Euthanasia and the role of the physician

Consider this argument:

1. (Premise) It is not professional for a physician to perform a procedure when there is not sufficient scientific evidence or professional experience about the sequelae of the procedure for the patient.[note 1]
2. (Premise) There is not sufficient scientific evidence or professional experience about the sequelae of euthanasia for the patient.
3. Therefore, it is not professional for a physician to euthanize a patient.

In support of premise (2), note that a crucial thing to have scientific or professional evidence about in the case of a medical procedure is what kinds of things, if any, the patient will be conscious of after the procedure. Now, there is good reason—and perhaps we can consider it "scientific reason"—to think that after the patient is killed, it will no longer be the case that the patient will be conscious of the particular pain, discomfort or indignity that prompted the request for euthanasia. However, there is no scientific evidence or professional experience about whether the patient would or would not have other pains, discomforts or indignities. In fact, there is no scientific evidence or professional experience about whether the patient would or would not have any conscious experiences whatsoever after the procedure.

For an analogy, consider a neurosurgical procedure that could be performed on a suffering patient, which procedure would place the patient in a coma-like state. Suppose further that there was no scientific evidenece or professional experience as to which of the following hypotheses was true:

4. There are no conscious patient experiences following the procedure.
5. The patient is conscious after the procedure, and her conscious states are extremely unpleasant.
6. The patient is conscious after the procedure, and her conscious states are extremely pleasant.
7. The patient is conscious after the procedure, and her conscious states are neither extremely pleasant nor extremely unpleasant.

Surely, the physician who performs the neurosurgical procedure in a responsible way has to have grounds for thinking that (5) isn't the likely outcome for this particular patient. Moreover, for the procedure to be done professionally, those grounds have to be of the sort recognized by the profession—namely, they have to be scientific or based in professional experience.

Observe that the patient's belief as to what the outcome of the procedure would be will not suffice to render a procedure professional. Suppose there is no scientific evidence or medical experience as to whether morphine fights colon cancer. If I request morphine from the physician because I believe, on non-scientific and non-medical grounds, that it fights colon cancer, the physician would not be acting professionally in granting my request. This is true even if my non-scientific and non-medical belief is justified, or even if it is knowledge, say because I know that an angel told me that morphine alleviates colon cancer. It is the physician's professional expectations as to the major sequelae of the procedure that are relevant to whether the physician should perform a procedure or prescribe medication, not the patient's beliefs. Professional medical practice, as it is generally understood in our society, requires both the actual or presumed or proxy informed consent of the patient and the physician's professional judgment.

Could one argue that a physician could kill a patient because she justifiably believes on non-professional grounds that this would be good for the patient? Perhaps the physician justifiably thinks she has an excellent philosophical argument against an after-life or a conclusive theological-cum-empirical argument for the claim that this patient, if killed, would go to heaven. Here, one needs to distinguish three questions:

8. Whether a procedure is or is not professional.
9. Whether a procedure is or is not unprofessional.
10. Whether a procedure is or is not morally permissible.

My argument, I think, does show that killing the patient is not a professional medical procedure. It does not immediately follow from this that it is unprofessional. For instance, reading a fun novel is not (typically) a professional medical procedure, but the physician who reads a fun novel is not behaving unprofessionally (typically). Possibly, however, when we add to (1) that the procedure is "by the physician in her medical role", then we can strengthen the conclusion of (1) to say that the procedure is unprofessional. Nonetheless, there is a further question whether the procedure is morally permissible or not. There might be times when it is morally permissible or even obligatory to violate professional standards (and then perhaps obligatory for any licensing body to take one's license away). Whether euthanasia constitutes such a case is a question I haven't addressed in this post. (Of course, I think euthanasia is always morally wrong, but I think this on grounds other than 1-3: it's wrong because it's an intentional killing of a juridically innocent non-aggressor.)