Q: Someone told me that there is a big difference in moral theology between not acting, taking indirect action, and taking direct action, even if all three achieve the same result. Is this true?
A: Yes it is. The reason is that, as the pope so often points out in accordance with historic Christian theology, the ends do not justify the means. Even if one has a just end, one must also use a just means to reach it, and sometimes taking the direct route involves doing something intrinsically wrong. In such cases, it may be possible to reach the just end by a different means than taking direct action.
These same distinctions between not acting, acting indirectly, and acting directly are even recognized by secular ethicists, as I can tell you from experience sitting in philosophy ethics classes and reading academic philosophy books on ethics.
A recent events in my own life offer an instructive illustration of the difference between inaction, indirect action, and direct action.
When my mother had her recent aneurysm, she was put on a drug to help regulate her blood pressure and keep it from falling to impossibly low levels. The doctors administered this to her by putting her on a continuous, intravenous drip.
Now let us look at how inaction, indirect action, and direct action would relate to the situation of a person in the same position as my mother. (Note: The details in this are not the same as what happened with my mother.) Suppose the doctors came to the family of such a person and said, “It is very tragic; but your loved one is brain dead and has no hope of recovery. Prolonging life will serve no purpose and only prolong your agony.” The family then decides to not prolong their loved one’s life.
CASE 1 — Inaction: The family instruct the doctors to not do anything–to let the intravenous drip bag run empty and not to put a new one in its place.
CASE 2 — Indirect Action: The family tells the doctors to take their loved one off the drug immediately, so a nurse goes into the room and stops the machine that is regulating the drip. In this case, an indirect action was taken which led to the loved one’s death. It was an action because the nurse took a positive step of turning off the drip, but it still only indirectly resulted in the loved one’s death, as a comparison with the next case shows.
CASE 3 — Direct Action: The family tells the doctors to take their loved one off the drug, but this time when the nurse goes into the room, she doesn’t just turn off the drip, but disobeys the doctor’s orders and injects a lethal quantity of cyanide into the intravenous drip, sending the deadly poison down into the loved one’s veins. Alternately, she goes into the room and smothers the loved one with a pillow, hidden from the family’s view by the curtain in the room’s door.
All three of these different cases involve doing or not doing something that led to the loved one’s death, however, they have very different moral character. In case 1 the family simply lets the loved one go ahead and die by not giving treatment that would uselessly extend life. In case 2 an action is taken which indirectly results in death by stopping a treatment that is uselessly extending life. In both of these cases, then, the family simply let the loved one go ahead and die. In case 3, however, the nurse murders the loved one by taking steps which directly cause death, not simply allow it to take place on its own.
There is a big difference between killing and letting die, between simply throwing up one’s hands and letting it come and actively calling it down by poisoning or suffocation. This distinction is one of the perennial discussions in secular philosophy books on euthanasia and other death-related topics, such as Philip Devine’s The Ethics of Homicide.
In secular discussions, the killing versus letting die distinction is still up for grabs in relation to the terminally ill, however, in the Church it has been settled. ONE MAY NOT KILL (take an action which directly causes the death of) a person who is terminally ill. However, one MAY REFUSE CARE (inaction) or CEASE CARE (indirect action) under certain conditions (e.g., the person does not wish to continue the care, they have no hope of recovering from the affliction, the affliction is truly terminal, the care is something other than ordinary bodily maintenance [such as the giving of nutrition and hydration], etc.).
In other words, there is just a big moral distinction between saying, “Don’t begin administering that drug as it will only uselessly prolong the inevitable,” between stopping the administration of the drug, and between going into the room and smothering the loved one with a pillow.
The reason direct action is prohibited in such circumstances is that, according to Christian moral theology, the means do not justify the ends. Even if an end is just, this does not justify any and all means by which this end is attained. Only just means must be used to pursue and just end. Unjust means may not be used to pursue a just goal. Since God has not given us the right to deliberately take innocent human life, taking direct action which leads to the death of an innocent may not be used under any circumstances. Thus euthanasia or “mercy killing” is forbidden by Christian moral theology, but stopping or refusing care when someone is terminal and no longer wishes to live is permitted.