Article
Assisted dying
Death & life
4 min read

Behind the data: the social messages physician assisted suicide sends to the autistic

If intense suffering caused by society drives autistic people to seek assisted death, then society has failed.
A hand rest gently on another outstretched hand.
Alexander Grey on Unsplash.

Statistically speaking, autistic people are far more likely to die by suicide than non-autistic people. They are also, statistically speaking, far more likely to die by physician assisted suicide than non-autistic people, in countries where this is allowed.  

For example, in a study of 927 people who sought physician assisted suicide in the Netherlands (where this is legal) 39 of them were autistic. That’s about four per cent, but the prevalence of diagnosed autism in the Netherlands is only one to two per cent. The researchers go on to note that 21 per cent of these 39 people cite autism or intellectual disability as the “sole cause of suffering” that had prompted them to request assistance to die.  

I don’t like speaking statistically. For a start, 21 per cent of 39 people is 8.19 people, which raises obvious questions. A little digging reveals that what the researchers mean really is eight people. Eight people with eight unique stories that include an account of autistic suffering so intense that they asked for help to end their lives.  

But we do not have those stories, not really. Included in the report are carefully anonymised excerpts from the physicians’ notes, and this is the nearest that we can get.  

‘The patient suffered from his inability to participate in society [ … ] [He] was not able to live among people, because he was easily overstimulated. This made him isolated’ (2019 (22), male, 70s, ASD) 

‘The patient had felt unhappy since childhood and was persistently bullied because he was just a bit different from others [ … ] [He] longed for social contacts but was unable to connect with others. This reinforced his sense of loneliness. The consequences of his autism were unbearable for him [ … ] The prospect of having to live on in this way for years was an abomination to him and he could not bear it’ (2021 (26), male, 20s, ASD) 

The debate about legalising physician assisted suicide in the UK is ongoing, and the British Medical Association have provided a helpful guidance document which sets out the main arguments, both for and against, without making a recommendation either way. In the document, they observe that the reasons people ask for assisted suicide are predominantly personal and social, not clinical, and also that “laws send social messages.” I agree that laws do that, and I also think that those seeking assisted suicide send social messages too.  

For example, even just from these two tiny excerpts, I hear that a life worth living is one where people can participate in society and have social contacts, even if they are a “just a bit different from others.” It would be good to hear more. It would be good to sit down over a cup of coffee with each of these two men and ask them all my questions about their lived wisdom when it comes to autism.  

I could ask “2019 (22), male, 70s, ASD”: 

What causes the overstimulation - are there places where you don’t feel that?  

Can we create more such places for autistic people to socialise?  

And I could ask “2021 (26), male, 20s, ASD”:  

What makes you feel different?  

What kind of social contacts and connections do you think that you are looking for?  

But of course, I can’t do that, because these two men have been assisted to die.   

The word ‘welcome’ is striking to me here. What does it mean to welcome someone, not to merely include or tolerate, but to really welcome someone. 

When approached for comment, autistic theologian Claire Williams said:  

‘There is something of a personal and social tragedy reflected in these cases. If we understand that much of the difficulty that autistic people suffer is caused by society – as per the neurodiversity paradigm – then it is the case that these two nameless men were failed by society. They felt that their lives could not find a place in an unwelcoming world. It is, of course, their choice to end their lives but I do also think that God chose to start their lives and finds them to be infinitely valuable. They were both made in God’s image and reflect something of it. That they felt there isn’t a place for them that is suitable is a tragedy because society should do better to welcome them.’ 

The word ‘welcome’ is striking to me here. What does it mean to welcome someone, not to merely include or tolerate, but to really welcome someone, even if they seem ‘a little bit different from others’? Dr Léon van Ommen, another theologian who writes about autism, suggests that it is a matter of making oneself and one’s resources fully available to that person, to the point where they feel that you belong to them. This is not to promote relationships with unhealthy power dynamics, but to highlight that when a person feels truly welcomed by another, they feel the opposite of owing a debt or being a burden – they feel they are of value, that you would be lacking something without them.  

I feel we are lacking something without you, “2019 (22), male, 70s, ASD”. And I feel we are lacking something without you, “2021 (26), male, 20s, ASD”. Not to forget the 37 others who are a little like you. We can pause to reflect on the social messages that you have sent, what you are teaching all of us about what it means to live a “good” life. But I am sorry that you have all died now and we cannot hear more.   

Whether people in the UK should be able to choose physician assisted suicide, I, personally, am not yet sure. Like the BMA, I see and respect the very good arguments both for and against. But eight people have chosen physician assisted suicide due to autism or intellectual disability, and when it comes to the social messages that sends, I feel compelled to sit down and listen.  

Review
Culture
Death & life
Digital
Film & TV
6 min read

Mickey 17: If we replicate then where does our humanity lie?

Bong Joon-ho has a stark warning about dehumanization.

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

Two cloned humans stand side by side.
Warner Bros.

One of my favourite films of the last decade was Bong Joon-ho’s Parasite, a groundbreaking masterpiece in social commentary, humour and suspense. It won four Academy Awards in 2020, including Best Film - which was a first for a non-English language film - as well as numerous other accolades. So, when the director’s latest project, Mickey 17, was announced, I was eager to see if Bong could deliver another cinematic triumph of similar beauty, depth and precision.  

Mickey 17 took me by surprise. To be honest, the change in genre took some adjusting to, but as I recalibrated my expectations, I realised that the film nevertheless retained Bong’s trademark thought-provoking and daring exploration of identity, purpose and the human condition.  

Mickey 17 is in fact the eighth major film from Bong Joon Ho, but he is probably best known for Snowpiercer and Parasite. These films share common themes, particularly the stark divide between rich and poor and the rigid, two-tier nature of human society. In Parasite, we see the poor trapped in the flood plains of Seoul while the elite live in grand houses on hills. The film is structured around the visual metaphor of descent and ascent. In Snowpiercer, the class struggle is represented by the different carriages of the train, with the poor at the back of the train suffering in squalor while the privileged at the front enjoy luxury. 

Us and them 

In Mickey 17, this theme of societal hierarchy continues but in a futuristic, intergalactic setting. The divide now exists between the expendables—a class of human clones used for dangerous tasks—and the higher echelons of the spaceship crew, who are embarking on a mission to colonize a new planet.  

Mickey’s journey to the spaceship begins in poverty. He and a supposed friend start a business, funding it through a loan shark. When the business fails, the loan shark threatens their lives. Desperate, Mickey signs up for the space expedition, barely reading the fine print—only to discover that he has agreed to be an expendable. 

All expendables are humans who have been digitized – their entire bodies, brains, and psychologies are stored as data. When they die, they are simply reprinted, with only a week’s worth of memory lost. They exist to perform dangerous tasks such as testing the effects of radiation exposure, new vaccines, or extreme planetary conditions. In Mickey’s case, he has been fatally experimented on 16 times. He has been resurrected to his seventeenth version, and while he is still called Mickey, the question is whether this Mickey is the same Mickey who signed up for the space mission in the first place.  

What does it mean to be human? 

One of the film’s central philosophical questions is: What makes someone human? Mickey is biologically and mentally identical to himself, yet each iteration has a different personality. Some versions of him are more caring, others more aggressive or anxious. If he is just a replica, then where does his humanity lie? Is he just a product of his genetic code, or is there something more—something intangible—that makes him who he is? 

It is the same question that has been asked since the beginning of time. The Bible claims that the first human beings were created in the image of God, but what does that mean? Did that first iteration of humankind have the same power, the same worth, the same purpose as God? This was the forbidden fruit dilemma – Adam and Eve were already like God, but the serpent tempts them to eat the fruit so they could be like God in a different way.  

In our technologically advanced world, we are faced with the same fundamental difficulty in defining personhood: are we physical and spiritual beings with intrinsic dignity, infinite worth and unique purpose, or are we just biological replications existing for pre-programmed functions. If human cloning were to become common practice, would each clone be truly human?  

What is a human life worth? 

As far as the ship’s crew is concerned, Mickey is expendable. His pain, suffering, and even his existence are secondary to the mission. While the crew pursue the possibility of extending their own influence and power by colonising another planet, the expendables have no influence or power at all. The portrayal of this devaluing of human life is the most challenging of themes in Bong’s most popular films. In Parasite, the poor are only useful to the rich until they become an inconvenience. In Snowpiercer, the people at the back of the train serve those at the front, but they are seen as disposable. In Mickey 17, this exploitation is taken to its extreme—Mickey’s entire purpose is to die over and over again for the good of others. 

In a world that often assigns value based on productivity, Mickey 17 provides a stark warning about dehumanization. If we begin to measure worth based on what someone can do rather than who they are, we risk treating people as commodities. The Adam and Eve story turns that on its head. They were declared ‘good’ before they were given their roles to take care of one another and creation. Their function was an overflow of their dignity, not the other way around. And even after the forbidden fruit incident where the world was infected with sin and death there is a thread that reminds us that each life is precious. The Psalms declares that each of us is “fearfully and wonderfully made”. Jesus spent his life upholding the dignity of those society deemed inconvenient and expendable – the poor, sick and marginalised.  

What does death achieve? 

Despite dying multiple times, Mickey still fears death. Even though he knows he will be reprinted, the experience remains terrifying. No amount of technology, it seems, can remove the instinctive human fear of mortality. In fact the question that everybody that has contact with Mickey wants to ask is what death feels like, because everyone, whether a friend or simply a user of Mickey has to confront their own mortality. 
In the final act, Mickey makes a choice. Instead of living in an endless cycle of death and resurrection, he chooses to grow old with one person. He destroys the only means by which he could achieve immortality. The film is suggesting that relationship is more important that reusability. Finiteness—the ability to die permanently—is part of what makes life meaningful. 

The Bible teaches that there is an Adam 2.0. While the first Adam brought sin and death into the world, the second Adam – Jesus – brought redemption and eternal life. Both Jesus and Mickey choose death to break the cycle of suffering. But while Mickey chooses to abandon his contract as an expendable, Jesus willingly became expendable for the sake of others. His death was a once-for-all sacrifice that broke the power of death for all.  

What about resurrection? 

If there is life beyond this life what does it look like? Is it merely reprinting? A chance to try again? Or is there, as Adam 2.0 leads us to believe, a resurrection into a whole new world that even science fiction cannot begin to imagine? 

At its heart, Mickey 17 asks profound existential and ethical questions. It forces us to confront what it means to be human, what that human life is worth and how we deal with our mortality. It doesn’t provide us with answers but it invites us to wrestle with these crucial ideas. And in doing so, it points us back to the only hope that is worth having: a view of life where value is not earned, our existence is not expendable, and death is not the end. 

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