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 (Penguin, 1977)
There is clearly a difference between killing and letting die, but is this difference always morally significant? If in both cases the death was intended and the result of a deliberate decision, aren’t the people who made the decision equally culpable?
In the case of Dr Grey, it does seem odd to make a sharp distinction between killing and letting die. He had wanted to flip the switch on the life support machine and let the patient die. In fact, he merely failed to plug the machine back in, with the same intention and the same result. If it would have been wrong to act to make the patient die, then surely it is equally wrong to fail to do something easy to stop the patient dying? Or to put it the other way round, if it is morally justifiable to let the patient die, surely it would have been equally justifiable to have turned off the machine.
Yet the laws on euthanasia do distinguish sharply between killing and letting die. This has the bizarre consequence that doctors can stop feeding a patient in a permanent vegetative state, effectively starving them to death, but they can’t administer a lethal injection and kill them quickly. In either case, the patient has no awareness and would not suffer. Nevertheless, it is hard to see how starving could be seen as ethically superior to a swift and painless death.
It could be argued that, although there is not always a morally significant difference between killing and letting die, it is important for legal and social reasons not to sanction any deliberate killing. There are some ethical grey areas, such as this life-support machine case, but society needs rules and the best and clearest place to draw the line is on the boundary between killing and letting die. In a few hard cases this may mean we have unsatisfactory results, such as with the patient of Dr Grey. However, this is better than opening the door to deliberate killing by doctors.
Nevertheless, since it assumes the difference between killing and letting die is the best way to distinguish between ethical and unethical treatment of patients, this argument begs the question: why not make the basic principles those of minimizing suffering and respecting the wishes of patients?
Whatever we conclude, the case of Dr Grey shows that, from an ethical perspective, the distinction between killing and letting die is far from unproblematic.
See also
| 15. | Ordinary heroism |
| 29. | Life dependency |
| 53. | Double trouble |
| 89. | Kill and let die |