Many philosophers, psychologists, and medical practitioners believe that killing is no worse than letting die on the basis of James Rachels's Bare-Difference Argument. I show that his argument is unsound. In particular, a premise of the argument is that his examples are as similar as is consistent with one being a case of killing and the other being a case of letting die. However, the subject who lets die has both the ability to kill and the ability to let die (...) while the subject who kills lacks the ability to let die. Modifying the latter example so that the killer has both abilities yields a pair of cases with morally different acts. The hypothesis that killing is worse than letting die is the best explanation of this difference. (shrink)

The bare‐difference methodology is considered to be a powerful tool in ethical reasoning. The underlying idea is that we can identify the intrinsic evaluative significance of some feature by constructing contrast cases or bare‐difference cases, i.e., two cases that hold everything constant but for the feature of interest. While this popular methodology has been challenged by prominent philosophers such as Kagan, Thomson, and Kamm, it is intuitively appealing because, as Perrett identifies, the methodology appears to share the same logical structure (...) as a fruitful scientific procedure. In this paper, I argue that examining this ‘scientific analogy’ is crucial to understanding both the limitations and the prospects for ethical bare‐difference reasoning. I expand upon Perrett's discussion of the scientific analogy and examine another relevant similarity. I then highlight two relevant dissimilarities between ethical bare‐difference reasoning and its scientific analogue. Though these differences threaten to undermine the analogy, I show how the analogy might be mended to better bring the ethical methodology in line with its scientific counterpart and avoid challenges to ethical bare‐difference methodology raised by philosophers in the literature. (shrink)

The difficulty in discovering a difference between killing and letting die has led many philosophers to deny the distinction. This paper seeks to develop an argument defending the distinction between killing and letting die. In relation to Rachels’ cases, the argument is that (a) even accepting that Smith and Jones may select equally heinous options from the choices they have available to them, (b) the fact that the choices available to them are different is morally relevant, and (c) this difference (...) in available choices can be used to distinguish between the agents in certain circumstances. It is the principle of justice, as espoused by Aristotle, which requires that equal things are treated equally and that unequal things are treated unequally that creates a presumption that Smith and Jones should be treated differently. The magnitude of this difference can be amplified by other premises, making the distinction morally relevant in practical reality. (shrink)

With few exceptions, the literature on withdrawing and withholding life-saving treatment considers the bare fact of withdrawing or withholding to lack any ethical significance. If anything, the professional guidelines on this matter are even more uniform. However, while no small degree of progress has been made toward persuading healthcare professionals to withhold treatments that are unlikely to provide significant benefit, it is clear that a certain level of ambivalence remains with regard to withdrawing treatment. Given that the absence of clinical (...) benefit means treating patients is not only ethically questionable but also taxing on resources that could meet the needs of others, this ambivalence is troubling. Equally, the enduring ambivalence of professionals might be taken to indicate that the issue warrants further attention. In this paper, we review the academic literature on the ethical equivalence of withdrawing and withholding medical treatment. While we are not in outright disagreement with the arguments presented, we suggest that asserting theoretical and decontextualized claims about the ethical equivalence of withdrawing and withholding life-saving treatment does not fully illuminate the moral questions associated with the relevant clinical realities. We argue that what is required is a broader perspective, one rooted in an understanding that withdrawing and withholding life-saving treatment are different practices, the meanings of which are fully comprehensible only through an appreciation of their place within the practice of healthcare more generally. Such an account suggests that if one is to engage with the inappropriate protraction of life-saving treatment resulting from healthcare professionals’ disinclination to withdraw it, then the differences between these practices should be taken seriously. (shrink)