56). This refers the fact that the AMA "…allows the withdrawal of what it calls extraordinary means of preserving life" (Sullivan, 1977, p. 56). Ordinary means refers to " & #8230;All medicines, treatments and operations which would offer a reasonable hope of benefit for the patient ands which can be obtained and used without excessive expense, pain and other inconveniences" (Sullivan, 1977, p. 57). Extraordinary means refers to "… all those medicines, treatments, and operations which cannot be obtained without excessive expense, pain, or other inconveniences, or which, if used, would not coffer a reasonable hope of benefit" (Sullivan, 1977, p. 57). The implied intention is therefore to do as much as possible ensure the continuation of life without promoting suffering in the face of a hopeless situation.

If we take this point into account then the intention of the AMA document becomes clear and the views that Rachels suggest seem to be somewhat one-sided. As Sullivan states, Rachel tends to ignore a distinction that the AMA document does in fact make, which is crucial to the interpretation of this document.

A number of critics have also referred to the central issue of the difference between causality and moral culpability and the view of "letting nature take its course. Kuhse and Singer refer to this aspect in relation to the ethical significance of this view. This also addresses the question of the difference between being letting a patient die and actively being involved in killing the patient. Kuhse and Singer question the 'philosophical naivety' of these views. This can also be related to the above argument in that while semantics and logic can ne used to differentiate between active and passive euthanasia, yet the intentionality behind these actions and decisions is the true moral determinant. .

Interestingly, Daniel Callahan ( 1992) places this debate into the larger and more inclusive context of changes and developments in Western thought. He is concerned that the acceptance...

He also questions the modern ideology of self-determination that allows an individual to decide about his life or death on an idiosyncratic basis His concerns are relevant to the preceding argument in that suggest an underlying and disturbing proclivity in modern society towards a rather lax ethics and morality.
Conclusion

What becomes clear for the above arguments is that the issue of euthanasia and more especially the distinction between active and passive euthanasia is one that has enormous repercussions in terms of views and philosophies surrounding the role of medical ethics in terminal situations. While Rachel critiques the AMA document and policy statement for a certain alleged inconsistency in its moral preference for passive over active euthanasia, this critique should be seen, I believe, against the larger and more holistic background of the aims and intentions of the AMA document. I believe that to analyze this document without taking into account the issue of intention is to run the risk of creating as distorted view of the AMA document and thereby presenting a biased view of what is in fact meant by passive euthanasia. Intention in the understanding of passive euthanasia is, as Sullivan suggests, clearly a core aspect of the document. The document en does not in fact deviate from the traditional ethos of medicine which is not to murder or kill but, through the use of passive forms of euthanasia, to allow a patient to die in only the most extreme cases where there is no medical hope and where suffering is a factor.