What do we mean by 'killing' and 'letting die'?

Ivar R. Hannikainen, Anibal Monasterio-Astobiza, & David Rodríguez-Arias
www.bioxphi.org
Originally published 22 Feb 20

Bioethicists have long asked how to distinguish killing from letting die. Opponents of the legalization of euthanasia routinely invoke this distinction to explain why withholding life-sustaining treatment may be morally permissible, while euthanasia is not. The underlying assumption is that, when physicians refrain from applying life-sustaining treatment, they merely let the patient die. In contrast, a doctor who provided a lethal injection would thereby be 'killing' them. At a broader level, this view implies that 'killing' and 'letting die' are terms we use to distinguish actions from omissions that result in death.

Theorists such as Gert, Culver and Clouser (1998/2015) advanced a radically different understanding of this fundamental bioethical distinction. In a germinal paper, they argue that to 'kill' involves a contextual assessment of whether the doctor violated a prior duty. In turn, whether the doctor violated their duty—namely, to preserve the patient's life—depends on the patient's preferences. (They actually argued for a more sophisticated view according to which only some preferences, i.e., refusals, constrain a doctor's duty—while others, i.e., requests, do not.) This view is qualitatively different from the first (what we call commissive) view. On this alternative view, which we refer to as deontic, 'killing' and 'letting die' serve to differentiate patient deaths that result from breaches of medical duty from those that do not.

How well does each of these theoretical perspectives capture people's use of the killing versus letting die distinction? In a recent paper published in Bioethics, our goal was to develop an understanding of the considerations that carve this bioethical distinction in non-philosophers' minds.

We invited a group of laypeople, unfamiliar with this bioethical debate and lacking any formal training in the health sciences, to take part in a short study. Each participant was asked to consider a set of three hypothetical scenarios in which a terminally ill patient dies, while we manipulated two features of the scenario: (1) the physician's involvement, and (2) the patient's wishes.

The info is here.

Experimental Philosophical Bioethics

Brain Earp, and others
AJOB Empirical Bioethics (2020), 11:1, 30-33
DOI: 10.1080/23294515.2020.1714792

There is a rich tradition in bioethics of gathering empirical data to inform, supplement, or test the implications of normative ethical analysis. To this end, bioethicists have drawn on diverse methods, including qualitative interviews, focus groups, ethnographic studies, and opinion surveys to advance understanding of key issues in bioethics. In so doing, they have developed strong ties with neighboring disciplines such as anthropology, history, law, and sociology.  Collectively, these lines of research have flourished in the broader field of “empirical bioethics” for more than 30 years (Sugarman and Sulmasy 2010).

More recently, philosophers from outside the field of bioethics have similarly employed empirical
methods—drawn primarily from psychology, the cognitive sciences, economics, and related disciplines—to advance theoretical debates. This approach, which has come to be called experimental philosophy (or x-phi), relies primarily on controlled experiments to interrogate the concepts, intuitions, reasoning, implicit mental processes, and empirical assumptions about the mind that play a role in traditional philosophical arguments (Knobe et al. 2012). Within the moral domain, for example, experimental philosophy has begun to contribute to long-standing debates about the nature of moral judgment and reasoning; the sources of our moral emotions and biases; the qualities of a good person or a good life; and the psychological basis of moral theory itself (Alfano, Loeb, and Plakias 2018). We believe that experimental philosophical bioethics—or “bioxphi”—can similarly contribute to bioethical scholarship and debate.1 Here, we introduce this emerging discipline, explain how it is distinct from empirical bioethics more broadly construed, and attempt to characterize how it might advance theory and practice in this area.

The paper is here.