Interview
America
Culture
Politics
S&U interviews
15 min read

America's mood check: Matt McDonald interview

Dilemma, apathy, and what we get wrong about politics and religion.

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

The White House illuminated against the night sky.
The White House, Washington DC.
Tabrez Syed on Unsplash.

Continuing our series trying to take the mood of the USA, and in particular the role of religion in its public life, Graham Tomlin recently spoke to Matt McDonald, based in Washington DC who is Managing Editor of the US edition of The Spectator. 

Graham: Thank you for giving us your time. You are someone who comes from Britain, lives in the US, is conversant with American politics and straddles these two worlds. You can help us understand and interpret what's going on in America, both for those who are listening from the UK context but also in America as well. So, how do you describe the political mood in the USA at the moment? You've got the elections on the horizon. It looks like Trump vs Biden all over again. What is the mood that you pick up right now? 

Matt: In some respects, you could say it's fraught, if you compare it to previous election cycles. It's strange the extent to which both sets of primaries were a foregone conclusion. The big question was whether or not Joe Biden would run again, given his advanced years and questions about senility.  

But then on the Republican side, Trump cleared the field by getting into the race so early. Now there's speculation as to why he did that. Obviously being President comes with certain legal protections, which can be useful for someone who's facing, I think, 91 potential criminal charges, but also I think there's a sense that Trump wanted to be back in the White House because I don't think he takes defeat very well. In fact, he has yet to accept defeat in the previous election and so wants to use the platform of a presidential campaign as a means of trying to address the rest of the country and maintain his hold on the American right,  

We've just come through this period where you had a fairly lacklustre attempt to challenge Joe Biden. None of those candidates really got much traction. He won in New Hampshire, which was the first Democratic race.  

And then on the Republican side, we had this strange sort of like ‘Ghost Ship’ primary, where there were various other candidates in the race, presenting alternatives and competing ideas to Trump, and arguments about the fact that he probably can't win in swing states because he can't build a broad enough coalition. Ultimately, if you've got the presidency, the House and the Senate, you're much more able to act and shape the country to your policies, yet there was scepticism about whether or not he could do that. I think those concerns remain, but ultimately, he cleaned up in every primary. The only thing that would keep Trump off the ballot on November 5th is an unforeseen health issue or one of these criminal trials actually preventing him from doing so. At the moment, on the current timeline, it's a case of delay, delay, delay. His lawyers have been doing a fairly good job filing various different appeals, which means that he may face only one of these four trials before the Election Day or before the convention in July, which is when he would be officially named nominee. 

Do you think Trump is going to win? 

The polls are very favourable towards him now. I try not to make predictions, but I think the main thing which is going to shift as you get closer to Election Day is that people will ask themselves, “Do I want to repeat the Trump presidency?” And I think I think a number of Americans will decide they don't want to. I don't think Biden does a particularly good job at articulating the good things that he's done - and they do exist - but ultimately his messaging is most effectively done effectively by his surrogates – the younger faces who are better at television than Biden is. And Biden, historically, over his long career, has been gaffe-prone, and can sometimes botch his communication. That's obviously even more the case now that he's, you know, the wrong side of 80. 

And if Trump does get in, do you think the Presidency this time would be different from last time? 

Yes it will. When Trump got in last time, his transition team was overseen by much more mainstream Republicans than would be the case this time around. A number of the first-generation Trump appointees probably would have been appointed by any incoming Republican President. The fear among a lot of people is that that's not what's going to happen this time. So what we're probably going to end up with is more yes-men, more loyalists. It sounds stupid to say, but you'll you end up with a more in-tune and marching-in-step idea of enforcing the MAGA agenda. But then again, the MAGA agenda fundamentally is just going to be defined by what Trump feels that day. 

So what strikes you as different between American and British political culture?  

If we are doing a comparison between the two elections this year, I think that the British election is a foregone conclusion in a different way. Everyone knows what's going to happen. It's just a case of when it happens. Whereas at least for this American one, I think it's still very much the case that it could go either way. The fact that America also elects judges is an interesting thing. British politics seem generally quite parochial in comparison to America. 

I guess the UK doesn't play quite the same sort of global role as the US does, and maybe that matters? In the past, America has always felt like a kind of global policeman intervening in conflicts around the world where the UK has a diminished status. 

Yes, I think I think that's true. Yet I don't think that's something American voters think about. Since the Iraq invasion, in fact through its history, there have been periods since the country's founding, where it has leant in a more isolationist direction. We’re in one of those waves currently when it comes to swing voters and average Americans, where Democratic voters in cities and moderate Republican voters in cities and suburbs, would be more aware of the global dimension, whereas in rural America, they ask ‘why would we spend my money on that? Why would we send my son there to die?’ 

When you think of angry nations, America and Britain are on the podium - both of us are. 

One of the differences we sometimes perceive in the UK is that the political discourse in the US seems that much more polarised, that much more angry, that much more distinct between progressives and conservatives. Is that true, and if so, why is it more polarised in the US than it seems to be here? 

I think British people are way more angry! I think since the populist wave of 2016, Britain is at a point where its sliding towards a major transformative political shift in a way that hasn't happened since the 2010 election. And I think that some of that is still motivated by anger.  

Whereas, in America, let's say you're Republican. How you think towards Democrats and your attitude towards President Biden or Nancy Pelosi or Kamala Harris or like whoever is your hate figure of the day is different from people you see and interact with.  

Every Republican knows a Democrat, and every Democrat knows a Republican and I think that that generally speaking, Americans tend to be pretty good and civil with getting along with other people. There is the stereotypical argument over the Thanksgiving dinner about the political issue of the day. But then, there is this zooming out and many people have this wider question about how the country's going. Republicans will think - gas is $5 a gallon, inflation is rising and so on. Things seem so much worse than they were under Trump. And many of those factors will be related to immigration and the economy. So, they will blame Biden. I think with economics it’s slightly more complicated as to who you blame for the existing economic situation. It's usually more the previous president than the current one just by the virtue of way economic cycles work.  

When you think of angry nations, America and Britain are on the podium - both of us are. 

Are there particular mistakes you think British people make in reading American political culture? Maybe that's one of them to kind of assume that we're different. We're more different than we are? 

Yes, I think both countries are more similar than either will let on or admit. I'm thinking obviously just about my youngish British friends, who assume that every single US election or vote has to be about guns and abortion. Now they're only half right in that I think abortion is going to be a big factor in this election, particularly given President Trump's recent statement. He basically said he wants abortion to be decided by the states, which is a more moderate position than many activist Republicans would like to see him articulate. The gun issue is a regularly occurring national tragedy, which ultimately, not much legislation never gets passed on it.  

And with abortion, I remember seeing various people I know in England thinking that Roe v. Wade falling meant that all abortion had become outlawed, or illegal in America, which was not the case. It’s just that the court ruling, that federally allowed it was gotten rid of, whereas in Britain, obviously abortion has been legal since 1967 because of David Steele’s Act of Parliament, which is usually the way that laws are decided as they're passed by elected representatives.  

Yes, we don't have that federal - state polarity in quite the same as in the US. 

Matt: Also – in the UK, I guess the High Court has been mentioned in conversation just once in the last 10 years with the Gina Miller Brexit thing? Whereas in the US the Supreme Court is one of three branches of government. 

The Trump events that I've been to have quite a megachurch vibe about some of them. 

Biden on the campaign trail.

Joe Biden holds a phone as two supporters crowd in for a selfie

I want to ask you about the place of religion in American life and politics, because it seems that religion, and Christian faith in particular, plays quite a role in in American politics in a way that it doesn't in the UK. American Presidents almost have to say that they are Christian in some way whereas in UK politics, faith is something kept in the background. How would you describe the role that religion plays in American politics and public life? 

I think it's interesting. I was trying to think about a UK election in the last 50 years, where religion was a deciding factor and couldn't really come up with one. Obviously, there are parts of Britain where religion matters massively, such as Northern Ireland and Scotland more than in England.  

In American politics, it's also interesting because you do have to seem loosely religious, but it's more giving the impression of seeming traditionally moral. Now obviously there are exceptions to this. And that of the political leaders of America in the last 50 years, I think Joe Biden technically is probably one of the most churchgoing. He's there every Saturday or Sunday, whether he's in Delaware or DC or elsewhere. But it doesn't actually count for that much. He's popular among Irish Americans. But Biden's issue with American Catholics is his support for abortion. Not that all religion and all Catholicism could be distilled just down to abortion. But there are a number of American Catholics who think that that is the number one issue. And because he changed his view on the Hyde Amendment, which is whether federal money can be go towards that – it basically made a number of Catholics feel like that he's betrayed that part of his faith, and so while he personally may be Christian and Catholic and churchgoing, he doesn't get political capital for that.  

Donald Trump's most famous incident at a church involved him going outside one. They sent in the National Guard, cleared out the protesters outside the White House in the immediate aftermath of the George Floyd protests. Trump walks to St. John's Church and holds up the Bible. He didn't even go inside. I think Trump thinks of himself as a Presbyterian, but then he's on the golf course on the weekends. He's at Mar-a-Lago, DJ-ing weddings on his iPad. And there is that huge crossover trend, between Evangelical churches and MAGA and the Trump movement. The Trump events that I've been to have quite a megachurch vibe about some of them. I think there’s a fair bit of crossover there in terms of the people who attend both of those things. If you're an evangelical right-wing Christian, you want a Conservative majority on the Supreme Court. He picked three conservative justices. And so they focus more on political actions rather than alleged personal indiscretions.  

Does that account for the evangelical support for Trump? There seems to be a sort of Faustian bargain here, that because he adopts conservative policies, which many evangelicals in the USA want to see happen in public life, they overlook his indiscretions, his affairs and his personal morality, which is probably not anywhere near  what evangelicals would expect, and treat him like a kind of king Cyrus in the Old Testament, a king who's not an Israelite, but who does the will of God. Is that how you read it? 

He once compared himself to David, didn't he? Or he was compared to David as a flawed king, but nonetheless like a vessel for God's for God's message.  

I think Donald Trump's a bit of a Rorschach test. If you like him, you see what you like in him and then and then are blind to the bad parts. And I think evangelicals see a strong leader, which they like. They see he's undeniably charismatic and a good speaker. He speaks well to large rooms of people, which they like, so the aesthetics are there and helpful for him. And then you can ignore the fact that he’s said to have had three or more affairs, etc.  

You're often successful in politics when you portray your opponent as extremist and you as the defender of normalcy. And that's basically how I think swing states are decided. 

One of the other factors that always strikes us from the UK, looking at American Civil religion is the very kind of close relationship between religion and the flag, the nation. So where does that come from, that kind of very, very strong connection between religion and the and the nation? 

I was speaking to one of my colleagues about this, who is much more churchgoing than I am. I asked what do you think the biggest misconceptions are? And she said the separation of church and state often is brought up as if the purpose of that was to stop religion and the church from influencing government, whereas actually the founding fathers put that into the Constitution because they were way more concerned about government influence in the church. 

I think because America is a founded country, it's a country that split off and said we're going to do things differently. These are the ideals upon which our country exist. So, the flag and the US flag has always been a fairly central part of that. It is a default introductory part of the American way. 

Britain is a country that seems to have always existed. And therefore, we don't have the same kind of loyalty to the Union Jack unless you are a loyalist in in Glasgow or Northern Ireland. In Britain, you value it only if you think that that part of you is under threat. In America that's just the default setting. 

Trump does well when he's able to point at the left, at the Democrats and say they are victimising you because of who you are. So like Hillary Clinton referring to his supporters as a ‘basket of deplorables’ - he runs on that. Trump can basically present that and say if you're a Christian and you like America, then the Democrats are coming after you. You're often successful in politics when you portray your opponent as extremist and you as the defender of normalcy. And that's basically how I think swing states are decided. So, Trump will point to whether the FBI has been tracking and targeting Christian national groups, Catholics, things like that. On LGBT stuff, Trump is a bit more of a New Yorker than I think most Republicans are, however where you've got an Episcopalian church, for example, which is wielding a stars and stripes alongside a pride flag – Trump will point to that and using that as a wedge issue, and ask: is this the America you want to live in?

Trump speaks at the Pray Stand Vote summit in 2023.

Donld Trump speaks against a US flag backdrop while the audience hold up phones.

So many Christians that I know of in the US tell me that they're caught between the two sides when they come to an election like this. They feel uncomfortable voting for Biden because some of his policies don't seem to be aligning with the kind of values that they have. Yet at the same time, they feel repelled by Trump, his character, and his fitness to hold the office of President. They're really wondering what to do. Do you see a lot of people in that category? And if so, do you have any advice for them as to what they, what they should do when you're caught between that dilemma? 

Yeah, I think that there's way more apathy now than at any point in any previous presidential election since I've lived here, I think that most people aren't happy with that. The vast majority of America is in that situation. They aren’t particularly happy with either candidate. I can see a depressing turn out. Both Democrats and Republicans, Trump and Biden, are trying to make this election seem existential, but ultimately, I mean, this probably isn't going to be the end of America either way.  

And it's comforting in a way that our political systems and structures can survive these the tests and the waves that come at them, whether it's Brexit, or the polarisation of the culture wars or whatever it might be. 

I guess for those people who can’t decide, I'd recommend prayer could be helpful? 

 Exactly. That's good advice.  

One of the questions I often get in the in the UK is, of all the number of people that who live in the USA, could they not find two other candidates who are younger and a little less polarised? They wonder why these two particular candidates seem to have been thrown up by the system, both of whom are in or near their 80s? 

I think Biden is hamstrung because he didn't make a particularly savvy vice-presidential choice. Kamala Harris is even less popular than he is. I don't think Kamala Harris massively helped him win the 2020 election that much. But Biden, as a white five-eighths Irish, three-eighths English, Catholic male, felt that he needed to pick an African American woman. He basically pledged that in his one of his final debates with Bernie Sanders before COVID started. And he went for Harris as a kind of young Gen X candidate, but her public speaking and oratory skills are sometimes even worse than Biden's, which is incredible.  

One of the things that Biden said when he was running last time, was that he wanted to be a bridge to a future generation of candidates. One way to do that would be for him to have said in 2023 “I'm not running, we're going to have an open competitive Democratic primary.” Harris would have competed alongside any number of Democratic governors and you therefore you could have ended up with a different option.  

Given the age of the candidates – you were talking about prayer a little while ago - maybe one of the prayers is to pray for good Vice-Presidential candidates as much as the actual President themselves? 

Yes. It’s going to seem to matter more this time.  

Matt – thanks so much for your time, it’s been really insightful.  

Article
Assisted dying
Care
Culture
Death & life
8 min read

The deceptive appeal of assisted dying changes medical practice

In Canada the moral ethos of medicine has shifted dramatically.

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.