The medical profession has recently been caught in the middle of the social controversies that rage over euthanasia. Government and religious groups, as well as the medical profession itself have sided with the 1973 American Medical Association s euthanasia policy statement. However, there are those who oppose the statement are speak out against the AMA s seemingly contradictory definition. James Rachels speaks out against the AMA s policy statement in his essay, "Euthanasia, Killing, and Letting Die," by arguing that there is no moral difference between active and passive euthanasia. In doing so, Rachels criticizes the AMA policy statement as irrational and he claims that the medical profession should reject it. However, Bonnie Steinbock, in her Book, "The Intentional Termination of Life," disagrees with Rachels position, arguing that there is a difference between active and passive euthanasia, and that the AMA statement does not endorse or denounce either, and thereby supports the American Medical Association s views. Even though Steinbock disproves Rachels thesis by arguing that the AMA policy disregards euthanasia, she does not claim that Rachels moral standpoints are incorrect.

Steinbock argues that the AMA policy statement does not provoke a moral discussion between passive and active euthanasia, which implies that Rachels, fails to fully understand the message of the AMA statement. Rachels entire essay, and portions of his book, The End of Life: The Morality of Euthanasia, are based upon the assumption that the "cessation of the employment of extraordinary means to prolong the life of the body when there is irrefutable evidence that biological death is imminent " is referring to the term "passive euthanasia." If this were the case, according to Steinbock, Rachels essay would be considered an intelligent response to an immoral policy. However, Steinbock contends that the AMA statement does not refer to moral differences between two types of euthanasia, but rather, that the statement rejects both forms of death and in their place allows for the "cessation of the employment of extraordinary means." Steinbock claims that euthanasia and the cessation of treatment are completely different ideas, and that the AMA never intended to imply passive euthanasia as an accepted medical practice.

Although Rachel s interpretation of "extraordinary means" seems reasonable, by showing that the cessation of medicine is not necessarily allowing a patient to die, Steinbock proves Rachel s thesis wrong. Steinbock states that the " AMA statement does not make the distinction Rachels wishes to attack" (Steinbock, 164, I). According to Steinbock, the AMA position was directed towards cases where treatment would worsen the state of a patient. Rachels most blatant error was in stating " for what is the cessation of treatment if it is not the intentional termination of the life of one human being by another?" (Rachels, 155, I). He substantiates this claim by stating, " if it were not, there would be no point to it." Steinbock denounces this blas manner of corroborating the statement. In effect, Steinbock invalidates Rachels main focus by presenting the notion that the only moral discussion that may arise from the AMA statement is in defining what constitutes extraordinary care; not the moral differences between passive and active euthanasia.

Steinbock attempts to explain instances of extraordinary care by pointing out that sometimes a doctor s decision to refuse treatment is an attempt to sustain life, not shorten it. She states that, " discontinuing treatment is not to bring about the patient s death but to avoid treatment that will cause more discomfort " (Steinbock, 161, II). Steinbock uses the example of a frail cancer patient on the verge of death in which harsh treatments will only worse the patient s status. In this case, by halting treatment, the doctor was not trying to kill the cancer patient, but rather trying to prolong the patient s life. "Intentionally ceasing life-prolonging treatment is not the intentional termination of life unless the doctor has, as his or her purpose in stopping treatment, the patient s death." Steinbock successfully demonstrates that Rachels is wrong in assuming those ceasing treatment only serves to bring about a patient s death.

However, this is not to say that Steinbock vehemently disagrees with Rachels views on passive and active euthanasia. Steinbock s thesis wasn t that Rachels was wrong in his views, only that he was wrong in interpreting the AMA statement. Although Steinbock never directly states it, she implies that passive and active euthanasia is morally acceptable. Her statements suggest that she is against permanently labeling the ceasing of life-prolonging treatment as a form of passive euthanasia, but on the other hand, she claims that in some instances it is morally correct to support passive euthanasia. She even agrees with Rachels statement that, in some circumstances, it is beneficial to exercise active euthanasia. One would think that she would support active euthanasia while denouncing passive euthanasia so as not to contradict her own thesis, but she does not do this. She states, "In general, a competent adult has the right to refuse treatment, even where such treatment is necessary to prolong life." She also states, "I do not deny that there may be cases in which death is in the best interest of the patient. In such cases, a quick and painless death may be the best thing." Unlike Rachels, Steinbock never states that the two are morally equivalent. Steinbock does, however, stress that morals tell us that different situations call for different types of euthanasia.

By providing clear and concise examples of how the refusal to medicate does not necessarily imply passive euthanasia, Steinbock successfully disproves Rachels thesis. Although Rachels insists that the moral sameness between passive and active euthanasia is based upon the AMA policy statement, Steinbock s views on the differences between the two actions seem to coincide with those of Rachels. Whether or not active euthanasia becomes a medically accepted procedure, there is no doubt that the AMA statement is not binding, but only meant to imply that passive euthanasia is an accepted medical practice.