Routinely, in Arriving at decisions on what treatments to recommend in intensive care wards, the moral presumption is that there is an intrinsic difference between the positive duty to save lives and the negative duty not to take lives. The discontinuation of treatment – say stopping chemotherapy or removing a ventilator – is thought of as a “negative” action, an allowing to die, not “positively”, say as an act of suicide by the patient, or a killing by the hospital staff. (...) But the distinction between “positive” and “negative” here, despite its grave ethical import, is elusive and difficult to grasp firmly. St. Anselm of Canterbury was fond of citing the trickiness of the distinction between “to do” and “not to do”. In answer to the question “What's he doing?” we say “He's just sitting there.”, really meaning something negative: “He's not doing anything at all.” Sometimes the “negative” action is described in “positive” terms, or vice versa, and that makes one wonder if the distinction might be somehow trivial, a bit of jesuitry too insubstantial to bear much serious ethical weight. (shrink)

This essay offers an action-theoretic analysis of the distinction between positively bringing something about and passively letting something happen. The analysis, based on the notion of an agent''s bringing about some state of affairs, is closest to the analysis of omissions of Brand (1971), but utilizes the relatedness logic of Epstein (1979). Syntactic features bring out the idea that an action can be partially positive and partially negative, e.g., by not bringing about one thing an agent can bring about something (...) else. An ethical implication of this analysis is that a passive course of action is sometimes less culpable than an active one, just because it is passive. (shrink)

This article assesses what standards of safety and certainty of diagnosis need to be met in the determination of brain death. Recent medical, legal, and philosophical developments on brain death are summarized. It is argued that epistemologically adequate standards require the finding of whole-brain death rather than destruction of the cortex. Because of the possibility of positive error in misdiagnosing death, a tutioristic approach of being on the safe side is advocated. Given uncertainties in diagnosis of so-called vegetative states like (...) the apallic syndrome, anything less than whole-brain death, especially given the present state of diagnostic capability, should not qualify as an argument for removing therapy specifically on grounds that the patient is dead. (shrink)