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.  

Article
Community
Culture
Generosity
Psychology
7 min read

Is empathy really a weapon?

Musk and Fonda disagree on whether empathy is a bug or a feature.
A montage shows Elon Musk wielding a chain saw, Jane Fonda flexing her muscles and Hannah Arendt smoking.
Wordd Wrestling Empathy.

You may have heard that you can kill a person with kindness, but in recent weeks have you also heard that you can bring about your own death through empathy? In an interview recorded with podcaster Joe Rogan in February, Elon Musk added his voice to a cohort of American neo-capitalists when he claimed, “We've got civilizational suicidal empathy going on” and went on to describe empathy as having been “weaponized” by activist groups.  

“The fundamental weakness of western civilization is empathy, the empathy exploit… they’re exploiting a bug in western civilization, which is the empathy response.”  

In recent weeks empathy has become one of the hot topics of American politics, but this is not the first time that Musk has shared his thoughts about empathy, and it should be noted that on the whole he is not really against it. Musk identifies, rightly, that empathy is a fundamental component of what it means to be human, and in previous interviews has often spoken often about his vision to preserve “the light of human consciousness” – hence his ambition to set up a self-sustaining colony of humans on Mars.  

But he also believes that empathy is (to continue in Musk’s computer programming terminology) a vulnerability in the human code: a point of entry for viruses which have the capacity to manipulate human consciousness and take control of human behaviours. Empathy, Musk has begun to argue, makes us vulnerable to being infected:  

"The woke mind virus is fundamentally anti-science, anti-merit, and anti-human in general. Empathy is a good thing, but when it is weaponized to push irrational or extreme agendas, it can become a dangerous tool." 

Strangely, on certain fundamentals, I find it easy to agree with Musk and his contemporaries about empathy. For example, I agree that empathy is essential to being human. Although, far from empathy leading us to “civilisational suicide”, I would say it is empathy that saves humanity from this fate. If consciousness is (as Musk would define it) the brain’s capacity to process complex information and make a rational and informed choices, then empathy, understood as the ability to anticipate the experiences, feelings, and even reactions of others, is a crucial source of that information. Without empathy, we cannot make good decisions that benefit wider society and not just ourselves. Without it, humanity becomes a collection of mere sociopaths. 

Another point on which Musk and I agree is that empathy is a human weak point, one that can be easily exploited. Ever since the term “empathy” was coined in the early twentieth century, philosophers and psychologists have shown a sustained fascination with the way that empathy causes us to have concern for the experiences of others (affective empathy), to think about the needs of others (cognitive empathy), and even to feel the feelings of others (emotional contagion). Any or all of these responses can be used for good or for ill – so yes, I agree with Musk that empathy has the potential to be exploited.  

But it is on this very question of who is exploiting empathy and why, that I find myself much more ready to disagree with Musk. Whilst he argues that “the woke mind virus” is using empathy to push “irrational and extreme agendas”, his solution is to propose that empathy must be combined with “knowledge”. On the basis of knowledge, he believes, sober judgement can be used to resist the impulse of empathy and rationally govern our conscious decision making. Musk states: 

“Empathy is important. It’s important to view knowledge as sort of a semantic tree—make sure you understand the fundamental principles, the trunk and big branches, before you get into the leaves/details or there is nothing for them to hang on to." 

What I notice in this system is that Musk places knowledge before empathy, as if existing bits of information, “fundamental principles”, are the lenses through which one can interpret the experiences of another and then go on to make a conscious and rational judgement about what we perceive.  

There is a certain realism to this view, one that has not been ignored by philosophers. The phenomenologists of the early twentieth century, Husserl, Heidegger, Stein – those who first popularised the very idea of empathy – each described in their own way how all of us experience the world from the unique positionality of our own perspective. Our foreknowledge is very much like a set of lenses that strongly governs what we perceive and dictates what we can see about the world around us. The problem is: that feeling of foreknowledge can easily be manipulated. To put it another way – we ourselves don’t entirely decide what our own lenses are.  

To graft this on to Musk’s preferred semantic tree: empathy is a means by which the human brain can write brand new code. 

In The Origins of Totalitarianism, another great twentieth century thinker, Hannah Arendt, explored how totalitarian regimes seek to control not just the public lives but also the thought lives of individuals, flooding them with ideologies that manipulate precisely this: they tell people what to see. Ideologies are, in a sense, lenses – ones that make people blind to the unjust and violent actions of a regime:  

"The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated communist, but people for whom the distinction between fact and fiction, true and false, no longer exists." 

A big part of the manipulation of people’s sense of foreknowledge is the provision of simplistic explanations for complex issues. For example, providing a clearly identifiable scapegoat, a common enemy, as a receptacle of blame for complex social and economic problems. As we know all too painfully, in early twentieth century Europe, this scapegoat became the Jewish people. Arendt describes how, whilst latent antisemitism had long been a feature of European public life, the Nazi party harnessed this this low-level antipathy and weaponised it easily. People’s sense of foreknowledge about the “differentness” of this group of “outsiders” was all too manipulable, and it was further cultivated by the Nazis’ use of “disease”, “contagion” and “virus” metaphors when speaking about the Jews. This gave rise a belief that it was rational and sensible to keep one’s distance and have no form of dialogue with this ostracised group.  

But with such distance, how would a well-meaning German citizen ever identify that their sense of foreknowledge about what it meant to be Jewish had been manipulated? Arendt identified rightly that totalitarian systems seek to eliminate dialogue, because dialogue creates the possibility of empathy, the possibility of an exchange of perspectives that might lead to knowledge – or at least a more nuanced understanding of what is true about complex situations. 

When I look at Musk’s comments, I wonder if what I can see is a similar instinct for scapegoating, and for preventing dialogue with those who might provide the knowledge that comes from another person’s perspective. In his rhetoric, the “woke mind” has been declared a common enemy, a “dangerous virus” that can deceive us into becoming “anti-merit” and “anti-human.” In dialogue, those who claim to be suffering or speaking about the suffering of others might be enabled to deploy their weaponized empathy, trying to make us care about other, to the potential detriment of ourselves and even wider humanity’s best interests. Therefore, it is made to seem better to isolate oneself and make rational judgements on behalf of those in need, firmly based on one’s existing foreknowledge, rather than engage in dialogue that might expose us to the contagion of wokeness.  

Whilst this isolationist approach appears to wisely prioritise knowledge over empathy, it misses the crucial detail that empathy itself is a form of knowledge. The experience of empathising through paying attention to and dialoguing with the “other” is what expands our human consciousness and complexifies our human decision making by giving us access to new information. To graft this on to Musk’s preferred semantic tree: empathy is a means by which the human brain can write brand new code.  

In these divisive and divided times, there are, fortunately, those who are still bold enough to make the rallying cry back to empathy. At her recent acceptance speech for a Lifetime Achievement Award, actor and committed Christian Jane Fonda spoke warmly and compellingly in favour of empathy:  

“A whole lot of people are going to be really hurt by what is happening, what is coming our way. And even if they are of a different political persuasion, we need to call upon our empathy, and not judge, but listen from our hearts, and welcome them into our tent, because we are going to need a big tent to resist successfully what's coming at us.”  

Fonda’s use of the tent metaphor, I’m sure, was quite deliberate. One of the most famous bible passages about the birth of Jesus describes how he “became flesh and dwelt among us.” The word “dwelt” can also be translated “tabernacled” or, even more literally, “occupied a tent” among us. The idea is that God did not sit back, judging from afar, despite having all the knowledge in the world at his disposal. Instead, God came to humanity through the birth of Jesus, and dwelt alongside us, in all our messy human complexity.  

Did Jesus then kill us with his kindness? No. But you might very well argue that his empathy led to his death. Perhaps this was Musk’s “suicidal empathy.” But in that case Musk and I have found another point about empathy on which we can agree – one that is summed up in the words of Jesus himself: “Greater love has no one than this: to lay down one’s life for one’s friends.”   

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