale.

Conclusion
Theabovedistinctionsrepresentdeeplyfeltdifferences.Whetherornotthesedifferencesaremorallyrelevant,andifso
onwhatgrounds,isadebatethatisstillcontinuing.Thereis,however,oneotheraspectoftheeuthanasiadebatethat
hasnotyetbeentouchedon.Peoplefrequentlyagreethattheremaybenointrinsicmoraldifferencebetweenactiveand
passiveeuthanasia,betweenordinaryandextraordinarymeans,andbetweendeathsthataredirectlyintendedand
deathsthataremerelyforeseen.Nonetheless,theargumentissometimesputthatdistinctionssuchastheserepresent
importantlinesofdemarcationasfaraspublicpolicyisconcerned.
Publicpolicyrequiresthedrawingoflines,andthosedrawntosafeguardusagainstunjustifiedkillingsareamongthe
mostuniversal.Whilstitistruethatsuchlinesmayappeararbitraryandphilosophicallytroubling,theyarenonetheless
necessarytoprotectvulnerablemembersofsocietyagainstabuse.Thequestionis,ofcourse,whetherthiskindof
reasoninghasasoundbasis:whethersocietiesthatopenlyallowtheintentionalterminationoflifeundersome
circumstanceswillinevitablymoveintoadangerous'slipperyslope'thatwillleadfromjustifiedtounjustifiedpractices.
Initslogicalversion,the'slipperyslope'argumentisunconvincing.Therearenologicalgroundswhythereasonsthat
justifyeuthanasiamercyandrespectforautonomyshouldlogicallyalsojustifykillingsthatareneithermercifulnor

showrespectforautonomy.Initsempiricalversion,the'slipperyslope'argumentassertsthatjustifiedkillingswill,asa
matteroffact,leadtounjustifiedkillings.Thereislittleempiricalevidencetobackupthisclaim.WhilsttheNazi
'euthanasia'programmeisoftencitedasanexampleofwhatcanhappenwhenasocietyacknowledgesthatsomelives
arenotworthytobelived,themotivationbehindthesekillingswasneithermercynorrespectforautonomy:itwas,rather,
racialprejudiceandthebeliefthattheracialpurityoftheVolkrequiredtheeliminationofcertainindividualsandgroups.
Asalreadynoted,intheNetherlandsa'socialexperiment'withactivevoluntaryeuthanasiaiscurrentlyinprogress.Asyet
thereisnoevidencethatthishassentDutchsocietydownaslipperyslope.

References
Aquinas,'I'SummaTheologiae,II,ii,question64,article5and7.
Foot,P.'Theproblemofabortionandthedoctrineofdoubleeffect',KillingandLettingDie,ed.B.Steinbock(Englewood
Cliffs,NJ:PrenticeHall,1980).
Kant,I.'Dutiestowardsthebodyinregardtolife',LecturesonEthics,trans.LouisInfield(NewYork:HarperandRow,
1986).
LinacreCentreWorkingparty:EuthanasiaandClinicalPractice:Trends,PrinciplesandAlternatives(London:The
LinacreCentre.1982).
More,T.Utopia(1518):(Harmondsworth:Penguin,1951).SacredCongregationfortheDoctrineoftheFaith:Declaration
onEuthanasia(VaticanCity:1980).

Furtherreading
Bennett,J.'Whatevertheconsequences',KillingandLettingDie,ed.B.Steinbock(EnglewoodCliffs,NJ:PrenticeHall,
1980),pp.10927.
Capron,AM.'Therighttodie:progressandperil',EuthanasiaReview,2,Nos.1and2,(1987),4159.
Davis,N.'Thepriorityofavoidingharm',KillingandLettingDie,ed.B.Steinbock(EnglewoodClifts,NJ:PrenticeHall,
1980),pp.I73215.
Glover,J.CausingDeathandSavingLives(Harmondsworth:Penguin,1987)
Goldman,H.'Killing,lettingdieandeuthanasia',Analysis,40(1980),224.
Kuhse,H.TheSanctityofLifeDoctrineinMedicineACritique(Oxford:OxfordUniversityPress.1987).