The distinction between killing and allowing to die.

In his "Notes on Moral Theology: April-September 1975," Richard A. McCormick, S.J., takes up some recent treatments of the distinction between killing and allowing to die. I want to comment on one part of that discussion—his treatment of an article by Gerald J. Hughes, S.J.1 will suggest that neither Hughes's argument nor McCormick's discussion takes us much beyond where Paul Ramsey had already gotten in chapter 3 of The Patient as Person, and that we can get further only by taking seriously a remark which Ramsey makes almost in passing and perhaps does not himself take with sufficient seriousness. Hughes presents an interesting argument designed to lead us to question whether there is a (morally relevant) distinction between killing and allowing to die. He considers two cases: (1) a patient presently receiving artificial life-support without which he will die; (2) a terminally-ill patient who will die within a few days. In each case one act on the part of the attending physician can have a decisive significance. In case 1 the doctor can switch off the life-support machine(s), and the patient can be "allowed to die." In case 2 the doctor can give the patient an injection as a result of which he would die as quickly as would the first patient when deprived of artificial life-support. In neither case is there any hope of saving the patient, since both are irretrievably in their process of dying. In both cases the physician has at his disposal an action which will result in the death of the patient. Neither physician need want the patient dead in the sense of having any ulterior motives which would render his intent evil. How is it possible to say that, since in case 1 the patient is allowed to die and in case 2 the patient is killed, some morally relevant difference is involved? McCormick summarizes the conclusion to which Hughes's argument seems to lead: "The conclusion would seem to be either that euthanasia is morally permissible in those instances in which a decision not to maintain life is permissible, or that neither euthanasia nor refusal to prolong life is permissible" (p. 105). Hughes, in fact, rejects these alternatives and suggests another possibility. However, I am less interested in his other suggestion than I am in noting that the alternatives seem strikingly similar to what Ramsey calls "the same objection from two opposite extremes" to his suggested ethic of caring (but only caring) for the dying. Each of the two