Except for differences of side-effects consequentialist or teleological arguments against killing are equally good arguments against letting die, or in favor of saving lives. Utilitarians in particular teach that killing is shortening a life, while saving a life is extending it, and that the traditional difference of moral evaluation is solely defensible to the extent that it reflects differences of side-effects on other people. They do not think that an act like killing (intentionally) or an omission like allowing someone to die (intentionally) can ever vary in moral value when having identical effects. This may be correct within the consequentialist framework of the utilitarian, and also within the teleological framework of our neutralist, doctrine, it is not correct when this doctrine, or adherence to this doctrine, is judged from a metadoctrinal position. Then it has to be taken into account that two persons may adhere to different teleological, or other, doctrines and moralities. Acts and omissions do not relate in the same way to active extrinsic rights and nonactivating extrinsic duties.

Altho a doctrinaire utilitarian, or other consequentialist, would not be able to view matters from a metadoctrinal standpoint (like so many religious and political dogmatizers), it is even possible to attack 'er position from within a consequentialist doctrine on other considerations than those of side-effects. The point is that refraining from a wrong act and a right omission do not require anything physical of the agent, whereas a right act and refraining from a wrong omission do. Thus abstaining from murder requires no physical effort as such but refraining from not saving lives, or from not striving to keep alive, does. Now, it is quite possible that everyone can endeavor to keep one person alive, but no-one may be able to keep everyone alive. Or, more generally, it is quite possible to abstain from one, or a limited number of wrong omissions, but it may physically be impossible to abstain from all omissions which are consequentially speaking wrong. This is not a question of normative conditions in themselves anymore but of modal conditions: a person may be able to do everything 'e should do separately, but is 'e able to do everything 'e should do together? (Compare the precautions you should take to prevent the occurrence of one particular disease. You can take these precautions, yet if you had to take all precautions you should take to prevent the occurrence of each disease, or of any disease, you could get, you would probably soon collapse from exhaustion.)

In respect of the DNI there is the additional aspect that it would fall foul of the spirit of neutralism to require a (positive) action which somehow involves change. All we can demand on the relevantist interpretation of the doctrinal principle of neutrality is that if one acts, it should ultimately serve a neutral purpose. This, of course, holds also for the consequences or effects of an intentional omission, yet an omission in itself differs markedly in character from an action.

The theory on which there can be a normative difference between an act and an omission with the same consequences is called "the acts and omissions doctrine". If we completely rejected this theory (as consequentialists do), not giving to a famine relief fund without being able to justify one's alternative spending as more important would be very similar to an act of killing. (It is to be feared tho that this position might make people not more willing to give to such relief funds but less reluctant to murder instead.) Yet, there is one significant difference: if the act of killing is a murder regardless of the doctrine espoused, then it is the most serious violation of someone's right to personhood, whereas not contributing to a relief fund is not as such. On the other hand, in the event that the famine concerned results from a large-scale violation of extrinsic property-rights in a region, or in the world, a contribution to the relief of this famine is merely a (partial) compensation for this violation. Not contributing to famine relief can in that case be on a par with murder even from a metadoctrinal standpoint. It is only when the country or the people that suffer from famine have not respected, or will not respect, the rules of the extrinsic right-duty constellation themselves that they cannot appeal to this compensative, metadoctrinal aspect of helping them.

On the utilitarian reckoning everyone should spend 'er time on good works right up to the point where the disadvantages to 'im outweigh the benefits to others. The ensuing prospect of an enormous reduction in income and/or the loss of a lot of spare time is a very demanding morality indeed for many (comparatively) rich people. One approach suggested to this problem (if it is one), is to accept the utilitarian, eudaimonist view, but 'to allow a huge discrepancy between professed beliefs and actual conduct' and to distinguish 'ordinary people' from the 'few saints who manage to live up to the utilitarian view'. This, however, is a serious admission of failure largely due, not only to the utilitarian's neglect of extrinsic right-duty relationships but also of the individual's general modal condition. Take the modal condition of a bridge by way of comparison: a bridge may easily be able to carry each one of a thousand vehicles, without being able to carry all of them. In other words, a bridge has a carrying-capacity, but so has a person, or human body, in a way. When two people do not live up to the utilitarian's expectations, it may be that one of them does not try hard enough, but it may also be that their carrying-capacities are simply dissimilar. In that case they may both be exerting themselves to the utmost. Thus we had better forget the deceptive terminology of one of them being 'a saint' and the other just being 'ordinary'.

Not only suppositions about modal conditions but also suppositions about factual conditions play a role in consequentialist or teleological ethics. The positions of two utilitarians, for instance, may radically differ dependent on their empirical or modal presuppositions. In discussions on whether famine can be avoided there is a remarkable difference of opinion amongst utilitarians themselves. First of all, there is the position of those who believe that a population growth which is faster than the growth in food supplies leads to famine. Among them we find so-called 'optimists' who believe that famine can be reduced and averted by bringing the rate of growth of population below the rate of achievable economic growth, and so-called 'pessimists' who do not believe that population control programs can end or avert famine. Furthermore, there are the 'developmentalists' who hold the view that population growth rates often do not fall until after a reasonable level of economic well-being has been reached. An optimistic utilitarian may tend to underestimate the long-term consequences of saving human beings from famine when the growth of population is merely going to outstrip the available resources. A pessimistic utilitarian may see no way 'to curtail population growth except by letting famines run their natural course' -- as has seriously been argued. This divergence of opinions between thinkers with apparently the same moral outlook seems to be largely the result of the uncertainty of consequences.

Utilitarianism (and with it all consequentialism) has been attacked for not distinguishing justice from beneficence or 'essential duties' which are stringently required from 'supererogatory duties' which are meritorious, but which would not be required so stringently. In deontological terms it may be said that the duties of justice require that one act on no maxim which uses people as mere means, and that duties of beneficence require that one act on some maxim which fosters other people's ends. (Note the metadoctrinal basis of the supposedly doctrinal duty of beneficence.) It is then said to be 'a matter for judgment and discretion which of their ends to foster'. (Note how this valueless evaluative formulation now touches on a doctrinal dimension.) All those who emphasize this distinction between duties have to do, is to make sure that their acts are not unjust in that they would use people as mere means (whatever this might mean). Regardless of whether one is in a position to do something about it, helping the starving is merely a supererogatory duty on this deontological reasoning. Assuming that any beneficence is to be allocated at all, it leaves the allocation of this beneficence in utter darkness. Altho it may be mentioned that 'relief of famine should stand very high among duties of beneficence' since 'extreme poverty and hunger leave people unable to pursue any of their other ends', it may be stressed at the same time that 'the important moral choices are above all those in which one acts directly', that is, those which involve personal communication. Such a lack of concern with social issues (and such a lack of socioeconomic insight) on a larger than personal scale does not even require pessimistic presuppositions with regard to famine relief.

When metadoctrinal considerations are not mixed up with doctrinal ones, the difference between so-called 'duties of justice' and 'duties of beneficence' in matters of life and death resembles that between extrinsic and intrinsic duties. It is true that a person must not act unjustly in terms of the extrinsic right-duty constellation, but intrinsic duties are only supererogatory from the metadoctrinal angle. To maintain that they would be supererogatory on the doctrinal level is a fallacy; it is precisely at this level where the core of morality lies. Thus, on the Ananormative model we may accept the eudaimonist, doctrinal considerations of utilitarians with respect to saving lives if, and insofar as, they do not contradict anyone's right to personhood, do not disregard other neutral-inclusive values than the minimization of suffering, and do take into account that every person is a being with limited capacities. What the neutral-inclusivist should suppose with respect to the factual and modal conditions of famine relief and related issues cannot be laid down here since the truth and relevance of such suppositions are too much time- and place-dependent.

There is a lugubrious similarity between allowing other people to die of hunger, or of illnesses they would easily have survived if hunger had not weakened them, and passive involuntary euthanasia. In both cases people die, because they are allowed to die, not because their death is the result of a particular action (discounting the possible infringement of extrinsic property rights). And in both cases they die against their will. If a person's reaction should be different in the instance of passive involuntary euthanasia, then only because 'e is probably able to do much more about one isolated case close to home than about so many cases far away. But this argument is weak and the strong similarity remains. No-one can call passive involuntary euthanasia "murder", if 'e does not equally condemn the situation in which people let other people die of starvation. If aid is supererogatory in the latter case, it is so in the former case. Granted that it is not supererogatory on the doctrinal level, we must either condemn both situations or neither one. Involuntary euthanasia would, perhaps, hit a person we know, but only one or a limited number of people (who, moreover, cannot be cured either). On the other hand, the number of human beings struck by a famine is likely to be beyond comparison.

The least problematic instance of allowing the death of another person, or 'er body, is passive voluntary euthanasia. As it is passive, it only requires an omission; and as it is voluntary, it is an omission which is requested. It is the right to personhood of every person to refuse medical, or other, treatment while 'e is still able to communicate this desire, but also thereafter, if 'e has made it known beforehand that 'e does not want the life of 'er body to be prolonged. When the decision is an unmistakably free one, no-one has the right to treat, or continue treating, the person or 'er body, not even to save 'er life, if, and insofar as, only 'er own death is involved (and not the involuntary death, or possible death, of another person). It may be very regrettable that someone who is seriously ill or badly injured chooses to die; it may be that 'er life should be saved and could be worthwhile in our eyes. Yet, it is not our life, and our normative convictions may not be the other person's normative convictions, or our information and suppositions may not be the other person's information and suppositions.

People also allow, risk or cause their own death when they do not suffer from a terminal disease or are not seriously injured, or when their well-being does not seem to be threatened by demonstrable external factors. This matter will be our final concern.