Causation and Moral Responsibility for Death

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Causation and Moral Responsibility for Death

ABSTRACT: The distinction between killing and letting die has been a controversial element in arguments about the morality of euthanasia and physician-assisted suicide. The killing/letting die distinction is based on causation of death. However, a number of causal factors come into play in any death; it is impossible to state a complete cause of death. I argue that John Mackie’s analysis of causation in terms of ‘inus factors,’ insufficient but non-redundant parts of unnecessary but sufficient conditions, helps us to see that moral responsibility for death cannot rest on causation alone. In specifying the cause of death, some factors can be considered alternatively as either causal factors or merely parts of the presupposed background conditions. If a factor is moved from the background field into the causal field, the result is a changed background field. Comparisons of cases of killing and letting die often do just this; hence, the cases depend on different presuppositions and the causation cannot be directly compared. Moral judgments determine how to apportion factors to the causal and background fields.

The distinction between killing and letting die has been used by many to condemn euthanasia and assisted suicide while giving approbation to withdrawing life-support systems in at least some patients. In the recent United States Supreme Court decision which denies a right to physician-assisted suicide, Chief Justice Rehnquist writes that "when a patient refuses life sustaining medical treatment, he dies from an underlying fatal disease or pathology; but if a patient ingests lethal medication prescribed by a physician, he is killed by that medication." (1) It is doubtful, ho...

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..., no.3 (1976): 15-16.

(7) John Mackie, The Cement of the Universe: A Study of Causation, paperback edition (Oxford: Clarendon Press, 1980).

(8) Ibid., 60-62.

(9) Ibid., 63.

(10) Ibid., 66-67. This statement of a "gappy" universal is fundamentally the same as Mackie’s, but I have altered the formulation for consistency.

(11) O.H. Green, "Killing and Letting Die," American Philosophical Quarterly 17 (1980): 195-204, and Helga Kuhse, The Sanctity-of-Life Doctrine in Medicine: A Critique (Oxford: Clarendon Press, 1987).

(12) Kuhse, 50-51.

(13) Ibid., 67-68.

(14) Ibid., 68.

(15) President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research, Deciding to Forego Life-Sustaining Treatment: Ethical, Medical, and Legal Issues in Treatment Decisions (Washington: U.S. Government Printing Office, 1983), 69.

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