In James Rachels’ famous article, “Active and Passive Euthanasia,” he argues that, if the only relevant difference between active and passive euthanasia is that the former involves killing and the latter involves letting die, then that difference is not a morally relevant difference if there’s no morally relevant difference between killing and letting die.  And indeed, he argues, there is no morally relevant difference between killing and letting die, a conclusion drawn from the Bathtub Case (which, along with Judith Thomson’s Violinist Analogy, is one of the most famous thought experiments in moral philosophy).  Now there’s indeed a lesson to be learned here, but I don’t believe it’s the one Rachels had in mind.  Instead, I think there’s a really interesting lesson about the asymmetry of our patterns of blame and praise to be had.

The Bathtub Case goes as follows: Smith and Jones both stand to inherit quite a bit of money upon the death of their young nephew, so both want that kid dead.  Smith sneaks into the bathroom one night when his nephew is taking a bath and drowns him, then arranges things to make it look like an accident.  In the second case, Jones sneaks into the bathroom one night when his nephew is taking a bath, prepared to drown him, but then the boy slips, hits his head, and drowns all on his own.  Jones is ready to push the kid’s head back down under the water, but he doesn’t have to.  Rachels’ conclusion: the only difference between the two cases is that one involves killing and the other involves letting die, but what Jones did is just as morally bad as what Smith did, so there’s no moral difference between them, and so there’s no moral difference between killing and letting die (there’s a more precise way to put the argument, but I’m sure you get the drift).  And if the only relevant difference between active and passive euthanasia is the killing/letting die distinction, then there’s no moral difference between active and passive euthanasia.

In teaching this article over the years, I’ve tried to raise possible counterexamples, pairs of cases of killing/letting die where the killing case is morally worse than the letting die case.  I’m sure many of you take the same tack.  What I had done for a while was present the following pair: in case (a1), you’re the only one who knows about a family of four in


who will starve to death unless you send them money immediately.  It turns out you hate African families and want them to die, so you don’t send any money.  In case (b1), you fly to


and gun down the family yourself.  It seems (b1) is morally worse than (a1), so we’ve got a counterexample.  But as Doug Portmore rightly emphasized to me a few months ago, there are morally relevant differences between (a1) and (b1) other than the killing/letting die distinction.  The primary disanalogous feature is in the degree of effort and sacrifice involved in the second case: insofar as you had to do so much more to get that family dead in (b1), what you did strikes us as more wrong than the mere sort of lazy malevolence involved in (a1).

Now what’s interesting is that, the more one eliminates the disanalogies between various pairs of cases and the Bathtub Case, the more it becomes difficult to see them as counterexamples to Rachels.  So, for instance, suppose we move the family of four to the apartment next door to you: in (a2), you know they’ll starve to death if you don’t bring them any food, so you don’t bring them any food; in (b2), you hear them through the wall watching TV one night and aim your shotgun at where their heads would be and pull the trigger, killing them all.  (In both cases, you want them dead because their laughter at night reminds you of your own pitiful loneliness.)  The effort, motives, and so forth are now roughly on a par in both cases.  But now it also seems as if the cases are on a moral par: what you do in letting them die seems just as bad as what you do in killing them.

Portmore suggested to me a very different pair of counterexample cases.  In (a3), I drive my boat to the lake one Saturday, and I see one person clinging to a rock on one side of the lake, and five people clinging to a rock on the other side of the lake.  I want to save some folks from death, and everyone will drown if I don’t do something, but I can only save either the one or the five.  I motor over to the five and save them, letting the one die.  In (b3), I’m driving my boat to the lake one Saturday, and I see five people offshore, clinging to a rock, clearly about to drown.  I can – and want to – save them, but only by driving over one person who’s unconscious on the loading dock.  I nevertheless drive over him, killing him, but I manage to save the five in so doing.  Now it seems there’s a moral difference between a killing and letting die case, and that (b3) – the killing case – is morally worse than (a3) – the letting die case.

But now there’s a disanalogy with Rachels’ original case, for in (a3) and (b3), the agent’s motive is good, i.e., in either case I intended to save as many people as I could.  In Rachels’ case, however, the motive was bad, for the agents in question intended to bring about the death of someone solely for financial gain.  What I want to suggest, then, is a series of speculations, based on the previous remarks.

First, I don’t believe one can come up with counterexample pair-cases to Rachels where the motive in question is bad.  This is purely speculative, of course, perhaps based on my own lack of imagination, but I hereby present it as a challenge to our sharp readers.  As I think is illustrated by the family-of-four case above, the more structurally analogous it’s made to the original Rachels case, the less we’ll be inclined to judge there’s any morally relevant difference between them.

Second, I take it that the Portmore examples are indeed counterexamples to the claim that there is never a morally relevant different between killing and letting die.  If I’m wrong about this, though, speak up.

Third, what explains the fact that we can’t find counterexamples to Rachels when the motives of the agents are bad, but we can find counterexamples to Rachels when the motives of the agents are good?  One obvious explanation is that there’s an asymmetry in our attributions of moral responsibility and it turns on our assessment of motives: there must be some kind of “moral motive threshold,” such that once we determine certain identical outcomes are either directly or indirectly dependent on the motives of some agent(s) that fall below that threshold in terms of moral acceptability, our blame knows no gradations, i.e., we judge that any agents “producing” those outcomes dependent on that bad motive (either by omission or commission) are equally blameworthy – it’s all bad, to introduce a variation on a common contemporary locution.  However, when the motive is above that threshold, we do maintain gradations, either in praise or in general assessments of moral worth.  So given that Smith’s and Jones’ motives are below the threshold (theirs are morally impermissible motives), they’re both equally blameworthy, as are the people in my family-next-door case.  But in the Portmore case, the motives are good, and so here we’re willing to assess the cases differently (in moral terms).  And this different assessment may at that point rest entirely on the difference between killing and letting die.

(All of this may simply be another way of reaffirming the work that our own Joshua Knobe (and others) have done, showing (via more straightforwardly experimental methodology) that our antecedent moral judgments determine (at least in part) the moral relevance of certain distinctions, such as killing/letting die.)

Fourth, if this is right, then it has a real payoff for the euthanasia case.  For while we may agree with Rachels that there’s no morally relevant difference between killing and letting die in the Bathtub Case, because Smith’s and Jones’ motives were below the moral motive threshold, we may insist there is (or could be) a morally relevant difference in cases where the motive is above the threshold.  And insofar as cases of euthanasia are precisely cases in which the motive is good (to stop the terrible pain of a terminally ill patient), there may still be a morally relevant difference between active and passive euthanasia.

30 Replies to “Killing and Letting Die in the Bathtub

  1. David, nice post. I’ve used a modified Thomson example to display a moral difference between killing and letting die.
    Most (though certainly not all) agree that in the Violinist example, detaching yourself is permissible. But I have found no one who agrees that you can reach over and inject the violinist with a painless neuro-toxin, wait till hie dies, and then detach yourself. It does not matter what your motives are. Maybe you dislike violinists anyway: you may detach yourself, but you may not inject him with a (painless) deadly toxin. Maybe you like violinists: you may detach yourself, but you may not inject him with a (painless) deadly toxin.
    Suppose there is some disagreement about whether detaching yourself amounts to killing the Violinist. In that case, imagine that you find yourself in the hospital with the choice to attach yourself to the violinist or not. You may choose not to do so. Supposing you alone have the right blood type, etc., you will then let him die. But you may not instead inject him with a painless but deadly toxin. I think it is again true that it does not matter what motives you have, or whether you like or dislike violinists.

  2. David,
    I have two comments for you. First, a utilitarian might respond to your argument as follows. Although it is true that we make more fine grained judgments concerning a person’s responsibility depending on whether his motive is good or bad, this does not show that there is any intrinisc moral difference between the actions of killing and letting die. This is just the familiar utilitarian position that we must distinguish the moral evaluation of actions from the moral evaluation of people. I am not sure how convincing this response is, but it does seem available to someone like Rachels.
    Second, I want to question whether the argument does indeed apply to the case of euthanasia. Suppose that in euthanasia, the death of the patinet is not an all-things-considered harm to the patient. Indeed, this seems to be part of what is required if her death is to be seen as a case of euthanasia in the first place. If that is true, then there is a disanalogy between Doug’s rescue cases and the case of euthanasia. In the rescue cases, you must harm someone in order to save others. In the case of euthanasia, no one is being harmed.

  3. Mike:
    Interesting move to bring in the violinist case. I’m not sure, though, that it does what you want. Compare two pairs of cases.
    HATE: I find myself attached to the person I’ve hated and wanted dead for several years now. In the first version, I poison him, with the aim of bringing about his death. In the second version, I unhook myself in order to bring about his death.
    RIGHTS: I find myself attached to the violinist, a stranger, and someone I’ve not granted permission to be attached to me. In the first version, I poison him, wait for him to die, and then I unhook myself. In the second version, I unhook myself, and he dies.
    My very strong intuition is that, in HATE, there’s no moral difference between killing and letting die, whereas in RIGHTS, there is. The difference between my reactions , then, is just a matter of the aims of the various agents. You’re right: it’s always going to be wrong to poison the violinist, regardless of your motives. I’m saying, though, that when your motives go below some threshold, it’s also going to be just as wrong to let someone die.
    Where people think that, in HATE, it’s still okay to detach yourself, I strongly suspect it’s going to be in virtue of the fact that, in putting ourselves in the agent’s shoes, our motive in detachment would be simply about there being a lack of permission granted and our own individual freedom (or some such), and it’s easy enough to attribute this motive as well to the agent in HATE, in which case his action is overdetermined. But once we prize apart the motives — stating that the person doesn’t care at all about rights or about permissions, he just hates the guy and wants him dead — I suspect the intuitions would conform to my suggestions.

  4. David,
    I’ve been always very confused about these examples and the whole distinction (Knobe’s work has confused me about it even more). Anyway, here’s a classic case from Nesbitt that might be considered to be a counter-example in which the intentions are both bad. It’s just a version of the basic Smith and Jones case.
    In the original case, Smith and Jones both went to the bathroom with the same intention – preparedness to kill. Nesbitt claims that we judge their actions based on these intentions and therefore the evaluations come out the same. In his revised case, Smith goes to the bathroom with the intention to kill and does just that. Jones, on the other hand, goes just to check on the nephew without intending to kill him. However, he sees the newphew slip and lets him die as the occasion arises. Nesbitt’s conclusion is that we think that Smith’s actions were worse because he had the preperadness to kill which Jones lacked. Jones still had a bad intention though when he let the nephew drown – he is just as much after the money for selfish reasons. In a way, he had the same bad intention as Smith but willingness to use different, less bad means.
    Of course, Kuhse’s reply seems right. The shown difference is only in the evaluation of characters the ones who are willing to do killing and the ones who only let people die in suitable circumstances. So, there is no direct conclusion that killing is worse than letting die. However, one might start to wonder whether the characters are evaluated differently because the acts have a different status. Probably not.

  5. Scott: I’m not sure how your first comment helps Rachels (or a Rachelsian??). Even if we distinguish evaluation of actions from evaluations of people, our evaluations of both the people and the actions in the Bathtub Case are identical to each other (the people are equally bad and what they’ve done is equally wrong), whereas our evaluations of the people and the actions in the Portmore case are different from each other (one action was better than another, and one person may be better than another). If the only difference between the two pairs of cases is that the aims in the Bathtub case are bad, while the aims in the Portmore case are good, then the only time a distinction between killing and letting die seems morally relevant for such evaluations is when the agent’s aims are good. But perhaps I’ve missed your point.
    Regarding your second point, while there may not be an all-things-considered harm, surely there are some harms attached to euthanasia (the euthanized person won’t get to see his loved ones tomorrow, say). It’s just that the net effect is good. Why, then, isn’t that the relevant analogy with the Portmore case, in which the net effect is good, even though there are some harms attached to the rescue?

  6. David you say,
    But once we prize apart the motives — stating that the person doesn’t care at all about rights or about permissions, he just hates the guy and wants him dead — I suspect the intuitions would conform to my suggestions.
    That is very interesting, but I can’t see how it could be right. It is true in both cases you describe that the violinist has no rights against me that I should remain hooked to him. So I think there is no question that I may detach himself in RIGHTS only if I may detach himself in HATE. But you seem to be saying that I am not permitted to detach myself in HATE, since that would be morally as bad as poisoning him in HATE. I just can’t see it. Compare: it is not wrong for me not to donate my (spare, I guess) kidney to Smith, whether I like Smith or not. It might be wrong from me to hate Smith or to wish him ill. It might be wrong that I gleefully refuse to donate the organ. But it seems perfectly evident that it is not wrong for me not to donate the organ. So I think I’d deny that in HATE I may not detach myself.

  7. David,
    Perhaps I misunderstood your third point listed above. You write:
    what explains the fact that we can’t find counterexamples to Rachels when the motives of the agents are bad, but we can find counterexamples to Rachels when the motives of the agents are good? One obvious explanation is that there’s an asymmetry in our attributions of moral responsibility and it turns on our assessment of motives
    I thought that you were suggesting here that the differences in our reactions between cases with good motives and bad motives had something to do with how we hold people morally responsible for what they have done, and not necessarily in the moral assessment of the actions themsevles. My point was that this position is comptible with the utilitarian view that there is no intrinsic moral difference between killing and letting die, while also allowing the utilitarian to (a) hold people who have terrible motives equally accountable and (b) discriminating amongst people who have good motives.
    In your reply, however, you claim that we judge both the people and the actions in the same way. Perhaps we do. But the utilitarian could argue that this is a mistake: that we are in fact conflating the two modes of judgment. I am not sure I buy this explanation, and offer it here simply to see what others think of it.
    As for the second point, there still seems to me to be a disanalogy. The overall net effect in the Portmore case is good, but this cuts across persons: more lives are saved, but one person is harmed (all-things-considered) in order to achieve this result, and receives no benefit for that harm. But in the euthanasia case, the person who suffers the prima facie harms is benefitted overall. Doesn’t this make the two cases different in some morally relevant respect?

  8. Mike: There may be other details of the cases you’re importing here. I have in mind just this: in HATE, I detach myself immediately in order to effect your death, regardless of the length of time I’d need to stay hooked up to you to keep you alive, regardless of whether or not I’ve granted you permission to be hooked up to me, regardless of the pain or discomfort I might be in otherwise.
    In RIGHTS, I had in mind a case like the one Thomson originally described, in which I’d be hooked up to you for nine months, bedridden, and I hadn’t granted you permission. We think it’s permissible to detach ourselves in those circumstances, but our general view of the morality of detachment is that it’s permissible (in part) because our aim is to avoid these heavy sacrifices where we’ve taken on no such responsibilities (a morally permissible intention). And if it turns out that the violinist survives after we detach, we’re certainly not warranted in going back over to suffocate him or otherwise ensure his death. In addition, I’m in the group that thinks it would be impermissible to detach if we only had to stay hooked up to him for a few minutes (or even a few days). So our sensitivity to these details is part of what makes our intentions “good” in the standard violinist case, whereas the opposite is true in the revised case.
    In any case, in the RIGHTS case, so described, it would not be impermissible for me to unhook myself. In the HATE case, so described, it would. Or so my intuitions suggest.
    I think that, were someone to run an actual intuitions experiment, most people would think that it’s wrong to refuse to give someone your kidney solely because you want that person to die, whereas most would think it’s permissible to refuse to give someone your kidney solely because you believe they’ve no right to it. (Of course, I’m not sure what any of this would show….) In general, though, I think the intentions one acts on (partially) determine our assessments of the act.

  9. Scott: You’re right, in my post I was ambiguous. All I mean to say is that, for whatever assessments we make — acts or people — they’re going to be equal in the bad intentions case, and (perhaps) unequal in the good intentions case. The utilitarian may beg to differ, but that’s got to be a theoretically-based objection, not one of pretheoretic intuitions (which is what Rachels’ original case is supposed to be based on).
    As for the allegedly persisting disanalogy, let me walk my dog and think about it.

  10. Dave,
    What would you say against the following suggestion: the difference between killing and letting die is that it is more difficult to justify killing someone than to justify letting someone die. So why do we think that in the Rachels’s Bathtub Case killing your nephew is just as bad as letting your nephew die? Answer: because you have no justification for “doing” either. By contrast, why do we think that it’s okay to let one die to save five, but not to kill one to save five? Answer: because saving five is sufficient for justifying letting someone die, but not for killing someone. This would allow us to say that in the euthanasia cases, both active and passive are permissible, because in cases where the patient consents and is better off dead, there is sufficient justification both for killing her and for letting her die.

  11. OK, Scott, suppose we accept that there’s a lack of compensation in the rescue case that’s not present in the euthanasia case. A weaker conclusion, then, could be this: the possibility of there being a moral difference between passive and active depends on there being a moral difference between killing and letting die. There is such a difference in the rescue case; therefore, it remains possible that there’s a moral difference between passive and active.
    Finding a sufficient condition for the moral difference between active and passive thus then might depend on finding a case in which the analogous kind of compensation occurs.

  12. I wonder if Smith is committing a crime, while Jones is not. There is no “duty” to save another person other than a possible argument that if Jones were the legal guardian and the nephew was very young there could be some form of neglect, sort of like when a parent leaves a child in a locked car and the child dies from the heat, but then again the latter is a foreseeable occurrence. What the Rachel scenario doesn’t take into account is that many of those who request to die due to intolerable suffering are making an informed decision. Interestingly, if you are on life support you have the legal right to have it withdrawn, knowing death will result. Conversely, if you’re terminally ill and not on life support, the only state where you can ask a doctor for medication to help you die is Oregon. One of the great paradoxes is that suicide is not against the law, yet helping someone to exercise that right is.

  13. Doug:
    Very interesting suggestion. I suppose I’m inclined to something like this myself, but what it does is simply render the killing/letting die distinction as always morally moot. Instead, what’s relevant are one’s reasons for action (or inaction). As I say, this seems initially fine to me, but I was trying to take seriously the main assumption of Rachels’ article, which is that (a) if there is a moral difference between active and passive, that difference rests entirely on the killing/letting die distinction, and (b) since killing/letting die is no morally relevant distinction, active and passive can’t be morally different. I’m interested to see if there are ways to block inference (b); you’re interested to block inference (a).

  14. Sorry, Doug, I didn’t mean to imply that you weren’t taking the Rachels assumption seriously, only that you were targeting a different inference than I was.
    Roland: Do you think it’s morally relevant that there’s no crime involved in Jones’ action? I’m inclined to think not. There are all sorts of good reasons not to criminalize certain immoral behaviors, especially those of the “good samaritan” variety (although Jones is not only not a good samaritan, of course; he’s an evil bastard), having to do with the state’s role in protecting certain forms of liberty and autonomy. But these reasons don’t apply in the moral arena.

  15. Dave,
    You write: “you’re interested to block inference (a).” Not so! I’m attacking the assumption in (b): that “killing/letting die is no morally relevant distinction.” And I’m suggesting an alternative explanation (an alternative explanation to the one that you provide) for “the fact that we can’t find counterexamples to Rachels when the motives of the agents are bad, but we can find counterexamples to Rachels when the motives of the agents are good.” The alternative explanation is that where the motives are bad (or, at least, where we’re talking about the bad-motive cases that you discuss) there is no justification for either killing or letting die, whereas in the good-motive cases that you discuss there is sufficient justification for letting die but not for killing. This explains why we think that the agents were equally guilty of wrong-doing in your bad-motive cases, and why we think that only the killers were guilty of wrong-doing in the good-motive cases.

  16. Dave,
    How does my suggestion that the moral difference between killing and letting die is that it takes more to morally justify the former than it takes to morally justify the latter “simply render the killing/letting die distinction as always morally moot”?

  17. Ahh, I see. OK, first, I didn’t say the killer was guilty of wrongdoing in the rescue case. I only said that we will assess the rescue cases differently, with one being morally better than the other.
    But second, and more importantly, your explanation is compatible with mine, but mine seems more basic. After all, surely one of the relevant factors in determining whether the action was justified is going to be the intentions of the agent.
    Here’s an interesting twist on the Bathtub Case that makes both points. Suppose it’s Hitler in the bathtub, and you know all the evil he’s going to cause. It seems to me that it would be justified for you either to kill him or to let him die, but that it’s morally better for you to let him die. Your intentions are good, so we can suppose, and either action is justified, but one action is morally better than the other only in virtue of one being a letting die and not a killing.

  18. Dave,
    You write, “your explanation is compatible with mine, but mine seems more basic. After all, surely one of the relevant factors in determining whether the action was justified is going to be the intentions of the agent.”
    I don’t follow. The fact that intentions/motives is *one* of the relevant factors in determining whether the action is justified doesn’t suggest that your explanation is more basic. Indeed, surely the agent’s intentions/motives is not the only relevant factor, and this suggests that my explanation is more basic. Yours is just one specific instance of my more general explanation.
    In your Hitler-baby case, I don’t have the intuition that “it’s morally better for you to let him die.”

  19. I’m not sure if this affects the main point, but I think it might be worth mentioning as a side point that the active/passive distinction doesn’t do any work in the A.M.A. statement against what they call active euthanasia. For one thing, unplugging a feeding tube is doing and not just allowing. It’s actively removing someone’s sustenance without replacing it with some other sustenance. I take that to be active killing.
    But I think the more pertinent issue here is that the A.M.A.’s stated reason for allowing what has often been called passive euthanasia and not allowing what has often been called active euthanasia doesn’t rely on the active/passive distinction at all. The A.M.A. statement simply says that euthanasia is presumed to be wrong except in cases where extreme measures would be required to save someone’s life.
    This is because other moral principles might conflict with saving the person’s life in these cases. In other cases, euthanasia is wrong, whether active or passive. At least that’s how it reads to me. It’s basically a statement that we should only be expected to do so much to save people’s lives, i.e. what amounts to a satisficing clause. So I think the opponent of active euthanasia can easily accept Rachels’ point that motivation is more important than the active/passive distinction in euthanasia cases and still think that most cases of euthanasia are wrong.

  20. Doug, I’m suggesting that your notion of justification is going to be contingent on the goodness or badness of the intentions of the agent, and it’s those intentions that are the source of our more fine-grained assessments of morally better or worse in killing/letting die cases where both actions have sufficient reason. The Hitler case was my attempt to show this, but if you’re not biting on the intuition, then I’m stuck.

  21. Here’s a possible argument:
    1. One cannot “come up with counterexample pair-cases to Rachels where the motive in question is bad”.
    2. There seems to be no reason to maintain a “moral motive threshold”, above which there’s a difference between killing and letting die, and below which there is.
    4. Portmore examples are NOT “counterexamples to the claim that there is never a morally relevant different between killing and letting die”
    The controversial premise is bound to be premise 2; but following Kagan (in The Limits of Morality), I think there’s at least some burden of proof to explain why we should believe in such a threshold.
    (I suppose one could also turn the argument on it’s head to demonstrate the negation of premise 1 – perhaps so, but either way, there’s a demand for consistency unless we find a way to reject premise 2)

  22. Alex: I’d of course have to hear more about your premise 2. At any rate, I don’t need there to be some black-and-white, identifiable threshold. I only need the fact that we do indeed judge some intentions as bad, and some intentions as good, and once we’re in the bad intentions zone, the distinction between killing and letting die is morally irrelevant.
    Jeremy: you’re right to remind us of the point about the AMA statement (more or less Steinbock’s original point against Rachels). But we can divorce Rachels’ original argument from his attack on the AMA statement and just put it in the following terms: if you believe passive is permissible but active isn’t, and you accept that the only difference between them is that the former involves letting die and the latter involves killing, then do I have an argument for you!
    I’m also curious about what you say here: “The A.M.A. statement simply says that euthanasia is presumed to be wrong except in cases where extreme measures would be required to save someone’s life.” I understood one of Steinbock’s points to be that the AMA statement implies that euthanasia — where one’s goal, or means to that goal, was the patient’s death — is always impermissible. Instead, one may cease extraordinary treatment for other reasons — adhering to the patient’s wishes, easing the patient’s pain — but the patient’s death could never constitute the explanation for one’s actions. Thus, even the extreme measures you talk about wouldn’t constitute euthanasia. Is that wrong?

  23. One issue that these cases overlook is the different responsibilities of the actors involved. The doctor’s responsibilities may be different than those of various family members who must decide what to do in cases where no action or some proposed action will lead to the patient’s death. Some state laws require a physician to be present when a death penalty is administered, in order to insure that the punishment is not cruel and unusual. Yet one could argue, as some have, that physicians who assist with the state’s administration of the death penalty are violating their professional ethical responsibilities.
    When I’ve use the violinist case with students or in public talks on abortion, opponents of abortion usually point out that the violinist case sidesteps one issue that is crucial for them, which is the pregnant woman’s responsibility for the fetus. If we were to change the violinist case to capture the relation between a woman and her fetus that they find morally significant, would our intuitions be the same? For example, suppose the woman in Thomson’s case discovers that the non-consensually-attached patient is a16 yr. old child she gave up for adoption years ago. Or suppose, upon awakening, she discovers that the non-consensually attached patient is her two-year old child, currently in her care and custody, or perhaps her spouse?
    The moral intuition that seems to drive some anti-abortionists is that there are circumstances in which we are required to care for others, even at significant sacrifice to ourselves, such as when we have a dependent family member whose survival depends on our care giving. Some anti-abortionists acknowledge that the degree of sacrifice is relevant and thus approve of abortion in cases such as a life-threatening pregnancy.
    Euthanasia raises similar concerns for some who identify as “pro-life.” Are we simply avoiding our responsibilities to care for family members by rationalizing that death is in that person’s best interest? Imagine family members who are deliberating about prolonging the life of a terminally ill and severely suffering relative who has been placed in their care. Their choices are (1) administer a lethal shot (with or without a physician’s help), (2) administer no more than minimal care which will allow the patient to die sooner than if extraordinary measures were taken, (3) provide less than minimal care so that the patient will die very soon but in an agonizing way, or (4) provide extraordinary care and prolong the patient’s life. We may have different intuitions here about whether killing or letting die is worse (and this may be a case where extreme passivity (3) is worse than action). But aren’t our intuitions clouded by imagining the burden that we (or the family members) would have to assume under these scenarios?

  24. Laurie: I agree wholeheartedly with one of the implications of what you say, which is that getting clear intuitions on these sorts of cases actually depends heavily on their precise details: what my relations are to the various parties matters a great deal. My suggestion was simply that, once we fill in the various cases with these crucial background details, the killing/letting die distinction will be morally relevant only if we antecedently judge (or merely have the intuition) that the intentions of the relevant killers/letter-diers are in some sense good. This leaves it open, of course, that we might judge some cases of letting die to be morally worse than some cases of killing — the scenarios you paint in (3) vs. (1) could very well be such cases. “You’re just going to let her die?!” would be a perfectly appropriate complaint in such a case.

  25. Dave,
    My inclinations in response to your second remark are that Portmore doesn’t provide a viable counter example. Our intuitions yield less blame (or more praise) to the (a3)-actor than to the (b3)-actor because the facts of the (b3) case are not intuitively believable. As described, we read the case and imagine the scenario, with the stipulation that ‘the only way to save the five is to trample the one.’ But even so stipulated it doesn’t seem intuitively plausible that this was the only alternative. We still wonder if there was another way to save the five. Why after all, would the (b3)-actor not simply pick up the unconscious person on your way to save the five? It can’t be because she knew there was only one way to save the five (by trampling the one) because nobody actually has that kind of foresight (or so our intuitions would tell us—well mine anyway). In short, we blame (or praise less) the (b3)-actor because we’re not wholly convinced that they had only one knowable course of action.
    Take a similar case to Portmore’s example that has different intuitive pull:
    Five people are involved in a plane crash in some remote part of the world. The pilot, a doctor and an obese comatose man (determined to be so by the doctor) are among the survivors.
    The analogies to the Bathtub Case are (a4) and (b4):
    (a4) The survivors have some food and water, which the doctor indicates should be enough to last for only 3 days, enough time (according to the pilot to reach the nearest town, which he saw as the plane was plummeting) if they leave immediately leaving the obese comatose man behind to his certain death. If they take the obese man along, they would move too slowly in the harsh desert and their water would not last the duration of the longer trip (he is so obese that the other 4 survivors would not be able to carry him).
    (b4) The survivors have no food, but plenty of water since they crashed in a region with snow. They wait for rescue to the point of near starvation but no one comes. They decide the only prudent course of actions is to venture to the town the pilot saw while the plane was plummeting, again 3 days away, sustaining themselves by eating the comatose obese man.
    These cases only differ (morally) in the treatment of the obese man. In both cases the survivors are driven by the same desire, self-preservation (morally this can possibly be seen as ‘good’, but is not prima facie ‘bad’); in both the survivors gather as much information on their fate as they can and hold out as long as the circumstances allow, before deciding the fate of the obese man (the epistemic concerns are equal in terms of knowing they will not be rescued, the only other option available to them in order to survive). The only difference is that in one the survivors kill the man and in the other they let him die. Unless my moral compass is completely divergent, this seems to be a case where killing and letting die carry the same moral weight, and in which the efficacious desire remains above the good-bad threshold. The reason for this is that the circumstances seem real, and our intuitions are more readily satisfied in thinking that the actors made the only possible choice to satisfy their desire, which I claim Portmore’s example does not do.
    Or maybe I’m just morally corrupt…

  26. Chris, you say: “Our intuitions yield less blame (or more praise) to the (a3)-actor than to the (b3)-actor because the facts of the (b3) case are not intuitively believable.” While I’m all for constructing examples in ethics that have as many fleshed-out, realistic details as possible, I guess I don’t have a serious problem with this one. I can imagine a version of the case that has all the requisite features, and makes perfect sense, such that the agent’s only other option was simply to stop short on the ramp and not save the five. He can see the five are just about to drown — perhaps they’ve got a walky-talky and are telling him that it’s all going south very fast — and the ramp is crowded on either side by overgrown trees, blah, blah, blah. I fail to see why this isn’t believable.
    As for your second case, I wonder if what’s really affecting our intuitions is the life or death nature of the case — life or death, that is, for the responsible agents. If they don’t do the killing/letting die, they themselves will die. This is disanalogous from the Rachels’ case, and it’s definitely disanalogous from the euthanasia case at its source. Given that disanalogy, then, I’m not sure what implications we can draw from our intuitions here.

  27. ‘Believable’ probably wasn’t the best word for me to use. It’s not that the case isn’t believable, but that it isn’t convincing in describing a situation that intuitively I’d believe that ‘yes, he had no other choices than killing the one or letting the five die” (so the case is not believable in a sense). As I imagine the case being further articulated, with the branches and walkie-talkies and so on, my intuitions become more like my intuitions in the letting die version. (It could very well be that my intuitions are not the norm, or even tainted by some underlying normative moral theory…)
    I was thinking more about this case last night, and I agree that the counter example doesn’t work, but I think for different reasons than the one you mentioned. The problem with my example (I think) is that the comatose man is going to die, whatever the outcome for the others, where in both the Bathtub case and Portmore case, that is not the case (ba bum tish!). The victims in these cases have hope for survival. In the Portmore cases, a choice could be made to save the one over the five, and that simply cannot happen in my example; either just the comatose man dies, or everyone dies… As such, our intuitions may well treat him like an object rather than a subject, or something along those lines.
    My problem with Portmore’s case isn’t that it’s not realistic, but that if we were to flesh out the details to the point where the actor genuinely seems to only have a choice between two options (killing/letting die the single person to save the five, or saving the one and letting the five die), then our intuitions about killing and letting die will sync up with the Bathtub case. In Portmore’s example our intuitions still seem to be driven by the lurking thought that there was something else that could be done (or my intuitions do anyway). If the actor really doesn’t have any other option, and merely has to choose whether to save the five or not, and can only do so via the demise of the one, then our intuitions would put killing and letting die on the same level of praise. Here’s a different example which I think excludes my worry about Portmore’s case, yet retains the relevant features of the Bathtub case.
    A demolitions expert arrives at the location of a bomb threat, and is the first and only policeman (and demolitions expert) there. He finds that there are two rooms, in the first there are five people heavily shackled to a complicated bomb (one only a demolitions expert could diffuse), with a 30 second timer that is ticking down. The other room is more than 30 seconds away from the first.
    (a5) This second room contains a bomb of the same kind in the first, but this bomb only has one person heavily shackled to it (shackled so heavily that it would take more than 30 seconds to unshackle the person). The demo expert only has time to diffuse one bomb before the other explodes, and there is no one else nearby enough that knows how to diffuse the other one. So the demo expert must make a choice to save either the five people, or the one person. He chooses the five, letting the one die.
    (b5) The second room contains a bomb and only one person shackled to it, but this bomb is not armed. If the first bomb (attached to five people) is diffused, it will release a signal via some advanced wireless technology causing the second bomb to explode. This is the only way the unarmed bomb will explode (assume the bomber left this information in a note at the scene). If the demo expert does nothing, the five die, and the one lives, but if he diffuses the first bomb chained to the five, the one dies. He chooses the five, killing the one.
    This case differs from Portmore’s in two (important) respects. First, is that it plausibly eliminates all intuitive possibilities for saving the group of five that don’t require the sacrifice of the one; i.e. it seems more fleshed-out. The second is that the circumstances of this case are in place as the result of another person (the bomber), and not simply as a result of (for lack of a better word) nature.
    This latter difference might be thought to account for the shift in our intuitive response compared to Portmore’s case, but that doesn’t seem right. The circumstances our actor finds himself in are essentially the same; he has to choose how to act in saving the relevant people. How those circumstance came about should not matter in our evaluation of his actions once those circumstances are in place (that is, unless he brought about those circumstances, which he hasn’t in either case). So it seems reasonable to account for the difference in our intuitions by reference to the inadequate description of the Portmore case and not the difference in causes of the moral dilemma.

  28. Chris: I’m not sure about a key detail of the case: does the demolition expert in (b5) kill the one? Setting a causal sequence in motion that one foreknows will result in the death of someone isn’t necessarily killing.

  29. I agree that acting in a way that results in the death of someone is not always killing, but when that act is willful, and the actor knows precisely whom it is will die, it’s hard to see what else it could be called. It’s not as if the demo expert was purely instrumental in the bomber’s plan, in the way a bullet is instrumental in a shooter’s. The demo expert made a choice in the way a bullet can’t. While we wouldn’t say a bullet kills, it seems fair to say that the demo expert does. Think of an analogous case drawn from the movie Saw. A woman is trapped a device that will kill her in a matter of seconds, and the only way to free herself from it is to retrieve the key from the stomach of an unconscious man next to her. In retrieving the key by lacerating his abdominal cavity she is “setting a causal sequence in motion that one foreknows will result in the death of someone,” but additionally she is doing it willfully, and that willful action is specifically direct toward the death of a particular person or group. I see nothing counterintuitive with say she kills that man, in the same way as I see nothing counterintuitive about saying that the demo expert kills the single victim in (b5).
    Regarding the Portmore case, I think it fails to be analogous to the Bathtub case because of the nature of the single victim. That is, there is another morally relevant difference between (a3) and (b3) beside killing/letting die, namely the innocence in the single victim. In (a3) the victim is drowning. Drowning is a foreseeable risk assumed by someone when near water. In participating in activities near the water, the drowning victim(s) assume that risk, either implicitly or otherwise. The unconscious victim in (b3), assumes no such risk. She can hardly be expected to anticipate being trampled by a car when she’s on a boat dock. As such our intuitions make her somewhat more innocent, making her death more tragic, and the actions that lead to it more reprehensible, which is why our intuitions see the killing case as worse. It’s not the killing that makes our disapprobation stronger, but the further innocence of the victim.

  30. David S: I haven’t had time to read right through this thread, but permit me to come in at the end with a short expression of agreement. I’ve always thought that the Rachels examples prove nothing against the act/ omission distinction. They show only that sometimes the AOD makes no moral difference, and in particular, that there is no moral difference (or at any rate, little) between murder by action and murder by omission. But no defender of AOD need deny any of this! Defenders of AOD themselves typically say that where the intention is bad, the action is bad, and so is the omission. AOD, as you say, is meant to apply to cases where the intention is *not* bad. By describing a pair of cases where this precondition is not satisfied, Rachels guarantees the irrelevance of his argument.
    A pity, then, that it’s been so influential.

Comments are closed.