Article

Culture

Economics

Ethics

Sustainability

3 January 2025

9 min read

Acquisitiveness is the key modern vice

When it comes to consumption, we keep our ethics on a lead.

Joel Pierce

Joel Pierce is the administrator of Christ's College, University of Aberdeen. He has recently published his first book.

a hand hold a black payment card that reads 'buy'.

Kelly Sikkema on Unsplash.

“Sell-out!” When I arrived in Seattle around the turn of the century, I was too tardy and too scrupulously Christian to make much of what was left of the fading grunge scene. Still, I had arrived in time to fumble my way through various university dorm room arguments with more musically astute peers about when this or that band had sold out, when they abandoned the authentic homemade purity of their sound for the greater financial rewards of mainstream pop. These bands still traded on their image as rebels and outsiders, but we all knew it was a pose. Even so, we sympathised. Who wouldn’t be tempted by selling-out if the alternative was poverty and virtuous obscurity?

I have been thinking about those conversations recently, not just because Nirvana T-shirts suddenly seem to be everywhere again, but because the other form of ambient idealism circulating in Seattle at that time, techno-utopianism, seems to have reached the end of its own version of selling out. In my decade in Seattle, I learned to scoff at those who didn’t embrace new technologies, dutifully parroting the slogan, “Information wants to be free!” The hackers of my generation had founded companies which were going to remake the corporate world. Many of my friends from university went to work for them. They were excited about building exciting new tools at lower costs, while doing it all with a social conscience. The bosses of these companies were rock stars in T-shirts and jeans, changing the world.

Two decades later, few of us are happy with the world they’ve built. The professions threatened by their innovations started with music and journalism and have now moved on to just about anything that an AI can imitate. Many of those bosses are still in T-shirts and jeans, still pretending to be outsiders, even as their wealth has piled into unimaginable sums. Their continual need for more has led many of them to decide that a social conscience is too expensive a liability to retain. They prioritise profits and share prices above employee well-being and social cohesion. Some demur from taking stands against authoritarian politicians, pretending that such neutrality is a matter of principle and not economic self-interest. Others openly egg on our broken politics, eager to snatch still more spoils from their demise.

What has gone wrong? As an ethicist, my temptation always is to say that if only these bosses were better advised, reminded of the responsibilities of their power, things could change. What is a skilled ethicist if not someone whose rhetoric and erudition can move the hearts of the mighty?

There is one immovable object that all his ethical demolition work could not shift. His king had palaces to build, heretic German princes to bring to heel, and an ancestral homeland to recapture.

At the advent of European colonialism, there was perhaps no more skilled or erudite moral theologian than Francisco de Vitoria. After taking the premiere professorship at the best university in Spain, what was becoming the richest state in Europe, he pioneered legal and ethical theories which reverberate in international and human rights law today. There were few more incisive critics of the self-deceptive rationalisations of his contemporaries and few better placed to have the ear of one of the most powerful rulers of the age, the king of Spain and Holy Roman Emperor, Charles V.

Today Vitoria is often pointed to as a prophet, someone who drew on his theological expertise and rhetorical acumen to tear apart Spanish justifications for their growing overseas empire. This reputation largely rests on his On the American Indians, a speech he gave in response to the horrific reports of “bloody massacres and of innocent individuals pillaged of their possessions and dominions” which were filtering back to Spain. In it Vitoria does indeed dismantle dozens of quasi-legal entitlements to which the Spanish appealed to justify these actions. By the time he reaches the end of the speech he even seems to be contemplating Spain abandoning the Americas. He says, “The conclusion of this whole dispute appears to be this: that if all these titles were inapplicable…the whole Indian expedition and trade would cease”.

However, when he turns to acknowledging the financial implications of this, he allows that it “would mean a huge loss to the royal exchequer, which would be intolerable.” Here Vitoria concedes that there is one immovable object that all his ethical demolition work could not shift. His king had palaces to build, heretic German princes to bring to heel, and an ancestral homeland to recapture from the French. Money was needed for Charles to play his role as a king among kings, and no ethical quibbles about evil deeds carried out far away could be allowed to impede its flow. After this admission Vitoria sputters to a conclusion with a few unworkable and naive suggestions about how to at least make colonialism marginally less terrible.

If there is a historical parable calculated to drive an ethicist to despair this is it. It shows ethical reflection for what it all too often is, an ineffectual expression of moral anxieties we air and then largely ignore. Our institutions, whether nation-states or companies, make a show of acting ethically, but few of us are fooled. It is a pose. The sorts of ‘ethics’ practised by countries and corporations are strictly those which aren’t a serious threat to the appetites of their leaders for more wealth, power, and security. Like Charles V, they too have peers among whom it is intolerable to contemplate losing status.

These priorities are reflected even among those of us with less stratospheric power or wealth. Many of us worry about the origins of our food, our clothes, and our cheap electronics, having heard stories of labourers spending long hours in fields or cramped sweatshops. We may even buy Fairtrade as a response, but only if the price isn’t too high and if this ‘ethical consumption’ doesn’t mean giving up our middle-class lifestyle.

The ‘ethics’ of our consumption are kept on a convenient lead. They are allowed to nibble around the edges of our consciences, but never to tear into the heart of the way we inhabit the world.

In his work, Whose Justice? Which Rationality?, Alasdair MacIntyre argues that the sorts of goods we pursue can be lumped into two broad categories, goods of effectiveness and goods of excellence. The former are the things like wealth, power, and fame, which can be conferred and even sometimes transferred and which bear little relation to the characters of the people involved. The latter are the sorts of skills and performances, the virtues and virtuosities, which people attain through long and disciplined development.

For MacIntyre, both kinds of goods are necessary, but it matters a great deal which one gets priority. In a society which prioritises goods of effectiveness – such as Vitoria’s, but also, for MacIntyre, most modern societies as well –procedural justice reigns supreme. As long as we didn’t break any rules in getting our money and status or, for that matter, our exciting new clothes or smart speakers, we are in the clear. The problem, as Vitoria’s case demonstrates, is that in such societies even this minimal kind of justice cannot be allowed to block the flow of wealth. So procedural justice winds up being a tamed tiger in the service of the powerful. It is let out of its cage only when convenient – typically to demonise the failings of others. This is not just true of billionaires and politicians. Those of us who are western, middle-class consumers play this game too. The ‘ethics’ of our consumption are kept on a convenient lead. They are allowed to nibble around the edges of our consciences, but never to tear into the heart of the way we inhabit the world.

What would it mean to prioritise goods of excellence? This is one of those questions MacIntyre poses, but does not answer, because he is convinced that in each society it would look different. Each community would need to begin by wrestling with what kinds of people they should be, what excellences they can and should pursue within their communities, and what virtues should be emphasised. Only then should they move on to think about what sorts of wealth or power are necessary to achieve these. Still, it can be frustrating that MacIntyre does not lay out his preferred programme. He offers no ready-made blueprint for a just society.

Of course, neither did Jesus when he counseled his disciples to seek first the kingdom of God, telling them that if they did so the necessities of life, food, drink, and clothes, would be provided. What Jesus meant by the kingdom of God is elusive, now and not yet, hidden and revealed in parable and aphorism. What it was not, however, is clear. It was not a kingdom founded on acquiring earthly power and wealth. In fact, much of the teaching of the gospels can be boiled down to Jesus’ warning about the dangers of prioritising the goods of effectiveness (“Where your treasure is there your heart will be also”, “One thing you lack. Go sell everything you have and give to the poor”, “The rulers of the Gentiles lord it over them. Not so with you”, “Man does not live on bread alone”, “What does it profit a man to gain the whole world and lose his soul?”) and urging his disciples to embrace the goods of excellence that constitute the kingdom of God.

Understood this way, the reason it is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom is that the hunger for riches, wealth, and fame pulls those enamoured with goods of effectiveness away from true fulfillment. There are always more houses to own, new neighbours to impress, and new areas to conquer. Acquisitiveness, MacIntyre reminds his readers, is the characteristic vice of modernity. That many of us, from billionaires down to underpaid academics, habitually think that what is missing from our life is a little more money or fame, is evidence that he’s right.

For Jesus, virtuous obscurity and poverty were preferable to fame. We remember this at every nativity play when we acknowledge that the best God could manage for witnesses to the divine arrival was a hard scrabble group of animal herders and a few foreign astrologers. It is not that Jesus refused to use his abilities or hid away from public notice. However, the public he chose to act among was nestled in a corner of a corner of the empire, far from the rewards offered by the cultured salons of Roman power and privilege. In two of the gospels, Jesus is tempted to sell out. He is offered unimaginable fame and power at the outset of his ministry. He forcefully rejects it. For Jesus, an itinerant life spent ministering to fishermen and farmers was enough.

What would it look like for us to embrace Jesus’s priorities? A place to start would be actually listening to Jesus about practices such as fasting, praying, and the almsgiving. Each of these is an act of resistance against the continual appetite for more and a testimony to an economy of grace that exists beyond all human economies. We also could try preaching in a way that takes seriously the admonitions of Jesus. I have heard numerous sermons about the rich young ruler which include an extended caveat on how maybe it was important for him to sell his possessions, but that doesn’t mean we have to. Maybe not, but shouldn’t those of us who call ourselves Christians, at least be open to God having that radical a call on our life? If our ethics and our faith are not allowed to ask these questions of us, if we have sold out in such a way that the real possibility of them radically disrupting our lives is intolerable to our imagination, what good are they?

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Article

Assisted dying

Care

Culture

Death & life

13 November 2024

8 min read

The deceptive appeal of assisted dying changes medical practice

In Canada the moral ethos of medicine has shifted dramatically.

Ewan Goligher

Ewan is a physician practising in Toronto, Canada.

a doctor consults a tablet against the backdrop of a Canadian flag.

Once again, the UK parliament is set to debate the question of legalizing euthanasia (a traditional term for physician-assisted death). Political conditions appear to be conducive to the legalization of this technological approach to managing death. The case for assisted death appears deceptively simple—it’s about compassion, respect, empowerment, freedom from suffering. Who can oppose such positive goals? Yet, writing from Canada, I can only warn of the ways in which the embrace of physician-assisted death will fundamentally change the practice of medicine. Reflecting on the last 10 years of our experience, two themes stick out to me—pressure, and self-deception.

I still remember quite distinctly the day that it dawned on me that the moral ethos of medicine in Canada was shifting dramatically. Traditionally, respect for the sacredness of the patient’s life and a corresponding absolute prohibition on deliberately causing the death of a patient were widely seen as essential hallmarks of a virtuous physician. Suddenly, in a 180 degree ethical turn, a willingness to intentionally cause the death of a patient was now seen as the hallmark of patient-centered doctor. A willingness to cause the patient’s death was a sign of compassion and even purported self-sacrifice in that one would put the patient’s desires and values ahead of their own. Those of us who continued to insist on the wrongness of deliberately causing death would now be seen as moral outliers, barriers to the well-being and dignity of our patients. We were tolerated to some extent, and mainly out of a sense of collegiality. But we were also a source of slight embarrassment. Nobody really wanted to debate the question with us; the question was settled without debate.

Yet there was no denying the way that pressure was brought to bear, in ways subtle and overt, to participate in the new assisted death regime. We humans are unavoidably moral creatures, and when we come to believe that something is good, we see ourselves and others as having an obligation to support it. We have a hard time accepting those who refuse to join us. Such was the case with assisted death. With the loudest and most strident voices in the Canadian medical profession embracing assisted death as a high and unquestioned moral good, refusal to participate in assisted death could not be fully tolerated.

We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

Regulators in Ontario and Nova Scotia (two Canadian provinces) stipulated that physicians who were unwilling to perform the death procedure must make an effective referral to a willing “provider”. Although the Supreme Court decision made it clear in their decision to strike down the criminal prohibition against physician-assisted death that no particular physician was under any obligation to provide the procedure, the regulators chose to enforce participation by way of this effective referral requirement. After all, this was the only way to normalize this new practice. Doctors don't ordinarily refuse to refer their patients for medically necessary procedures; if assisted death was understood to be a medically necessary good, then an unwillingness to make such referral could not be tolerated.

And this form of pressure brings us to the pattern of deception. First, it is deceptive to suggest that an effective referral to a willing provider confers no moral culpability on the referring physician for the death of the patient. Those of us who objected to referring the patient were told that like Pilate, we could wash our hands of the patient’s death by passing them along to someone else who had the courage to do the deed. Yet the same regulators clearly prohibited referral for female genital mutilation. They therefore seemed to understand the moral responsibility attached to an effective referral. Such glaring inconsistencies about the moral significance of a referral suggests that when they claimed that a referral avoided culpability for death by euthanasia, they were deceiving themselves and us.

The very need for a referral system signifies another self-deception. Doctors normally make referrals only when an assessment or procedure lies outside their technical expertise. In the case of assisted death, every physician has the requisite technical expertise to cause death. There is nothing at all complicated or difficult or specialized about assessing euthanasia eligibility criteria or the sequential administration of toxic doses of midazolam, propofol, rocuronium, and lidocaine. The fact that the vast majority of physicians are unwilling to perform this procedure entails that moral objection to participation in assisted death remains widespread in the medical profession. The referral mechanism is for physicians who are “uncomfortable” in performing the procedure; they can send the patient to someone else more comfortable. But to be comfortable in this case is to be “morally comfortable”, not “technically comfortable”. We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

There is also self-deception with respect to the cause of death. In Canada, when a patient dies by doctor-assisted death, the person completing the death certificate is required to record the cause of death as the reason that the patient requested euthanasia, not the act of euthanasia per se. This must lead to all sorts of moments of absurdity for physicians completing death certificates—do patients really die from advanced osteoarthritis? (one of the many reasons patients have sought and obtained euthanasia). I suspect that this practice is intended to shield those who perform euthanasia from any long-term legal liability should the law be reversed. But if medicine, medical progress, and medical safety are predicated on an honest acknowledgment about causes of death, then this form of self-deception should not be countenanced. We need to be honest with ourselves about why our patients die.

There has also been self-deception about whether physician-assisted death is a form of suicide. Some proponents of assisted death contend that assisted death is not an act of deliberate self-killing, but rather merely a choice over the manner and timing of one's death. It's not clear why one would try to distort language this way and deny that “physician-assisted suicide” is suicide, except perhaps to assuage conscience and minimize stigma. Perhaps we all know that suicide is never really a form of self-respect. To sustain our moral and social affirmation of physician-assisted death, we have to deny what this practice actually represents.

There has been self-deception about the possibility of putting limits around the practice of assisted death. Early on, advocates insisted that euthanasia would be available only to those for whom death was reasonably foreseeable (to use the Canadian legal parlance). But once death comes to be viewed as a therapeutic option, the therapeutic possibilities become nearly limitless. Death was soon viewed as a therapy for severe disability or for health-related consequences of poverty and loneliness (though often poverty and loneliness are the consequence of the health issues). Soon we were talking about death as a therapy for mental illness. If beauty is in the eye of the beholder, then so is grievous and irremediable suffering. Death inevitably becomes therapeutic option for any form of suffering. Efforts to limit the practice to certain populations (e.g. those with disabilities) are inevitably seen as paternalistic and discriminatory.

There has been self-deception about the reasons justifying legalization of assisted death. Before legalization, advocates decry the uncontrolled physical suffering associated with the dying process and claim that prohibiting assisted death dehumanizes patients and leaves them in agony. Once legalized, it rapidly becomes clear that this therapy is not for physical suffering but rather for existential suffering: the loss of autonomy, the sense of being a burden, the despair of seeing any point in going on with life. The desire for death reflects a crisis of meaning. We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

We have also deceived ourselves by claiming to know whether some patients are better off dead, when in fact we have no idea what it's like to be dead. The utilitarian calculus underpinning the logic of assisted death relies on the presumption that we know what it is like before we die in comparison to what it is like after we die. In general, the unstated assumption is that there is nothing after death. This is perhaps why the practice is generally promoted by atheists and opposed by theists. But in my experience, it is very rare for people to address this question explicitly. They prefer to let the question of existence beyond death lie dormant, untouched. To think that physicians qua physicians have any expertise on or authority on the question of what it’s like to be dead, or that such medicine can at all comport with a scientific evidence-based approach to medical decision-making, is a profound self-deception.

Finally, we deceive ourselves when we pretend that ending people’s lives at their voluntary request is all about respecting personal autonomy. People seek death when they can see no other way forward with life—they are subject to the constraints of their circumstances, finances, support networks, and even internal spiritual resources. We are not nearly so autonomous as we wish to think. And in the end, the patient does not choose whether to die; the doctor chooses whether the patient should die. The patient requests, the doctor decides. Recent new stories have made clear the challenges for practitioners of euthanasia to pick and choose who should die among their patients. In Canada, you can have death, but only if your doctor agrees that your life is not worth living. However much these doctors might purport to act from compassion, one cannot help see a connection to Nazi physicians labelling the unwanted as “Lebensunwortes leben”—life unworthy of life. In adopting assisted death, we cannot avoid dehumanizing ourselves. Death with dignity is a deception.

These many acts of self-deception in relation to physician-assisted death should not surprise us, for the practice is intrinsically self-deceptive. It claims to be motivated by the value of the patient; it claims to promote the dignity of the patient; it claims to respect the autonomy of the patient. In fact, it directly contravenes all three of those goods.

It degrades the value of the patient by accepting that it doesn't matter whether or not the patient exists.

It denies the dignity of the patient by treating the patient as a mere means to an end—the sufferer is ended in order to end the suffering.

It destroys the autonomy of the patient because it takes away autonomy. The patient might autonomously express a desire for death, but the act of rendering someone dead does not enhance their autonomy; it obliterates it.

Yet the need for self-deception represents the fatal weakness of this practice. In time, truth will win over falsehood, light over darkness, wisdom over folly. So let us ever cling to the truth, and faithfully continue to speak the truth in love to the dying and the living. Truth overcomes pressure. The truth will set us free.