Agora: Red Deer Polytechnic Undergraduate Journal
Volume 14:1 2023 Agora Conference Proceedings

Nasty Uncles and Swedish Truckers:
Killing, Letting Die, and the Ethics of Euthanasia
Ryan Henri
Euthanasia can be controversial, and much of the controversy centers on the difference
between active and passive euthanasia (Rachels 225). In order to explore the difference between
actively killing and passively letting die, James Rachels, in "Active and Passive Euthanasia," uses
the cases of two uncles motivated to kill (227). Scrutiny is called for with a controversial topic of
interest or concern in law, medicine, and ethics. Thus I examine whether the distinction between
active and passive euthanasia is morally relevant and whether euthanasia is equivalent to killing
or letting die. I argue that the distinction between passive and active euthanasia is a false
dichotomy. So the controversy regarding active and passive killing does not apply, making
euthanasia less controversial. I argue that euthanasia, by definition, is different from the kinds of
active or passive killing in the cases of the nasty uncles (Taylor, Section 4.B.ii). I use the case of
the Swedish truck drivers supplied by Helga Kuhse (241) in "Why Killing is Not Always Worse
and Sometimes Better–Than Letting Die" to illustrate the difference between euthanasia and
motivated killing. In other types of motivated killing, the agent who brings about the death benefits
most in some way, but euthanasia intends to benefit the patient who receives the death. With that
distinction clarified, the controversy between active and passive forms of euthanasia becomes
essentially meaningless, and with it, so does much of the controversy surrounding euthanasia itself.
Since euthanasia is materially different from other types of killing, the moral prohibitions against
killing do not apply to the same extent. To illustrate that point, I briefly describe possible
deontological arguments against euthanasia and how those same arguments can support euthanasia
of the type seen in the Swedish trucker case and modern medical contexts. I conclude that with the
controversy of the false dichotomy of active and passive euthanasia resolved, euthanasia becomes
morally acceptable and much less controversial.
Euthanasia can be defined as an intervention in the life of a person "who is reasonably
considered to be terminally, or irreversibly, ill or injured for the express purpose of causing the
imminent death of that patient, normally for reasons of mercy" (Taylor § 4. B. ii). In James Rachels'
classic work, he quotes a definition of euthanasia from the American Medical Association,

defining it as the intentional ending of a life in the form of a "mercy killing" (225). Rachels calls
attention to the controversy surrounding euthanasia and points out that the critical ethical issue is
the distinction between the passive and active forms of euthanasia (225). Rachels states that this
distinction is important because letting someone die may be morally acceptable, but killing
someone is much worse (227). This distinction, and its importance, has been called the "difference
thesis" (Nesbitt 235).
Active euthanasia is simply euthanasia in the form of committing an action, and passive
euthanasia is brought about by not committing a certain action (Taylor § 4. B. ii). Rachels explores
that difference using the cases of two uncles and the deaths of their nephews. In one case, an uncle
actively drowns his nephew; in the other, the uncle intends to drown the nephew but finds that the
drowning has already begun by accident, so the uncle does not have to do the work directly.
Critically, in both cases, the uncles are motivated by gain for themselves and the best interests of
the nephews are either ignored or acted against. We may call examples of this type "motivated
killings" to distinguish them from cases fitting the given definition of euthanasia, where it is in the
best interests of the person who dies, which is the primary concern, in the form of mercy. Returning
to our definition of euthanasia, we can see that the cases of the two uncles do not represent
euthanasia. Euthanasia is not just the ending of a life; it is motivated by mercy, meaning that the
intent is to benefit the person whose life is ended. Rachels makes this point explicit, stating that
cases of euthanasia (customarily performed by doctors) do not involve personal gain for the
doctors (227).
At this point, we may ask, if the cases of the nasty uncles do not represent euthanasia, what
does? Moreover, what if the euthanasia is not performed by a doctor? Helga Kuhse answers these
questions in response to the Difference Thesis. In contrast to motivated killing and euthanasia
performed only by a doctor, Kuhse provides the case of the Swedish truckers (241). In this case,
one truck driver is trapped and burning to death after an accident, who then asks a second trucker
to shoot him. The second trucker does so, which would almost certainly seem merciful from the
driver's point of view. On the surface, one trucker shooting another to death seems wrong (a point
addressed later below), but what is critically important is Kuhse’s point that the trucker acted out
of compassion to benefit the driver and that intuition indicates there is nothing morally wrong in
this case (241).

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The trucker's death was inevitable and irreversible, so the death itself cannot be the morally
relevant point. What is relevant is how that death occurs. Rachels and Nesbitt might bring up the
Difference Thesis at this point, so we should examine the sequence of events in the Swedish
truckers' case. The relevant facts are: 1) a person is reasonably considered to be in the process of
dying, 2) a second person weighs what might be in the best interests of the dying person, 3) the
second person carries out a sequence of actions accomplish those best interests, 4) those actions
lead to the biological cessation of the dying person's life. The Swedish truck driver who is trapped
and burning to death indicates they wish to die immediately; a second person concludes that would
be merciful and gets a gun, uses it on the driver, and the gunshot wound quickly causes a biological
chain reaction that ends the trucker's life with a minimum of suffering. This could be characterized
as "active" euthanasia, but it is directly comparable to cases of passive euthanasia since they would
follow the same pattern. Consider another case raised by Rachels: a doctor with a patient who will
die from incurable throat cancer within days (225-226). The doctor could choose to passively let
the patient die, which would involve the doctor weighing the options and carrying out a course of
(non-lethal) treatment, and the biological chain reaction of cessation of life (eventually) follows.
Therefore, it is clear that there is no real morally relevant difference between active and passive
euthanasia; it is a false dichotomy. With that "crucial" difference rendered meaningless, much of
the controversy of euthanasia is resolved. What remains is whether euthanasia is in the best
interests of the dying person.
The definition of euthanasia excludes motivated killings and cases like the Nasty Uncles
involving the death of persons against their best interests. This leaves cases like the Swedish
trucker or the terminal cancer patient, where the primary factor seems to be the amount or length
of suffering before their approaching death. With all else being equal, a reasonable person would
agree that less suffering is virtually always in a person's best interests. This is a consequentialist
perspective, and Nesbitt (235) and Kuhse (242) raise the point that different moral theories might
lead to different stances. Major objections might include the sort that a deontologist like Kant
would raise.
Kant might object that killing a person will always be wrong no matter the context or consequences
since it would violate the categorical imperative regarding the irrationality of willing a world where
people can go around killing each other (Jankowiak § 5.b), or would violate the categorical
imperative in treating a person (or treating oneself if euthanasia is a kind of suicide) as merely a
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means to an end (De Jong slide 13). These objections rest on what Kant emphasizes as the two
things at the foundation of duty-based ethics: human rationality and autonomy. A deontologist
might argue that killing another person would violate their autonomy and be irrational and that
euthanasia as suicide would be the same. However, Stephen Luper presents a case that responds
to these objections from a deontological perspective.
Luper's case is of a patient named Diane with terminal leukemia whose doctor assists with
a prescription that would allow Diane to overdose intentionally, in other words, the sort of
euthanasia that might be called suicide. From the doctor's perspective, he takes steps to verify that
Diane retains her rational faculties, clarifies her autonomous informed consent, and allows Diane
to make a choice about her life freely. From the perspective of Diane, she follows Kant's imperative
to act in a rational way that respects and preserves her autonomy and dignity: taking steps to
maintain her ability to choose and act on her own, both in the face of a condition that will certainly
degrade her capacity in the future and in a way that she could will others to behave as a universal
maxim: if dying of an incurable disease, die in a way that maximizes dignity and autonomy.
There remains the Kantian concern that Diane (or her doctor, who facilitated the
euthanasia) was only treating her as an object, a means to an end (a merciful death) instead of
maintaining Diane's dignity as a rational, autonomous human being. However, that is the whole
point; Diane's condition was already reducing her to an object: stripping her of her dignity by
taking away her autonomy and, in her final overwhelmingly painful or pharmaceutically dulled
hours, her rationality. The Kantian duty of Diane and her doctor was to preserve that rationality
and autonomy, to prevent a dignified person from being reduced to a "heteronomous" object ruled
by pain and cancer. In the end, the doctor and Diane agreed that euthanasia or doctor-assisted
suicide was the best way to allow her to face her inevitable death with maximum dignity and
rational control. The case of the Swedish truckers puts an even finer point on it. The driver used
his rationality and autonomy to decide his last moments: dying with the minimum pain that could
be respectfully given to a human in that situation and without being reduced to an inhuman state
by the terror, agony, and protracted torture of being trapped burning to death.
Having seen how deontological objections might actually support the reasons for
euthanasia, we can conclude (following Rachels) that opposition to euthanasia probably focuses
on the controversy regarding the morality of active or passive ending of life. However, I have
argued that there is no morally relevant difference between active and passive euthanasia.
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Therefore, I conclude that with the crucial opposition and controversy addressed on their terms, if
only in cases excluding motivated killing and meeting the definition of euthanasia, it must be
accepted that euthanasia is morally acceptable.

Works Cited
De Jong, Brandon. “Topic 3.3: Euthanasia continued” PSYC 386 A Bioethics, Fall 2022, Red
Deer Polytechnic, PowerPoint.
Jankowiak, Tim. “Immanuel Kant.” Internet Encyclopedia of Philosophy,
https://iep.utm.edu/kantview/#H5. Accessed 15 November 2022.
Kuhse, Helga. “Why killing is not always worse – and sometimes better – than letting die”,
Bioethics: An Anthology, 4th ed., edited by Udo Schuklenk and Peter Singer, John Wiley
& Sons Inc., 2022, pp. 240-243.
Luper, Steven, “Kantianism: Is duty respect for humanity?” A Guide to Ethics, 2002, pp. 141156.
Nesbitt, Winston. “Is killing no worse than letting die?” Bioethics: An Anthology, 4th ed., edited
by Udo Schuklenk and Peter Singer, John Wiley & Sons Inc., 2022, pp. 235-239.
Rachels, James. “Active and passive euthanasia,” Bioethics: An Anthology, 4th ed., edited by
Udo Schuklenk and Peter Singer, John Wiley & Sons Inc., 2022, pp. 225-229.
Taylor, Stephen C. “Health care ethics,” Internet Encyclopedia of Philosophy, 15 November
2022, https://iep.utm.edu/h-c-ethi/#SSH4bii. Accessed 5 June 2023.

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