Charles McKnight

ABSTRACT In his paper ‘The Survival Lottery’John Harris suggested that there could be situations where the rational thing to do would be to kill a healthy person and harvest his organs for transplantation, thereby saving several lives at the cost of one. Anne Maclean claims that such a proposal, far from being rational, does not qualify as a moral proposal at all since what it suggests is ‘plain murder’. I argue that she is correct to claim that the proposal is not uniquely rational and that doctors could quite rationally reject it, but that she overreaches herself when she holds it not to be a moral proposal at all.

Discrepancies between our moral theories and our practice, particularly as embodied in the law, are not infrequent. The main theme of this book is that this situation is not necessarily a matter for regret and may even be desirable. What scholars have tended to ignore or underplay (though surely at least since Bentham they are aware of it) is the process of translating theory into practice, which is itself something subject to moral evaluation. Orentlicher examines the process in relation to three life and death issues; first euthanasia, then abortion, and finally the withholding of futile treatment. With reference to euthanasia the problem is that the law draws a distinction between withdrawal of treatment (passive euthanasia) which is legal, and assisted suicide (active euthanasia) which is almost everywhere illegal. But the distinction seems to lack a moral basis. Orentlicher examines in detail attempts to defend the distinction (natural versus unnatural deaths, acts versus omissions, proper pain management removes the need for assisted suicide etc) and does a good job in demolishing them all, concluding at the end of chapter 3 that there is no morally relevant difference. In chapter 4, however, he argues that a legal distinction between the two is still justified. How can this be? The answer is that there is a real moral distinction to be made between justified and unjustified deaths. By way of illustration he describes the deaths of four different patients. The first patient is a young man of 24 who refuses life saving antibiotics without giving a reason; the second an elderly patient who requires ventilation …