Review

Ambition

Culture

3 November 2023

6 min read

The awe and outrage of Musk's toxic ingenuity

Walter Isaacson’s Elon Musk, is a biographic rollercoaster reckons Krish Kandiah. One marked by magnificent moments and moral crossroads.

Krish Kandiah

Krish is a social entrepreneur partnering across civil society, faith communities, government and philanthropy. He founded The Sanctuary Foundation.

Elon Musk, wearing a dark suit, stands on a stage to a white robotic looking surgical robot.

Elon Musk at a demonstration of the Neuralink technology in 2020.

There is something both inspiring and unnerving about Elon Musk. He is a game-changing pioneer and innovator in so many industries pivotal to our future: rockets, electric cars, solar panels, batteries, satellite Wi-Fi, and Artificial Intelligence. But he is also no stranger to scandal, controversy and allegation. In his latest biography, author Walter Isaacson explores the toxicity as well as the ingenuity that has come to be associated with the richest man on the planet. As he reveals Musk’s series of successes, and what has been sacrificed to acquire them, I found myself going on an emotional journey: from compassion to awe to outrage.

Compassion: a man familiar with misery

In the opening chapter of his book Isaacson draws attention to the trauma in Elon’s childhood. Perhaps unsurprisingly, Elon was socially awkward at school. When he once pushed back at a boy who bumped into him, he was being beaten up so badly his face was unrecognisable. When he returned from hospital Musk reports how his father reacted: “I had to stand for hours. He yelled at me and called me an idiot and told me that I was just worthless.” There are a number of similar stories from Musk’s seemingly brutal childhood. Errol Musk, Elon’s father, features heavily in a series of shocking revelations including that he slept with his own stepdaughter, fathering two children with her. The background of Musk’s chaotic childhood, his experience of domestic abuse, and his series of fractured relationships provides a context for some of the strange, indeed outrageous things catalogued in the book.

Having worked for many years with children in the care system and with refugee experience, I understand a little about the impact of trauma and how it can change the brain in profound ways. There is a great deal of evidence showing how adverse childhood experiences can cause long-lasting impact on decision-making, impulse control, relationship building, mental health management and emotional regulation. While many turn to alcohol, drugs or self-harm as coping mechanisms, others, perhaps like Musk, channel the pain into ambitions and achievements.

I found myself feeling profoundly sorry for Musk. No child should have to experience such prolonged cruelty both at school and at home. All of us need to know that we are loved and valued, independent of anything we have done or anything that has been done to us.

Awe: a man of magnificent moments

Musk’s ideas have revolutionised so many industries. The automotive industries move to electric power owes a lot to the innovation of Tesla. His Space X programme is currently changing the way we think about space travel. His company was the first to create self-landing reusable rockets and was the first private owned company to develop a liquid-propellant rocket that reached orbit; the first to launch, orbit, and recover a spacecraft; the first to send a spacecraft to the International Space Station; and the first to send astronauts to the International Space Station. He is also trying to revolutionise Artificial Intelligence (AI) through his company xAI - a direct competitor to Open AI even though he was one of their early backers.

Musk has a complex relationship with AI as he is not only one of the lead innovators in the field but also the most prominent of the 33,000 signatories of a letter calling for a pause to ‘Giant AI Experiments’ until there is, in Musk’s words, “a regulatory body established for overseeing AI to make sure that it does not present a danger to the public."

AI, alongside each of the other major interest areas in Musk’s work, is way beyond any dreams I ever had of a futuristic world. Musk has managed not only to imagine the unimaginable, but to find a way to get there with impressive speed, scale and sustainability values. The more I read about the innovations involved in each step of each project, the more impressed I am with the genius behind them.

Outrage: a man without a moral compass?

Despite Walter Isaacson’s clear respect for all Musk is achieving, he paints a warts-and-all picture of his book’s subject. We see a man who is ruthless in his hirings and firings, who has often treated staff and colleagues badly. In 2018, he famously called a rescue diver, helping to save teenage boys from a flooded cave in Thailand, a ‘paedo’, in what seemed to be a reaction to a snub to his offer of using his minisub.

In light of these sorts of outbursts, and his apparent desire to save the world from looming environmental disaster, it is no wonder that some people have accused Musk of having a messiah complex. Yet if he does, it is a very different mindset from the true messiah. He appears to me to be morally, emotionally and financially the polar opposite to the Jesus whose willingness to sacrifice himself on behalf of those in need was central to his claim to be sent from God. From the way Isaacson describes Musk, I see him more as a man on a mission to save himself than to save those around him.

The future? Musk, a man at a crossroads.

Isaacson closes his book with the following analysis:

“But would a restrained Musk accomplish as much as Musk unbound? Is being unfiltered and untethered integral to who he is? Could you get the rockets to orbit or the transition to electric vehicles without accepting all aspects of him, hinged and unhinged? Sometimes great innovators are risk-seeking man-children who resist potty training. They are reckless, cringeworthy, sometimes even toxic. They can also be crazy. Crazy enough to think they can change the world.”

I find this a disconcerting epilogue to the book. It suggests that we can pardon toxicity in the name of innovation, that the ends always justify the means, that morality and decency can take second place to advancement and wealth. If this stance were to be applied to, say, the development of AI, Musk’s fears of it becoming a danger to the public may sadly well be realised.

While factors such as grand ambition, the contribution to society, early years trauma, and mental health struggles may provide a robust explanation of why a person may be toxic, toxicity itself can never be excused. No amount of wealth can undo the harm toxic masculinity does to those around us. No amount of charitable giving can buy a person a generous spirit or moral compass. No amount of environmental awards can create the sort of world we really want to live in in the future – a world where people treat one another with the respect they need and deserve.

Elon Musk’s biography is unusual because he is still mid-journey. Who knows what else he may go on to achieve or fail at, to create or destroy? Will his AI revolution be a force for good, helping to create a better future for those who need it most, or will it become the behemoth of the doomsayers? What will future editions add to his biography? Is being ‘untethered’ really integral to who Musk is, or can he change? The visionary in me would love to imagine a redemption and transformation story for Musk that can unleash a compassionate generosity that could even overshadow his creative genius. The sceptic in me fears he may end up doing more harm than good.

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.