In his comment1 on my paper on active and passive euthanasia,2 Coggon raises questions about my position that are worth answering in order to further the debate about the relevant issues. He writes,

I argue that McLachlan fails to establish that there is a moral difference between active and passive euthanasia and that he instead merely asserts that the difference exists. I suggest that McLachlan’s paper relies on a false commitment to general rules that do not apply in every case. Furthermore, I question the lack of a moral framework provided in his argument …1

In this reply to Coggon, I show that my position does not rest on the assumption that it is always wrong to kill. This is a useful elaboration of the argument. More significantly, the account that I gave of my moral framework in the original article was cryptic. It is useful to answer Coggon’s query by showing more fully and clearly the overall ethical stance from which my argument emerges. Whether or not my conclusion could be reached by a different route, it is worth noting that I approach it from an explicit rejection of consequentialism.

Furthermore, Coggon’s summary of what I wrote is misleading and unfair. He fails to address my specific argument. Indeed, he gives the impression that I do not present one and that I rely solely on assertion. It is one thing to disagree with a particular argument: it something else to say that no argument has been presented. However, given that my argument was misunderstood, it is useful to re-express and clarify it. My main aim remains not to attack Coggon or to defend myself but to pursue the debate.

TO KILL IS NOT THE SAME AS TO LET DIE

I do not merely assert that active and passive euthanasia are morally different. I present an argument. My argument is that to kill someone is different from letting him die. The relevant moral duties are different. Different people, in different contexts, might or might not have them. The moral duties can vary in strength depending on who holds them and on the circumstances in which they are held. The moral duty that would be breached or fulfilled were a particular person to kill another particular person is different from that which would be breached or fulfilled were he to let that particular person die.

For instance, if I am a visitor in a hospital, I have, in the main, a moral duty not to kill the patients. I do not in the same sense have, in general, a moral obligation to do that which is required to maintain the lives of the patients. I must not kill the patients but I may let them die. If one of the patients is, say, my wife and she begs me to end a life that she can no longer endure, then it is conceivable, although not manifest, that I would have a moral duty to kill her and to accept the legal repercussions. If, say, one of the patients was my brother and he required, for instance, a kidney transplant in order to continue to live, then I might well have a particular moral duty to sacrifice one of my kidneys for him. I do not have to the same extent a moral duty to sacrifice one of my kidneys for an anonymous stranger, even if I have such a moral duty. If one of the patients, who is to me a complete stranger, begs me to kill him, I am not morally obliged nor, I would imagine, morally permitted to comply. What if he begs me to switch off his life-support system? On the grounds that it is none of my business—good grounds in the circumstances, despite the unfortunate connotations they might seem to have—I should, unlike the good Samaritan of another story, walk on.

Suppose that a patient made similar requests to the doctor who was in charge of his treatment. The doctor would not have a moral duty to kill a patient who requested to be killed. It is a moot point whether it would be morally permissible for a doctor to kill a patient who requested to be killed. To kill is not the same as to let die. Hence, if the patient required a kidney transplant in order to live and begged the doctor to sacrifice one of his own, it would clearly be permissible for the doctor to let the patient die whether or not he had a moral duty to give him one of his kidneys. The doctor might have an ailing brother who also requires a kidney transplant. The doctor might prefer to keep both of his kidneys. He can, I suggest, do so without breaching anyone’s rights.

Suppose the patient requested the doctor who was in charge of his treatment to switch off his life-support machine. The doctor has a moral duty to do so and the patient has a corresponding moral right to have his machine switched off. The doctor has no moral justification for persevering with the treatment. He is obliged to desist. He has a moral duty to let the patient die. He does not have the excuse that to switch off the machine is none of his business: to ensure that it is switched off is his responsibility.

Imagine that you see an apparently naked child floating in the lake. Is she drowning? Is she merely floating on her back? Should you jump in and haul her out? What will her parents and other people say if she was happy and well and greatly resents being manhandled by you? Suppose you happen to be—whether fairly or not—a registered sex offender. It might be moral cowardice but, on the other hand, it might be plain common sense to refrain from pulling her naked body from the river. The law is often an ass; nonetheless, it is difficult to envisage that any mature legal system would consider such self-regarding prudence as criminal, far less as murder. To let die is not the same as to kill.

To kill someone is different from refraining from or ceasing to do something that might have thwarted the person’s death. The issue is broader than euthanasia. For instance, imagine that there is a particular prisoner in a cell who is on hunger strike. It would be wrong for warders to kill him. However, it would be morally permissible and, perhaps, even morally obligatory for them to refrain from force-feeding him. If the prisoner is a convicted murderer, some particular people might be authorised to execute him. However, they would not be similarly authorised to let him die of old age or to ensure that he died from lack of food and water. There are moral as well as mere conceptual differences between killing and letting die. In some circumstances, for various different reasons, it is morally preferable for some particular people to kill some other particular other ones than to let them die in particular ways.

IN SOME CONTEXTS, SOME OF US HAVE A MORAL DUTY—WHICH MIGHT CLASH WITH OTHER MORAL DUTIES—NOT TO KILL PARTICULAR PEOPLE

According to Coggon,

There is a tension throughout McLachlan’s paper, which is never addressed and which is problematic. Although his position seems to be modest— he does not argue that euthanasia, active or passive, may never be justified— he bases seeming absolute moral claims on general rules, which he then concedes may be broken in given circumstances. McLachlan does not seem concerned that the permissibility of breaking these rules destroys their absolute nature and thus leaves them entirely redundant as the basis for an absolute moral position. He posits the following, very strong obligation: “We are obliged to refrain from killing each and everyone.” This sentence seems unambiguous. But its normative force is somewhat tempered by a claim that follows in the same section, where he tells us that killing may in fact be “morally right” and that it may be “morally more justifiable to kill someone than to let him die”. This is confusing. It seems that we are morally obliged to refrain from killing, but that we can also be morally obliged to kill (or, at least, we are not morally obliged to refrain from doing it after all). The only way to overcome this is to treat the principle “do not kill” as a general rule, but concede that it permits of exceptions.1

It is not clear what Coggon means by an “absolute moral position”, what he thinks is wrong with one and why he thinks I take one. I suspect that, rather than “absolute”, he means “unequivocal”. In any event, he has failed to give an accurate account of my views with regard to the ethics of killing. It is manifest from what I wrote that I do not believe that it is always wrong to kill or that killing can never be morally justified. We have, at least in some circumstances, a moral duty not to kill, but that duty might clash with other duties. In any case, circumstances change. Consider the following quotations from my original piece. I say in the abstract: “We are, in general, obliged to refrain from killing each and everyone. We do not have a similar obligation to try (or to continue to try) to prevent each and everyone from dying.”2 The term in general is significant. Similarly, I write: “… we are morally obliged to refrain from wantonly killing anyone.”2 The term wantonly is significant.

Coggon is wrong to say that “do not kill” is a general rule that permits exceptions. It is not a moral rule or ethical principle of any sort. Like “Keep off the grass”, “Shut your face” or “Thou shalt not commit adultery”, it is a command. Commands are neither true nor false. They are, rather, authoritative or non-authoritative. Similarly, the statements “Shut your face, in general” and “In most but not all circumstances, do not kill” are commands rather than normative precepts or moral rules. They are different from the statements “One ought, in general, to be quiet” and “It is usually morally wrong not to kill”.3 4

CONSEQUENTIALISM IS FALSE

Articles published in the Journal of Medical Ethics do not normally contain an account of the author’s general theory of morality. Hence, it is curious that Coggon should criticise me for an alleged “lack of a moral framework provided in [my] argument”. It seems even more curious when we note that Coggon provides no such moral framework to his own paper in which his allegation occurs and that I actually do indicate the sort of moral framework whose alleged lack Coggon bemoans.

Coggon makes the following strange comment:

There is a fundamental problem with the way that McLachlan’s moral position is advanced. He gives no indication of what account of morality he is committed to. Perhaps, as his argument is said to relate to moral rights, he aims to speak against consequentialist theorists such as John Harris. If this is so, there is no immediately evident reason to believe he is correct in his assertions. Other analysts who shun consequentialist accounts find no special relevance to life-ending choices that allow people to kill by omission rather than act. Whatever the basis of McLachlan’s moral assertions, this needs to be stipulated before analysts can justifiably be bound by them.1

In my article, I write: “Even when acts and omissions have the same outcomes, they are not thereby necessarily morally identical: how and why what is done matters. It can matter too who does it.”2 This is certainly an indication of my moral position. However, it might be thought to be merely an indication. As Coggon suggests, a fuller exposition would be useful. That the quoted sentence is a rejection of consequentialism might not be clear to everyone. Furthermore, the reasons for the rejection might remain opaque.

Some actions such as, say, rape are wrong because of the sort of actions that they are, quite independently of the consequences that might or might not ensue from them in general or on particular occasions. Suppose that a women, who longed for a child was, unbeknown to her, raped in her sleep by a burglar. If the consequence was the birth of a happy and much-loved child who became a notable benefactor of humankind, the moral heinousness of the contemptible act and of the contemptible man would not in any way be mitigated. Consent was not given for that which could not, in the circumstances, be justified in its absence. The desirability of the outcome cannot be weighed in the balance against the undesirability of the act. Good consequences would not make this bad action better even if bad consequences might make it even worse.

Notice that, since any pleasure the rapist experiences is unfairly and unjustly brought about, it would be grotesque to suppose that it constituted in any way a good fragment of a bad situation. On the contrary, that he derives “happiness” so inappropriately makes the episode morally worse and even more repellent than it would otherwise be.

If Coggon had followed up the references given in the article, he could have found numerous expression and amplifications of my view on the nature of morality. For instance, on the very blurb of From the womb to the tomb: issues in medical ethics, its central themes are indicated as follows:

What, were it to happen, would be for the best? What ought we to do? These are different questions. It is not necessarily any one’s business nor the business of the state to bring about that which, were it to happen, would be the best outcome. Although outcomes matter in relation to both ethics and public policy they are not the only considerations. It matters what we do and also why and how we do what we do. 4

There is more to ethics than a consideration of consequences.i For instance, a lynch mob and a properly constituted court might produce the same consequences: a hanging. There is an obvious ethical difference. Suppose that one believed that Judas’s betrayal of Christ had the consequence of facilitating the saving of mankind and suppose that his action was motivated towards that end. One might still think that Judas acted wrongly. He breached a strong duty of friendship. It was none of Judas’s business to save mankind. It was his duty not to betray his friend. When discussing the ethical theory of Harris with reference to his account of Josephine Quintavalle’s views on stem-cell research, I write,

There are some kinds of considerations that ought not to determine, perhaps ought not even to influence the particular decisions of particular agents and agencies. Often, we are duty-bound to do certain things whatever the effect is in particular cases. What we should do is to mind our own business relative to the capacity in which we are acting. To keep our attention from the “big picture” and to ignore our “values” and “moral visions” is often our painful duty particularly if we are acting in an official capacity such as a university lecturer marking an examination script or as a Prime Minister contemplating the invasion of Iraq. (McLachlan and Swales, p27)4

Consider too the following example:

[S]uppose that it fell to the lot of the captain of a sinking ship to decide what ten passengers were to be allocated to the ten available places in the doomed and heavily populated ship’s only life raft. In terms of the outcome of the decision, we might suppose, as might the captain, that it does not matter which particular ten people are chosen. Suppose that there are ten and only ten white passengers aboard. Some people might think that it would be better, independently of the outcome of the decision, to choose ten people on a systematically random basis rather than to choose them on the basis of their colour even if, by remarkable chance, the random system happened to allocate the ten places to the same ten white people. Why things are done and not merely what is done can matter and in the absence of a good reason for making a decision, a reason which is not a bad one can suffice. (McLachlan and Swales, p192)4

Not all short and meaningful questions have a correct, short, informative answer. I think that a correct, short answer to all or, at least, most philosophical questions is: it all depends. When one knows that some proposition or other is true, how does one know? It all depends. What is it to be an X, when an X is a class term such as table, horse or game? It all depends. When an action is a good one or a bad one, by virtue of which is it such? It all depends. Hence, my rejection of consequentialism should not be misinterpreted as the acceptance of some other general, unidimensional theory of ethics such as, say, Kantianism. To say that, in relation to moral goodness, consequences are not of sole relevance is not necessarily to say that they are never relevant.ii

CONCLUSIONS

Coggon’s remarks elicit a clarification and an elaboration of my argument in support of the claim that there is a moral difference between killing and letting die. The relevant moral duties are different in nature, strength and content. Moreover, not all people who are involved in the relevant situations have the same moral duties. The particular case that is presented in support of the claim that to kill is not the same as to let die is based upon an explicit rejection of consequentialism.iii My rejection of consequentialism is unrelated to theology. Although it is fashionable in some quarters, the notion that theists would be likely to convert to consequentialism were they to become atheists is philosophically shallow.,iv