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Tuesday, February 15, 2022

How do people use ‘killing’, ‘letting die’ and related bioethical concepts? Contrasting descriptive and normative hypotheses

Rodríguez-Arias, D., et al., (2009)
Bioethics 34(5)


Bioethicists involved in end-of-life debates routinely distinguish between ‘killing’ and ‘letting die’. Meanwhile, previous work in cognitive science has revealed that when people characterize behaviour as either actively ‘doing’ or passively ‘allowing’, they do so not purely on descriptive grounds, but also as a function of the behaviour’s perceived morality. In the present report, we extend this line of research by examining how medical students and professionals (N = 184) and laypeople (N = 122) describe physicians’ behaviour in end-of-life scenarios. We show that the distinction between ‘ending’ a patient’s life and ‘allowing’ it to end arises from morally motivated causal selection. That is, when a patient wishes to die, her illness is treated as the cause of death and the doctor is seen as merely allowing her life to end. In contrast, when a patient does not wish to die, the doctor’s behaviour is treated as the cause of death and, consequently, the doctor is described as ending the patient’s life. This effect emerged regardless of whether the doctor’s behaviour was omissive (as in withholding treatment) or commissive (as in applying a lethal injection). In other words, patient consent shapes causal selection in end-of-life situations, and in turn determines whether physicians are seen as ‘killing’ patients, or merely as ‘enabling’ their death.

From the Discussion

Across three  cases of  end-of-life  intervention, we find  convergent evidence  that moral  appraisals shape behavior description (Cushman et al., 2008) and causal selection (Alicke, 1992; Kominsky et al., 2015). Consistent  with  the  deontic  hypothesis,  physicians  who  behaved  according  to  patients’  wishes  were described as allowing the patient’s life to end. In contrast, physicians who disregarded the patient’s wishes were  described  as  ending the  patient’s  life.  Additionally,  patient  consent  appeared  to  inform  causal selection: The doctor was seen as the cause of death when disregarding the patient’s will; but the illness was seen as the cause of death when the doctor had obeyed the patient’s will.

Whether the physician’s behavior was omissive or commissive did not play a comparable role in behavior description or causal  selection. First, these  effects were weaker  than those of patient consent. Second,  while the  effects  of  consent  generalized to  medical  students  and  professionals,  the  effects of commission arose only among lay respondents. In other words, medical students and professionals treated patient consent as the sole basis for the doing/allowing distinction.  

Taken together, these  results confirm that  doing and  allowing serve a  fundamentally evaluative purpose (in  line with  the deontic  hypothesis,  and Cushman  et al.,  2008),  and only  secondarily serve  a descriptive purpose, if at all.