Killing and letting die

This paper reassesses the alleged moral difference between killing and letting die by shifting the analysis from permissibility to the allocation of consequence responsibility. Within Fischer and Ravizza’s guidance-control framework, responsibility is two-staged: agents are conduct-responsible when their behaviour issues from a mechanism they own that is at least moderately reasons-responsive; and they are consequence-responsible when, in addition, the death arises along a non-deviant, normatively intelligible route from that behaviour. I then operationalise the second stage via a disciplined counterfactual-subtraction procedure that is neutral between actions and omissions and that distinguishes consequence-particulars from consequence-universals. Applied to canonical contrasts, the framework yields patterned results: where both killing and letting die satisfy (or both fail) the same responsibility conditions, they are moral equals with respect to the death; where they come apart, any asymmetry tracks ownership, reasons-responsiveness, or decisive causal contribution rather than the surface doing/allowing label. The upshot is a unified, practice-usable standard for foreseeable-death contexts in end-of-life medicine and clinical governance, clarifying documentation, role delineation, and the evidential focus for retrospective appraisal without presupposing a default moral privilege for omissions

Culpability · Moral responsibility · Normative · Ethics in medical practice · Healthcare Decision-Making and Restraints · Palliative Care and End-of-Life Issues

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