Yet another argument against physician assisted suicide

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:

1. death is the cessation of existence

2. after death, existence continues in a spiritual way in all cases without pain

3. after death, existence continues in a spiritual way in some cases with severe pain and in other cases without pain

4. 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.