Consequences count: against absolutism at the end of life

J Adv Nurs. 2004 May;46(4):350-7. doi: 10.1111/j.1365-2648.2004.03001.x.


Background: There has been a considerable amount of debate in the nursing literature about euthanasia, and especially the distinctions between acts and omissions, and killing and letting die. These distinctions are required by opponents of euthanasia to justify allowing some cases of passive euthanasia while forbidding all cases of active euthanasia.

Aim: This paper adds to the debate by arguing that the position that absolutely forbids euthanasia is theoretically inconsistent.

Methods: The paper first considers the place of moral theory in analysing moral problems, within the framework of the principles of biomedical ethics. It is argued that despite a moral pluralism that operates in many areas, the legal status of euthanasia is based upon an absolute deontological position against deliberate killing, which cannot be overridden by appeals to favourable consequences. In order that certain forms of passive euthanasia can be allowed, this position allows distinctions within three pairs of concepts--acts and omissions, killing and letting die, and ordinary and extraordinary means. A further method of justifying certain actions near the end of life is the doctrine of double effect. These paired concepts and the doctrine of double effect are analysed with special reference to their consequences.

Conclusion: The application of the doctrine of double effect and the three distinctions relies on consideration of their consequences, allowing in practice what in theory is denied. This is important because it weakens the absolute case against euthanasia, which disallows any direct consequentialist appeal. If consequences count in the application of the doctrine and the distinctions, then they should also count directly prior to their application. This strengthens the argument for active euthanasia in certain cases.

MeSH terms

  • Ethical Analysis / methods
  • Ethics, Nursing*
  • Euthanasia, Active / ethics*
  • Euthanasia, Passive / ethics*
  • Humans
  • Moral Obligations
  • Withholding Treatment