To Kill or Let Die?


13 March 2003

Dear Editor,

I enjoyed the paper by Isaacs1 about the distinction between euthanasia and letting terminally ill patients die. However, it seems to me that Isaacs comes unstuck in his final paragraph; the conclusion does not follow from his argument up to that point. In fact the last sentence of the paper contradicts itself: ‘Uncertainty about the inevitability of a poor outcome and the reasonable expectations that a society has of its doctors dictate that killing patients, even terminally ill patients, is morally unacceptable, even if morally indistinguishable from letting them die.’ It is clearly inconsistent to state that two actions are morally indistinguishable and that at the same time, one of them is morally acceptable while the other is not. This statement can stand only if we also accept that letting patients die is morally unacceptable. Moreover, society's expectations, reasonable or not, do not constitute a moral argument: the fact that the great majority of people in Texas favour the death penalty adds no moral force to an argument in favour of capital punishment in that state. Finally, while it is true that, in the example given by Isaacs of the withdrawal of ventilation from a neonate with a large intracranial haemorrhage, there is some uncertainty about the outcome, there are many circumstances in which the degree of uncertainty is negligible. An elderly man with metastatic cancer whose oesophagus is completely obstructed by tumour will die, of starvation if not of other causes, unless very active management (surgery or parenteral nutrition) is undertaken.

Subtracting this flawed last sentence from the paper leaves a persuasive argument in favour of euthanasia.