Years ago, I read a clever argument against physician assisted suicide that held that medical procedures need informed consent, and informed consent requires that one be given relevant scientific data on what will happen to one after a procedure. But there is no scientific data on what happens to one after death, so informed consent of the type involved in medical procedures is impossible.
I am not entirely convinced by this argument, but I think it does point to a reason why helping to kill a patient is not an appropriate medical procedure. An appropriate medical procedure is one aiming at producing a medical outcome by scientifically-supported means. In the case of physician assisted suicide, the outcome is presumably something like respite from suffering. Now, we do not have scientific data on whether death causes respite from suffering. Seriously held and defended non-scientific theories about what happens after death include:
death is the cessation of existence
after death, existence continues in a spiritual way in all cases without pain
after death, existence continues in a spiritual way in some cases with severe pain and in other cases without pain
after death, existence continues in another body, human or animal.
The sought-after outcome, namely respite from severe pain, is guaranteed in cases (a), (b) and (d). However, first, evidence for preferring these three hypotheses to hypothesis (b) is not scientific but philosophical or theological in nature, and hence should not be relied on by the medical professional as a medical professional in predicting the outcome of the procedure. Second, even on hypotheses (b) and (d), the sought-after outcome is produced by a metaphysical process that goes beyond the natural processes that are the medical professional’s tools of the trade. On those hypotheses, the medical professional’s means for assuring improvement of the patient’s subjective condition relies on, say, a God or some nonphysical reincarnational process.
One might object that the physician does not need to judge between after-life hypotheses like (a)–(d), but can delegate that judgment to the patient. But a medical professional cannot so punt to the patient. If I go to my doctor asking for a prescription of some specific medication, saying that I believe it will help me with some condition, he can only permissibly fulfill my request if he himself has medical evidence that the medication will have the requisite effect. If I say that an angel told me that ivermectin will help me with Covid, the doctor should ignore that. The patient rightly has an input into what outcome is worth seeking (e.g., is relief from pain worth it if it comes at the expense of mental fog) and how to balance risks and benefits, but the doctor cannot perform a medical procedure based on the patient’s evaluation of the medical evidence, except perhaps in the special case where the patient has relevant medical or scientific qualifications.
Or imagine that a patient has a curable fracture. The patient requests physician assisted suicide because the patient has a belief that after death they will be transported to a different planet, immediately given a new, completely fixed body, and will lead a life there that is slightly happier than their life on earth. A readily curable condition like that does not call for physician assisted suicide on anyone’s view. But if there is no absolute moral objection to killing as such and if the physician is to punt to the patient on spiritual questions, why not? On the patient’s views, after all, death will yield an instant cure to the fracture, while standard medical means will take weeks.
Furthermore, the medical professional should not fulfill requests for medical procedures which achieve their ends by non-medical means. If I go to a surgeon asking that my kidney be removed because Apollo told me that if I burn one of my kidneys on his altar my cancer will be cured, the surgeon must refuse. First, as noted in the previous paragraph, the surgeon cannot punt to the patient the question of whether the method will achieve the stated medical goal. Second, as also noted, even if the surgeon shares the patient’s judgment (the surgeon thinks Apollo appeared to her as well), the surgeon is lacking scientific evidence here. Third, and this is what I want to focus on here, while the outcome (no cancer) is medical, the means (sacrificing a kidney) are not medical.
Only in the case of hypothesis (a) can one say that the respite from severe pain is being produced by physical means. But the judgment that hypothesis (a) is true would be highly controversial (a majority of people in the US seem to reject the hypothesis), and as noted is not scientific.
Admittedly, in cases (b)–(d), the medical method as such does likely produce a respite from the particular pain in question. But that a respite from a particular pain is produced is insufficient to make a medical procedure appropriate: one needs information that some other pain won’t show up instead.
Note that this is not an argument against euthanasia in general (which I am also opposed to on other grounds), but specifically an argument against medical professionals aiding killing.
17 comments:
I notice that I already gave basically the same argument here: https://alexanderpruss.blogspot.com/2010/07/euthanasia-and-role-of-physician.html
Sorry, Alex, but this is a weak argument for several reasons.
Firstly, a doctor can give you a medicine to cure a certain illness it to respite from a particular pain, but he can't inform you about other illnesses or pain you may develop later on. His duty is to cure whatever you have at that moment if he can do so.
Secondly, in the case of a terminal patient, the doctor knows that the patient is going to die soon, and that the patient will be in condition a,b, c or d, no matter what the doctor does. The choice is between suffering plus a, b, c or d and a,b, c or d without extra suffering. Now the only relevant difference is the suffering, on which the doctor is scientifically informed.
Walter:
I think the case of medicine giving respite from a particular pain requires that there be good scientific reason to hold that the medicine does not have a side-effect which is another pain, or some other relevant harm.
Your argument in the terminal case sounds plausible at first sight. But let's set up an analogy. Alice is in location X, where there is a chemical in the air that causes her severe pain. In a week, she will be automatically teleported to location Y by aliens. You can teleport her to Y today. Should you? Well, you need good reason to think that Y does not have conditions worse than the ones found in location X. For if you transport her to Y, and it does have conditions worse than the ones found in location X, you've made her next seven days more miserable than they would have been. The fact that she will anyway be in location Y in a week seems irrelevant--if that location is more painful, you shouldn't send her there early!
Here's another argument against my argument. It is generally agreed that it is permissible for a physician to give painkillers that happen to hasten an imminent death when the intention is to relieve pain rather than hasten death. But doesn't this require the physician to know medically that this won't result in greater post-death pain?
That's a pretty compelling riposte. But not, I think, conclusive. In the case where the physician helps to kill the patient in order to relieve the patient's pain, the patient's _death itself_ is the means to pain relief. But this means is one that the physician does not have a medical understanding of. Death is a transition from State A to State B, and while we have a good medical understanding of State A, we have little medical understanding of State B--we don't even know medically if the patient continues to exist in State B or not.
A related point is that the majority opinion in our society is that human death is a "metaphysical" (in the popular sense of the word) transition rather than a biological or physical process. The physician who agrees with this should not use death as a means, since by their judgment it falls outside the physician's competence. It's a bit more complicated what we should say in the case of the physician who disagrees with this judgment and thinks death is just a biological process. We perhaps should divide up the case into one where the patient also thinks death is just a biological process and one where the patient thinks it is a "metaphysical" transition. But in any case, we can probably say that policy-wise it is reasonable to restrict physicians to means that are properly medical _in the view of the majority_, absent good scientific argument against the view of the majority.
Alex
I was not talking about side-effects. It's simply a fact that a doctor cannot give you all the information needed for an informed consent. He can only say that the treatment will probably do away with this particular pain and which side-effects might occur, and that is all that is needed for an informed consent. There is no difference between the assisted suidice case. The doctor gives you the information he has, which is that the procecure will remove your current particular suffering and will kill you.
The rest is up to the patient.
As for Alice, if teleporting her to Y is the only way to get rid of her pain, it is certainly permissible for you to teleport her, with her consent. It's a choice between a real chance of stopping the pain and no chance at all.
As to your seond point, what the physician does is purely medical. He relieves the pain and suffering in the only way that is medically possible, with the patient's fully informed consent.
That's all that's needed.
And I have personally witnessed giving painkillers that happen to hasten an imminent death when the intention is to relieve pain rather than hasten death, AKA as sedation both with my mother and my father-in-law. And it was a horrible experience for the whole family. We literally watched my mother suffocate and my father-in-law drown in his lung-fluids.
And when we asked the doctor whether the patients experienced anything, all they could say was, "We don't think so, but we do not know".
Walter:
Regarding teleporting, we do not approve drugs without controlled studies. Part of the point of the study is to get evidence about how likely the drugs are to produce effects that are worse than what they eliminate. I don't think we would approve a teleportation drug if we didn't have any scientific evidence about where the teleportation goes to.
Alex
When you are in a house that's going to collapse, you want to get out, even though there is a chance you'll end up in a worse position.
If the teleportation is the only way to stop the pain, it is permissible.
Approving drugs is a completely different matter.
That's fair about the collapsing house, but it's different when it's something being done, especially in a routine policy-governed way rather than in a one-off emergency, by a medical professional qua medical professional. You need scientific evidence then.
Alex
It's always an emergency, that's the point.
I thought of this argument, although it's probably been used before in some way.
1. Euthanasia is the sacrificing of a person for a non-personal, non-transcendent good.
2. Every person has a higher amount of value than any non-personal, non-transcendent good.
3. Therefore, euthanasia is always the sacrificing of a thing with a higher value for a thing with a lower value. (1,2)
4. It is always wrong to sacrifice a thing with a higher value for a thing with a lower value.
5. Therefore, euthanasia is always wrong. (3,4)
Heavenly Philosophy
What are transcendent vs non-transcendent goods? Freedom from constant suffering is a non-transcendent good on your view?
I'm not sure I agree with either 1 or 2 depending on these definitions.
Counter argument:
1) If some fates are worse than death, then it would be better to die than suffer those fates. (True by definition)
2) Some fates are worse than death. (We can come up with endless examples)
3) Therefore it would be better to die than suffer some fates. (Modus ponens)
Alex
Why do you oppose euthanasia? I'm highly confident death with dignity is the right way to go, so I'm curious.
Here's an argument from hypocrisy:
1) We should do unto others as we'd have them do unto us.
2) We would have others apply death with dignity to us in circumstances where our fates are truly unfortunate.
3) Therefore we should apply death with dignity to others when their fates are truly unfortunate.
Ben:
I oppose it due to the straightforward argument that it's wrong to kill innocent people, as well as Socrates' argument that our life is a station appointed to us by God [gods, in Socrates' formulation] which we have no right to abandon.
Ben:
By transcendent I mean something like freedom or justice.
Your counterargument commits the same fallacy as some forms of the ontological argument: assuming existence is a property. The ontological argument says that because an omniscient, omnipotent, omnibenevolent being that exists is more perfect than an omniscient, omnipotent, omnibenevolent being that does not exist, and God is defined as having all perfections, God must exist. The problem is that a being that does not exist cannot be better or worse than a being that does exist because that being does not exist. You're not comparing it to anything. The same problem is happening here: you can't compare an existing being to a being in non-existence because you're not really comparing it to anything.
Richard Swinburne explains it here.
Another thing that is noted in Pruss's One Body book (p.432n26) is that Kant says that suicide because of pain is internally self-contradictory. Pain is a mechanism for survival. In cases of this type of suicide, one perverts the mechanism of survival to its contrary purpose: death.
I do not know how a survivalist, like Pruss, would respond to the argument, however.
As for your other argument, you are assuming that one would actually choose death in those circumstances. I would also say that one should not do onto others as one would do onto oneself when one is in an irrational state. Since severe pain puts one in an irrational state, these types of analyses can be invalidated. One would rather speak of what one would want done to oneself in that situation when one is rational, not when you are actually in that situation. Since opponents of euthanasia would choose against euthanasia for their future, ill selves, it means that no opponent of euthanasia would accept the modified version of (2).
Heavenly Philosophy
Given your comment on existence not being a predicate, I don't know which premise I should reject.
1) If some fates are worse than death, then it would be better to die than suffer those fates. (True by definition)
2) Some fates are worse than death. (We can come up with endless examples)
3) Therefore it would be better to die than suffer some fates. (Modus ponens)
Premise 1 is trivial: A fate worse than death is a fate worse than death.
Premise 2 is obviously true. If I had to be burned at the stake for 100 years straight or die and go into an eternal existential blank, the latter would be better for me.
"Kant says that suicide because of pain is internally self-contradictory. Pain is a mechanism for survival. In cases of this type of suicide, one perverts the mechanism of survival to its contrary purpose: death."
This is false on two levels. On the first level, humans have the intention to avoid pain more than they have the intention to avoid death. So it's not internally inconsistent. On the second level, you may say it's irrational to die to avoid pain because death is worse than pain. But again that's clearly false.
As far as not doing unto others while in an irrational state—it would be irrational to prefer a fate worse than death to death. (So denying premise 2 is irrational.)
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