Review

Culture

Film & TV

Zombies

30 January 2024

5 min read

To boldly hope: how Star Trek dares us to be better

Amid dystopian dramas, Paula Duncan analyses the attraction of the Star Trek franchise.

Paula Duncan

Paula Duncan is a PhD candidate at the University of Aberdeen, researching OCD and faith.

Spock and Kirk stand on the bridge of a spacecraft.

The young Spock and Kirk, in 2009's Star Trek.

It’s something of a running joke that the popular animated series The Simpsons can predict the future – so much so that this was addressed by Time magazine. It is far from the only show that has a take on our pending fate. There is no shortage of dystopian futures available to us – nuclear war, rising sea levels, zombie apocalypse, super-contagious virus… Some of these no longer feel quite as fictional or remote a possibility as we might like. Such storytelling allows us to consider what it might mean for us to live through such scenarios and, perhaps, think more carefully about how we might prevent them.

I’m sure there are movies, games, books, or TV shows that spring to mind for each of us when we think about this. For me, it is the Hunger Games and the Divergent book series by Suzanne Collins and Veronica Roth, respectively. Even when these stories offer us a hopeful possibility of redemption, they do so in the wake of disasters that humanity has failed to prevent. We are invited to dwell in the worst parts of humanity and human nature. In some stories we destroy ourselves. In others, we find ourselves simply destroyed. I find it all too easy to become preoccupied by the potential horrors in our near or distant future.

This is why I’m so drawn to the vision of the future that the Star Trek franchise offers. There’s a hopeful message at the heart of the series that makes our continued existence seem plausible but doesn’t discount the changes we need to collectively make to achieve this. I am slowly making my way through Star Trek: Deep Space 9, having now completed The Original Series (TOS) and The Next Generation, and I’m always struck by this ultimately hopeful view for our future. It’s a not-quite utopian view of the future. We don’t achieve perfection in any way but we do learn to survive and thrive despite the challenges presented to us.

What do we pass on to our literal next generation? What morals, what values? What hope for a future in which we both survive and thrive? This, I think, is the crucial point.

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Podcast

Culture

Re-enchanting

Two scientists talk to each other at console in a space mission control room.

Re-enchanting... the universe

Belle Tindall

In this third episode of Re-enchanting, Belle and Justin talk all things space with astronomer, author, and speaker, Dr Jennifer Wiseman.

26 April 2023

1 min read

It's certainly not perfect. There are definitely things that are uncomfortable on the show – the portrayal of women, for one thing, often misses the mark in TOS. But I do think it represents a beginning, a promise that things can get better. I’m reluctant to write any line that begins “for its time”, but I think there is something in that here. I also defer to the judgement of someone who was actually there, contributing to the formation of the Star Trek universe: Nichelle Nichols, who played Lt. Uhura. She wrote compellingly about the importance of diverse representation in the cast and what it meant to viewers in her autobiography Beyond Uhura. She reflected there:

Like all of Gene’s characters, Uhura embodied humankind’s highest values and lived according to principles that he was certain would one day guide all human endeavor. In Star Trek Gene created a work of fiction through which he communicated a timely, yet timeless message about humankind’s power to shape its future. But most important, he gave that vision to the world: to writers, to enlarge upon; to directors, to dramatize; to actors, to personify and make real; and to audiences, to enjoy, cherish, and incorporate into their own hopes for the future and for humanity.

For all its flaws, TOS set up a universe where we could see a better and fairer future for ourselves. In this early series, there are certainly problematic elements that would be written differently today. But there is, at least, hope.

What speaks most clearly to me is the idea of stewardship. For those unfamiliar with the franchise, it began when TOS originally aired in 1966 and follows the crew of the star ship Enterprise on a five-year exploratory mission through space. On the bridge, Captain James T. Kirk is accompanied by some of the best crew Starfleet has to offer. We follow them through the stars, visiting new people(s) and places and getting into an uncanny number of scrapes.

Airing in 1987, The Next Generation shows us the new and improved Enterprise is now captained by Jean-Luc Picard and a whole new crew with new skills and talents but the principles are the same – a crew that looks out for one another and their ship, caring for their home away from home. The Enterprise changes and different people take the helm, but the common goals remain.

Perhaps if we contemplate our world to be something like this: if we consider that we might each be given a collective opportunity to hold the fate of our planet, how should we act to make sure that we hand over the best possible future to those that come next? What do we pass on to our literal next generation? What morals, what values? What hope for a future in which we both survive and thrive? This, I think, is the crucial point

There are some key messages that we can draw from Star Trek’s view of our future. Captain Kirk frequently talks fondly of an Earth that has eradicated poverty and many unjust power structures. What might need to change for us to get to a position where we hold the same values? Where might we need to sacrifice personal gain in order to create a more sustainable world? I cannot help but think that we are not acting on this as quickly as we should be. The BBC recently published an article focusing on the episode of Star Trek: Deep Space Nine in which 2024 is shown to be a year of riots and unrest on Earth. Even in our sci-fi not-quite-utopian future, our progress is slow.

I’d like to conclude with a reference to the 2009 movie reboot of Star Trek. Captain Pike says to a young Jim Kirk:

“your father was Captain of a star ship for twelve minutes. He saved eight hundred lives, including your mother's. And yours. I dare you to do better.”

What if we looked at our stewardship of our planet in the same way? We briefly, collectively, have a chance to make a difference. We have a chance to do better. We need, therefore, to boldly go.

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.