X-Message-Number: 33409
From: 
Date: Wed, 2 Mar 2011 04:02:55 EST
Subject: Passive and active euthanasia

Marta Sandberg wrote about the distinction between passive and  active 
euthanasia. The critical factor in determining this difference in a  

medico-legal context is the Rule of Double Effect, which more properly should be
called the Doctrine of Double Effect (DDE), since it's origin is in the 13th  

century theology of Thomas Aquinas. Aquinas derived this intellectual gem  when
he was wrestling with the problem of when it is permissible  to take action 
for a good end, whilst knowing that it will cause evil.  The use of the 
words "good" and "evil" here are apropos, since Aquinas' doctrine  is also the 
doctrine of the Roman Catholic Church. The Church's objection to  abortion 
has been a major driver for its attention to this area of "moral  

philosophy," and it has been a well supported career for Catholic theologians  
for 
decades.  
In essence what DDE states is that it in situations where  an action has 
both good effects and evil effects, the action is  permissible only if it is 
not morally wrong in itself, and if it does not  require that one directly 
intend the evil result.  
The classical definition of DDE sets out four requirements that  must be 
met if the action is to be moral: first, that the action contemplated be  (in 
itself) either morally good or morally indifferent; second, that  the evil 
result not be directly intended; third, that the good result not  be a direct 
causal result of the evil result; and fourth, that the good  result be 

"proportionate to" the evil result. Supporters of the principle  argue that, in
situations of "double effect," where all these conditions are  met, the 
action under consideration is morally permissible despite the evil  result. 
I could write pages and pages of discussion over "problems" and  

shortcomings in these four justifying elements, but why bother? Here's the  
practical 
bottom line. It is perfectly permissible for a person to, with the  

patient's consent, sedate a patient to the point of unconsciousness,  disconnect
life support and allow him to die. It is equally permissible to  do the same 
absent sedation, and in fact it is *both morally and legally  preferably* to 
do the second, rather than the first. It is morally better,  because 
suffering the full consequences of a choice to end life, even in the  face of 
terminal illness (but especially if it is not present) is a moral  good in the 

view of the Catholic Church. In fact, Mother Teresa, who I consider  a monster,
saw the suffering and dying of the terminally ill people she took  from the 
streets as a high moral good, and her facilities typically do not offer  
pain management. To understand this position, it is important to understand 
that  Mother Teresa did not want to abolish the suffering and dying poor, but 
rather  to comfort them, and bring them to Jesus Christ.  Penn & Teller do a 
 lovely job of highlighting this on one of their *Bullshit* episodes, and 
the  atheist philosopher Christopher Hitchens similarly (and accurately) 
indicts her  for the same thing: 

_http://barefootbum.blogspot.com/2007/09/penn-and-teller-on-mother-theresa.html_

(http://barefootbum.blogspot.com/2007/09/penn-and-teller-on-mother-theresa.html)
It is legally preferable to let a patient die in pain, and  with no 
diminution in native consciousness, because it is safer (carries less  risk of 

being confused or equated with murder) and because it ensures that  volition is
preserved until the biological limits imposed by the dying  process. The l
atter is considered advantageous because it answers any doubts or  concerns 
that might arise in the event the patient changes, or might have chosen  to 
change his mind, about ending his life by "passive means." 
This moral contortionism has now become the ethical and legal  basis upon 
which medical decisions are made regarding terminating life support -  or 
engaging in many other "conflicted" behaviors. 
So, if you want to know what's right and what's wrong,  you must run the 
proposed action through the DDE sieve, and see what comes  out.  
It is thus OK to give sufficient morphine to cause respiratory  arrest (and 
thus death), if that is what is what is required to relieve  terrible pain 
in a dying patient. It is not OK to do this in a patient who is  not 

dying... Nor is it OK to do this in a dying patient who is NOT in terrible  
agony, 
but who nevertheless wants his life to end. It is OK to stop mechanical  

ventilation, or LVAD support if you require these to stay alive, but it is NOT
OK to stop your own breathing or circulation if you do not require a 
machine to  provide one. 
It is all "Alice in Wonderland" reasoning, devoid of any  REAL assessment 
of the moral consequences of an action, or of the value  system from which 
those morals are derived. Of course, the unspoken truth is  that the moral 
system is that of the Roman Catholic Church, and more generally,  of 
Christianity. Since such a moral system has little basis in reality, it will  
frequently yield mad and non-sensical outcomes. 
Mike Darwin


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