Authenticity and the problem with men

The problem with men rarely leaves the headlines. James Ray looks beyond, seeking one potential solution - authenticity. Part of the Problem with Men series.

James Ray

James leads the XTREME CHARACTER CHALLENGE movement, running adventurous wilderness pilgrimages. He is also a priest in the church of England and a skilled leadership development consultant.

Three men wearing pink, spotty and yellow face masks stand in the street.

Chris Curry on Unsplash.

Masculinity is under scrutiny like never before. Knowing and living out what it means to be a man is a cultural challenge, a generational responsibility and a personal mission. Yet so much of the talk about men comes from the mouths of those who are not living the example themselves.

Take Caitlin Moran - the award-winning Journalist and feminist – for example. She too believes the masculine gender requires a reboot to assist what she calls 'the second half of feminism' and has offered insights of her own as to what might be required in this process. In her book What about Men? she highlights the side effect of so much energy being devoted to finding solutions to girls’ problems being a vacuum for contemporary men. A disaster for all.

The stats to support this are alarming. You may be aware that when compared to girls, educationally boys are falling behind and more boys are excluded from schools. We know that most jails are populated by men. Homelessness is mostly a male issue. Addiction (alcohol, drugs, porn) is a hugely male concern. Perhaps most alarmingly, suicide is the leading cause of death of males under fifty. Men are FOUR TIMES more likely to lose their lives to suicide. Nick Fletcher MP knows all this and has recently called for a Minister for Men to avert this masculinity crisis….. A Minister for Men!

The problem with men is one men must also be active in solving.

However, whilst Moran claims to have the wellbeing of men in sharp focus, the very fact that she is setting out the blueprint for the issue and offering some solutions is, in itself, an offence to many – especially some men – who have suggested she isn’t the person to lead the charge. They imagine the shoe on the other foot: a man telling women what their problems are and how to deal with them. We have been there (for too many years) and we don’t want to go back. No: the problem with men is one men must also be active in solving.

And some men are.

In his book, Of Boys and Men, Richard Reeves highlights many of the same issues as Moran offering statistical and empirical data to support his claims. He is dedicated to the issue and recently founded the American Institute for Boys and Men to help address the urgent need in research and policy making. But it was also through his research that Reeves noted that, in order to change, men need to be taught how to be men. Masculinity needs to be created, unlike femininity which happens often as an impulse response, masculinity is more often developed through such moments as a rite of passage or is passed down father to son (master to apprentice, Jedi to Padawan).

This all seems to make sense, and perhaps we could just stop there – with the instruction for men to teach other men how to man. But the problem is deeper than that because many men are incapable of teaching others for the inescapable reason that they just haven’t learnt themselves. Their own version of masculinity has been warped by selfish impulses, or after generations of poor role models, as well as a breakdown in communities and shared values. The adage ‘you can’t teach what you don’t know’ has never rung more true. Add to this the fact that you might not know anyone to teach and the problem deepens…..Meanwhile, the masculinity crisis rages on.

At the same time, men are also increasingly isolated, so much so there are many who claim men are in a friendship recession.

Max Dickens reflects on his own experiences of loneliness in his book Billy No Mates . Dickens was planning his wedding when his suddenly occurred to him that he couldn’t select a best man….because he had no mates! But before you men reading this think ‘how pathetic’, ask yourself, how many close friends do you have? Who would you ask to be your best man? How well does that guy know you? Apparently, you are increasingly unique if you have more than three very close friends.

Men are lonely.

So, it seems 50% of the population are in real trouble. But there is hope. Having spent thousands of hours discussing these issues with thousands of men I think we have found a path. It is a narrow route suspended between extremes. It’s the way of purpose, balance and responsibility. It is wide enough to contain all men but narrow enough to be individual to each man. It is the way of the Authentic Man.

Authenticity is more closely linked to integrity. It means being who you say you are. It’s about the outside and the inside being aligned.

Being “authentic” has sometimes been aligned to the idea that ‘this is me’, and ‘only I get to say exactly what that looks like’. ‘You just have to accept me as I am, including what I want to do and say, whether you like it or not’. But to me, that’s not being authentic, that’s more like a supercharged form of self-expression. Authenticity to me has a grander, more challenging mandate. Authenticity is more closely linked to integrity. It means being who you say you are. It’s about the outside and the inside being aligned. Another way to express it is that it’s the opposite of inauthentic – like not being fake. Someone who’s external image, reputation and appearance matches the life he is actually living behind closed doors. And here we start to see the Authentic Man emerge. In fact, when you look for him, you will find him everywhere. Because he isn’t just a self-construct, he is also a ‘we’ construct; he is challenged and mediated (and changed) by the needs and expectations of the wider world around him - of partners, family, community, faith and culture - and also by what is ultimately healthier and better for him and for us.

Thus, the Authentic Man is a kind of ideal towards which I can point all men. And in that sense following (or even pursuing) the Authentic Man is about discovering truth. The truth of who you are but more importantly the truth of what you could become. Looking ahead at the Authentic Man and seeing what you could be. Perhaps what you should be. Sometimes the Authentic Man might be visible out there in front of us in someone else. Sometimes others might be able to glimpse the Authentic Man in us. But for all men, the Authentic Man represents this true ideal. A true guide, who can lead us beyond the pitfalls and mires into which we all have a tendency to fall, towards firmer, higher ground. Better ground. For us and for everyone around us.

So, as we begin to take seriously again the question of what masculinity is, and what it looks like, and what it needs, I look to the Authentic Man and the authentic men in my life. Men who know their purpose and are grounded in responsibility: responsibility for our past, balance in our present and are taking responsibility for our future.

So, What About (Authentic) Men? – you will see, they are on the move!

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.