Art makes life worth living

Why society, and churches, need the Arts.

Jonathan Evens

Jonathan is Team Rector for Wickford and Runwell. He is co-author of The Secret Chord, and writes on the arts.

A choir sing at the front of a church while an audience looks on.

St Martin-in-the-Fields choir performance.

Arguing for the significance and role of the arts and culture during an election in an era where a cost-of-living crisis has followed austerity and a pandemic, may seem to be a hard task. The Arts being thought of often as frivolous and unimportant in comparison with the basics of survival. Yet it is essentially a task that the current government has attempted, as in June 2023, a ‘Creative industries sector vision’ was published which included a commitment to an additional £77 million in funding.

At that time, the government estimated that creative industries generated £126bn in gross value added to the economy and employed 2.4 million people in 2022. A range of research has also been examining the way in which creative industries and the arts can positively impact wellbeing, for example through public health interventions.

The foreword to ‘Creative industries sector vision’ stated:

“Our creative industries are world-leading, an engine of our economic growth and at the heart of our increasingly digital world. From 2010 to 2019 they grew more than one and a half times faster than the wider economy and in 2021 they generated £108bn in economic value. In 2021, they employed 2.3 million people, a 49% increase since 2011. Their impact reaches beyond their borders to other sectors, with advertising, marketing and creative digital innovation supporting sectors across our economy.

The importance of the creative industries also goes well beyond the economy. They provide the news that informs our democracy, the designs that shape our cities and the content and performances that enrich our lives and strengthen our global image. The sector has proved that it is an essential positive force for society, bringing joy, inspiration and opportunity to our lives. The creative industries form the national conversation through which we define our shared values.”

The arts and culture help tackle social injustice as theatres, museums, galleries and libraries are the beating heart of our towns and cities bringing communities together and making life worth living.

This positive view of the creative industries was echoed in a report ‘The arts in the UK: Seeing the big picture’ published in November 2023 by management consulting firm McKinsey. The report described the UK as a “cultural powerhouse” with a globally recognised arts sector and 91 per cent of UK adults engaging with the arts in the previous 12 months.

The Arts Council estimates that art and culture contribute £10.6 billion to the UK economy as the UK has a creative economy worth £27bn and culture brings £850m to UK, through tourism, each year. They also contend that the arts and culture help tackle social injustice as theatres, museums, galleries and libraries are the beating heart of our towns and cities bringing communities together and making life worth living. In addition, our creative industries are successful throughout the world - our leading cultural institutions are a calling card worldwide and have important trading links from the US or Germany to China and South Korea. Last year our National Portfolio Organisations earned £57m abroad.

Churches feature within these arguments because they often host or organise cultural events, exhibitions, installations and performances which contribute towards the economic, social, wellbeing and tourism impacts achieved by the arts and culture. The Arts are actually central to church life because, as well as being places to enjoy cultural programmes such as concerts and exhibitions and also being places to see art and architecture, many of the activities of churches take place within beautiful buildings while services combine drama, literature, music, poetry and visuals.

The artist Makoto Fujimura has suggested the creation of cultural estuaries in churches, schools and informal associations as a strategy for enhancing culture. Estuaries are where salt-water mixes with fresh in a confluence of river and tidal waters. They are environments not of protection but of preparation as critical nursery areas for fish that come downstream after hatching.

This suggestion has been taken up by Sam Wells, Vicar of St Martin-in-the-Fields, who advocates for churches to minister in and through the 4Cs; commerce, culture, compassion and congregation. He writes in ‘A Future that’s Bigger than the Past’ that:

“… the image of an estuary is helpful for a church regarding itself as a meeting place of human and divine, gospel and culture, timeless truth and embodied experience, word and world.

Churches work hard to make themselves inspiring locations where people are drawn into a sense of the presence of God; but they can work equally hard to make themselves hospitable locations where people of varied backgrounds may gather in a spirit or mutual appreciation, generous regard and constructive challenge. The two purposes of church need not be mutually exclusive.”

The arts, he suggests, provide a perfect example of how such an estuary space may flourish with participatory, aspirational and commercial activities all taking place in the same space. In a short time, he suggests, “a secluded, secretive space may be opened out to become a centre of community activity, energy, and creativity.” All that’s needed “is for a church to let go of the need for direct outcomes and linear trajectories and to let the Holy Spirit govern the interactions and catalyse its own surprises.”

The Bible adds to this missional assessment of the importance of the arts. At the point we are told of human beings as having been made in the image of God the one thing we know for certain of God is his creativity, making our own creativity central to our understanding of how we live in his image. Later, the very first people to be spoken of in terms of being filled with the Spirit of God are the artists and craftspeople who make the Tent of Meeting for the people of Israel as they journey through the wilderness. The Bible, itself, is a library of various genres of literature with many of its texts having been preserved through oral performance, whether spoken or sung.

Given these theological, missional, social and economic reasons for seeing the arts and culture as central to personal wellbeing and to national life, in this election period it surely makes sense to check the commitment of politicians in all parties to maintaining and developing the cultural industries and the vital place that the arts and culture have in the life of our nation.

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.