Harming and Not Helping
Underlying Boonin and Kamm’s arguments is the suggestion that the difference between what harms a person and what merely fails to help him can be more morally significant than the difference between what is, strictly speaking, killing or letting die. As they both argue in some way, I simply do not harm someone by killing him if I would not have been under a duty to rescue him (say, because the burdens for me of doing so are too great), and if killing him is the only way to resist helping, or to resist helping without incurring unreasonable burdens by the very act of resistance.
The basic proposition that the difference between harming and not helping can sometimes be the more important one in morality has much to recommend it. Phillipa Foot argued that in many instances, the moral meaning that is perceived in the difference between ‘doing’ and ‘allowing’ does not track the difference between acts and omissions, but rather that between not helping and harming.  In moral assessments, she claimed, it will not always matter whether a positive or negative kind of obligation is breached. As one example, Foot said, an actor who fails to turn up for a performance will spoil it rather than allow it to be spoiled, even though he does so by an omission. Equally, the parent who starves his child to death harms that child every bit as much as one who kills her through assault. On other occasions, the difference between positive and negative duties is of moral import. Foot’s example is that although we allow many people to die in India and Africa by not giving more charitable aid, this is not of a piece with sending them poisoned food. Here, the act is clearly harmful, but it seems the omission is not78
But what really makes the difference between the latter two cases? One is moved to say that the parent who neglects to feed his child does not just fail to rescue her, but that he positively kills her, just as the actor spoils the performance by his absence. Our confidence that harm has been done in these examples seems to lie in the agents’ clear pre-existing obligations to do otherwise. Conversely, by not giving money to charity, I might be failing to save the lives of people in poorer countries, but I am not, on most views, harming any individual as the negligent parent is his child, either because I do not have an obligation to provide such aid, or, more plausibly, because I do not have an obligation to provide it to anyone in particular.
From this it seems Boonin and Kamm would be right to think that whether a withdrawal of aid harms or only fails to help can depend on the agent’s existing positive obligations. But Boonin and Kamm wish to say something further: that the same can be true of aggressive acts. On this view, even if the only way to detach the violinist required a fatal attack on his body, your act will still only fail to save rather than harm him if you had no duty to begin with to lend him the use of your kidneys. By the same token, the non-existence of a woman’s positive duty to sustain the fetus means that the fetus is not really harmed by being killed.
While we might accept that the prior existence of positive duties sometimes determines which side of the harming/not-helping distinction one’s act or omission falls down on, there is, however, something odd about the way that distinction is being relied upon here to show that if unplugging the violinist is permissible, so is aborting a fetus by any method. To start with, it is a clear implication of the argument that if you could only detach yourself from the violinist by decapitating him, stabbing him, or scalding him to death, then you are permitted to do so, or to enlist others to do so. More than this, you are permitted to kill by any of these methods if they are appreciably less burdensome for you than unplugging him (we can imagine that unplugging him will cause you some amount of pain or discomfort which the other methods would not). I imagine that this will jar with what many people believe it is permissible to do to the violinist, especially where the option of unplugging remains, and that this is one reason to question the principle from which Thomson, Boonin, and Kamm are working.
In fact, the principle looks suspect even before it is applied to the violinist’s case. Could it be possible that the absence of a positive obligation to rescue someone is the main consideration relevant to the question whether you may kill her in order to avoid the burdens that rescuing her would entail? Suppose that I am rock-climbing alongside a stranger up a cliff face, when the stranger loses her footing and slips. She grabs hold of me to keep herself from falling a long way down to inevitable death, making me slightly unsteady. Her attachment now imposes a danger on me, such that I would not have been morally required to reach out and grab hold of her, and I am also permitted to now refuse to be a Good Samaritan and let go. Suppose also, though, that rather than merely shake her loose, it is less dangerous for me to grab some loose rock and club her over the head with it, simultaneously killing her and detaching her. Or suppose instead that I had a marksman positioned at the top of the cliff, poised to shoot her dead should this very eventuality arise, and that again, it is safer for me to command the marksman to shoot than it is to throw her off me (say, because it will cause me less imbalance). Am I permitted to do either of these things because I was not obligated to endanger myself in order to help her in the first place, and because (as per Kamm) apart from my assistance, she would have slipped and fallen in any case?
Perhaps Boonin and Kamm would argue that this is exactly correct. But many would struggle, I think, to subsume those actions under the refusal to be a Good Samaritan, even in the relevant conditions. In fact, one might just think that this is precisely what is entailed by the proposition that killing is substantially morally worse than letting die, a proposition that Boonin is willing to grant for the sake of argument. If killing is ever subject to constraints to which letting die is not, then surely these constraints will bear out most clearly when all other things are equal but where killing is considerably more convenient than permissibly letting die. This seems to be something that Thomson, Boonin, and Kamm all flatly deny—that is, they deny that there could be any special constraints on killing when it would have been permissible to let die, which is in truth just to say that there are no special constraints on killing.
But this cannot possibly be right. If it is permissible for me to refuse to save the lives of people dying in poverty by not giving more aid (say, because by refusing, we think I am not in fact harming them), this cannot mean it is equally permissible for me to shoot them down to prevent them from taking that aid from me by force. Moreover, the application of Boonin and Kamm’s principle does not seem to be affected by the weightiness of the burden which one is not positively obligated to assume. To explain, imagine that the violinist only needed to be plugged into you for one hour to survive (one of Thomson’s amended scenarios). And suppose we still accept that you would have no duty to offer the use of your kidneys for that sole hour. Still, one hour is not nine months. But on the principle we are examining, you are just as entitled to kill in lieu of discontinuing support so as to avoid it—a much weaker burden though it is. Just how burdensome the positive aid would have been makes no difference. Again, all that matters, it seems, is that by unplugging him you are discontinuing support you had no obligation to provide, and that killing him is sufficiently less burdensome than unplugging. But this again does not seem correct. If the duty to avoid killing is indeed notably stricter than the duty to rescue, the weight of the burden one seeks to avoid by doing either (that is, the original burden one could not be obligated to assume) must surely affect whether one is permitted only to let die or to kill as well.
The fact that the principle being considered permits far too much should alert us to some problem. As I see it, the problem is that the argument amounts to the outright denial of the different moral character of killing and letting die. Neither Kamm nor Boonin seems to believe that killing could be prohibited where letting die would have been permissible but killing is less burdensome. But if there is any moral distinction between the two, this is precisely the scenario in which it should be expected to make the difference. If we wish to remain committed to the belief that the rules of permissible killing are different to the rules of permissibly letting die, then ‘no duty to gestate’ and ‘no duty to refrain from killing’ cannot amount to the same thing, including when the consequences are the same for the ‘victim’. On the contrary: one’s conclusion about whether, all things considered, including the weight of the burden to be avoided, there exists a negative duty to refrain from killing the fetus will determine whether there is a duty to continue gestating it if there is no way of ending support other than by killing.
For those who still find it too much of a strain to distinguish unplugging the violinist from abortion by extraction, there are two options for how to proceed. First, we can just put extraction abortion in the subsequent discussion and assume that it, at least, is straightforwardly permissible if there is no positive duty to gestate, either because it does not amount to killing the fetus or does not entail harming it. Alternatively, we can assume for the sake of argument that by unplugging the violinist you will in fact be killing him, just as extraction abortion kills the fetus, and turn our attention to justifications for homicide. If unplugging the violinist is an example of justified killing, is the same true of abortion if the fetus is a person?
This chapter has made one main claim. I argued that whether or not a positive duty to gestate a fetus-person could ever obtain, the problem of abortion, if fetal person- hood is presumed, is a problem not about positive duties to rescue others but about the negative duty to refrain from killing them. Given that this is the case, the GST fails. If abortion is the prima facie violation of a strict negative duty not to kill other people, its moral and legal permissibility depends on the applicability of a special dispensation to kill in order to end a pregnancy, rather than on the absence of a duty to volunteer gestational services. It is this former possibility I now want to consider.
-  Foot (n 38).
-  Peter Singer has challenged the moral lines some might draw between moral duties and supererogation by arguing that we are in fact duty-bound to give far more charitable aid than we do. WhileSinger does not expressly argue that we harm less fortunate people by failing to provide them with moreaid, his argument might help make the case that people are harmed as a consequence of our wrongfulomission to give more. (See Peter Singer, ‘Famine, Affluence, and Morality’ (1972) 1 Philosophy andPublic Affairs 229.)