James Rachels 
The philosopher James Rachels has an argument that shows that the distinction between acts and omissions is not as helpful as it looks. Consider these two cases:
•Smith will inherit a fortune if his 6 year old cousin dies.
•One evening Smith sneaks into the bathroom where the child is having his bath and drowns the boy.
•Smith then arranges the evidence so that it looks like an accident.
•Jones will inherit a fortune if his 6 year old cousin dies.
•One evening Jones sneaks into the bathroom where the child is having his bath.
•As he enters the bathroom he sees the boy fall over, hit his head on the side of the bath, and slide face-down under the water.
•Jones is delighted; he doesn't rescue the child but stands by the bath, and watches as the child drowns.
According to the doctrine of acts and omissions Smith is morally guiltier than Jones, since he actively killed the child, while Jones just allowed the boy to die. In law Smith is guilty of murder and Jones isn't guilty of anything.
However, most people would regard any distinction between their moral guilt as splitting hairs.
Suppose Jones defends himself by saying:
Would we be impressed?
An objection to this analogy
You might argue that we can't compare the case of a doctor who is trying to do their best for their patient with Smith and Jones who are obvious villains.
Of course you can't. But if you don't find the difference between killing and letting die persuasive in the Smith/Jones case, you shouldn't find it effective in the case of the well-meaning doctor and euthanasia.
The importance of intention
The Smith/Jones case partly depends on us paying no attention to the intentions of Smith and Jones. But in most cases of right and wrong we do think that intention matters, and if we were asked, we would probably say that Smith was a worse person than Jones, because he intended to kill.
Consider this case (and yes, it's a fantasy, doctors don't behave like this):
•Brown is rushed into hospital after
•Smith will inherit a fortune if his 6 year old cousin dies.
•One evening Smith sneaks into the bathroom where the child is having his bath and drowns the boy.
•Smith then arranges the evidence so that it looks like an accident.
•Jones will inherit a fortune if his 6 year old cousin dies.
•One evening Jones sneaks into the bathroom where the child is having his bath.
•As he enters the bathroom he sees the boy fall over, hit his head on the side of the bath, and slide face-down under the water.
•Jones is delighted; he doesn't rescue the child but stands by the bath, and watches as the child drowns.
According to the doctrine of acts and omissions Smith is morally guiltier than Jones, since he actively killed the child, while Jones just allowed the boy to die. In law Smith is guilty of murder and Jones isn't guilty of anything.
However, most people would regard any distinction between their moral guilt as splitting hairs.
Suppose Jones defends himself by saying:
Would we be impressed?
An objection to this analogy
You might argue that we can't compare the case of a doctor who is trying to do their best for their patient with Smith and Jones who are obvious villains.
Of course you can't. But if you don't find the difference between killing and letting die persuasive in the Smith/Jones case, you shouldn't find it effective in the case of the well-meaning doctor and euthanasia.
The importance of intention
The Smith/Jones case partly depends on us paying no attention to the intentions of Smith and Jones. But in most cases of right and wrong we do think that intention matters, and if we were asked, we would probably say that Smith was a worse person than Jones, because he intended to kill.
Consider this case (and yes, it's a fantasy, doctors don't behave like this):
•Brown is rushed into hospital after