Killing and letting die

1. It is murder to disconnect a patient who can only survive with a ventilator without consent and in order to inherit from them.

2. Every murder is a killing.

3. So, it is a killing to disconnect a patient who can only survive with a ventilator without consent and in order to inherit from them.

4. Whether an act is a killing does not depend on consent or intentions.

5. So, it is a killing to disconnect a patient who can only survive with a ventilator.

Of course, whether such a disconnection is permissible or not is a further question, since not every killing is wrong (e.g., an accidental killing need not be wrong).

Trolleys, breathing, killing and letting die

Start with the standard trolley scenario: trolley is heading towards five innocent people but you can redirect it towards one. Suppose you think that it is wrong to redirect. Now add to the case the following: You're restrained in the control booth, and the button that redirects the trolley is very sensitive, so if you breathe a single breath over the next 20 seconds, the trolley will be redirected towards the one person.

To breathe or not to breathe, that is the question. If you breathe, you redirect. Suppose you hold your breath, thinking that redirecting is wrong. Why are you holding your breath, then? To keep the trolley away from the one person. But by holding your breath, you're also keeping the trolley on course towards the five. If in the original case it was wrong to redirect the trolley towards the one, why isn't it wrong to hold your breath so as to keep the trolley on course towards the five? So perhaps you need to breathe. But if you breathe, your breathing redirects the trolley, and you thought that was wrong.

I suppose the intuition behind not redirecting in the original case is a killing vs. letting die intuition: By redirecting, you kill the one. By not redirecting, you let the five die, but you don't kill them. However, when the redirection is controlled by the wonky button, things perhaps change. For perhaps holding one's breath is a positive action, and not just a refraining. So in the wonky button version, holding one's breath is killing, while breathing is letting die. So perhaps the person who thinks it's wrong to redirect in the original case can consistently say that in the breath case, it's obligatory to breathe and redirect.

But things aren't so simple. It's true that normally breathing is automatic, and that it is the holding of one's breath rather than the breathing that is a positive action. But if lives hung on it, you'd no doubt become extremely conscious of your breathing. So conscious, I suspect, that every breath would be a positive decision. So to breathe would then be a positive action. And so if redirecting in the original case is wrong, it's wrong to breathe in this case. Yet holding one's breath is generally a decision, too, a positive action. So now it's looking like in the breath-activated case, whatever happens, you do a positive action, and so you kill in both cases. It's better to kill one rather than killing five, so you should breathe.

But this approach makes what is right and wrong depend too much on your habits. Suppose that you have been trained for rescue operations by a utilitarian organization, so that it became second nature to you to redirect trolleys towards the smaller number of people. But now you've come to realize that utilitarianism is false, and you haven't been convinced by the Double Effect arguments for redirecting trolleys. Still, your instincts remain. You see the trolley, and you have an instinct to redirect. You would have to stop yourself from it. But stopping yourself is a positive action, just as holding your breath is. So by stopping yourself, you'd be killing the five. And by letting yourself go, you'd be killing the one. So by the above reasoning, you should let yourself go. Yet, surely, whether you should redirect or not doesn't depend on which action is more ingrained in you.

Where is this heading? Well, I think it's a roundabout reductio ad absurdum of the idea that you shouldn't redirect. The view that you should redirect is much more stable until such tweaks. If, on the other hand, you say in the original case that you should redirect, then you can say the same thing about all the other cases.

I think the above line of thought should make one suspicious of other cases where people want to employ the distinction between killing and letting-die. (Perhaps instead one should employ Double Effect or the distinction between ordinary and extraordinary means of sustenance.)

Killing, letting die and ensuring death

Suppose my wife tells me to ensure that my son brushes his teeth. I go to his bathroom and see him brushing his teeth. I did not bring it about that he brushed his teeth. Did I ensure it?

I may or may not have. I might have ignored my wife's request and just happened to go to my son's bathroom to fill a bottle of water. Or her request might have simply triggered a curiosity about my son's brushing habits. In those cases, I did not ensure it.

What needs to be the case for me to count as having ensured that he brushed his teeth? Maybe it's some kind of a disposition to make him brush his teeth if he does not do so on his own. But even such a disposition is not quite enough. Suppose, for instance, I am a domestic tyrant and I enjoy making people do things. I go to my son's bathroom quickly with a hope that I will get there before he brushes his teeth, so I will have an opportunity to make him brush his teeth. But alas he has foiled me: he already started and by the time I open my mouth in command, he has finished. In this case, too, it seems incorrect to say that I ensured that he brushed his teeth. For if I ensured that he brushed his teeth, then I succeeded at ensuring that he brushed his teeth. But in this case there is no plan of action that I succeeded at—in fact, I failed. (Note: I am talking of here of intentional ensuring. We also sometimes speak of some action unintentionally ensuring a result. In that case, "ensuring" just means something like "causally necessitating".)

For me to count as having ensured that he brushed his teeth, his brushing has to be according to my plan. Thus, I need to form a plan that he brush his teeth, and a part of that plan is the forming of a disposition to make him brush his teeth if he doesn't do so on his own, but the plan's goal needs to be that he brush his teeth rather than that I make him brush his teeth. Embarking on this plan is a genuine action on my part, an action whose end is that he brush his teeth. When I embark on the plan, I form a disposition to make him brush his teeth if he doesn't do so on his own, but that is not all that happens.

Why does this matter?

Well, consider this famous case of Rachels:

Jones also stands to gain if anything should happen to his six-year-old cousin. Like Smith [who drowns his cousin], Jones sneaks in planning to drown the child in Ills bath. However, just as he enters the bathroom Jones sees the child slip and hit his head, and fall face down in the water. Jones is delighted; he stands by, ready to push the child's head back under if it is necessary, but it is not necessary. With only a little thrashing about, the child drowns all by himself, "accidentally," as Jones watches and does nothing.

Rachels thinks that this case shows that the distinction between killing and letting die is bogus. Jones is morally on par with Smith.

Rachels is probably right. But the reason for this isn't that there is no morally salient distinction between killing and letting die. It is, rather, that there is no morally salient distinction between killing and ensuring death. What Jones does is ensure death. This is a genuine action on his part. He forms a series of dispositions in himself aimed at ensuring death. This is just as much an action of his as it would be an action to program a robot to watch the child and drown him if the child didn't drown on his own. And Jones succeeds at ensuring death: he doesn't just attempt to ensure death, but he succeeds.

The death of Jones' cousin is according to his plan, albeit not his original plan, but the revised one he forms when he enters the bathroom. Compare this case. Jones comes into the bathroom. He sees his cousin drowning. He has a failure of nerve and gives up on his plan. (It doesn't matter if the failure of nerve comes after or before the observation of the drowning.) But he still doesn't go to the trouble of rescuing his cousin, which he easily could do, nor does he turn on the music to drown out the noise of the drowing lest someone else come to the rescue, though he does hope the cousin will drown. He is a wicked man, but he hasn't ensured his cousin's death.

The moral difference between watching the cousin die and ensuring death is slight in the above case, but it could be greater if Jones' reasons were different. Suppose, for instance, that upon entering the room Jones has a change of mind due to fear of getting caught. But he also notices that his cousin is a carrier of a disease that will kill Jones if Jones touches the cousin, and it is this that now is the primary reason why Jones does not pull out his cousin. Jones had a change of mind but no great change of heart. He still hopes his cousin drowns and is glad he does. But at this point, Jones' actions and inactions in the bathroom are morally defensible (though his action of going to that bathroom in order to ensure his cousin's death is not defensible). (Cf. Ian Smith's paper.)

If I am right, then when thinking about killing and letting die, we need to distinguish letting die proper from ensuring death.