Cutting America to the bone

Civil War warns against worshipping civic and political violence.

Chris Wadibia

Chris Wadibia is an academic advising on faith-based challenges. His research includes political Pentecostalism, global Christianity, and development.

An explosion occurs at the Lincoln Memorail

Civil War's finale in Washington DC.

A24.

The president of the United States is dead. The film Civil War culminates with soldiers of the Western Forces (a fictional secessionist group composed of California and Texas) posing for pictures with a presidential corpse just minutes after executing him. It’s a chilling climax, with optics reminiscent of American soldiers capturing deposed president of Iraq Saddam Hussein in 2003. The film ends with a warning. No democratic country, no matter the perceived strength of its institutions, is immune from tyranny, civil violence, and the bloody process of state failure. Collapse follows when states lose the capacity to provide solutions to the linchpin challenges negatively affecting their citizens.

A strength of Civil War is the way it articulates a universal political message without defiling itself with the toxic hyper-partisanship asphyxiating real-world American society.

It features a number of loyalist and secessionist geopolitical groups each motivated by a distinctive combination of social, economic, and political interests and goals. These groups include the Western Forces, Florida Alliance, New People’s Army, and Loyalist States.

The film’s storyline prioritises a violently unfolding near future civil war in a United States whose president bucked constitutional tradition by remaining in office for a third term. The president, whose character is modelled after Donald Trump, is the villain of the film, despite being supported by over half of the 50 American states. The Western Forces function as the film's hero group. Unlike the mercilessly murderous and viciously xenophobic soldiers affiliated with the Loyalist States, the soldiers of the Western Forces treat an eclectic team of journalists and war photographers (the film’s main protagonists) with kindness and respect, allowing them to accompany them during the final stages of their assault on the White House and entrance into the belly of the beast, the Oval Office.

The film includes shocking scenes that would make the most patriotic Americans shudder. Shortly after it begins, a suicide bomber associated with the Loyalist States, proudly carrying a large American flag, sprints into the centre of a group of vulnerable people, pleading with agents charged with guarding a water tanker, and detonates a bomb. Dozens of people including children are killed, many of whom were non-White Americans. This scene's power is that it bring home the threats Americans associate with foreign lands. Suddenly the menaces Americans instinctively link with states like Afghanistan, Burkina Faso, and Venezuela exist in cities like Charlottesville, New York, and Washington DC. America is no longer safe, and the threats have come from within instead of from abroad.

The message of Christ applies to theocracies and secular states alike. Every state, regardless of its attitudes toward religion, has an interest in its people living together peacefully.

As an American watching this film from a cozy cinema in Oxford, I thought about how the violence, polarisation, and civic rage depicted in the film already exists in many forms in the country I love from a distance. Shootings, many of them mass in nature, happen every day in an America whose citizens are comfortable with violence but afraid of each other. The United States suffers from an embarrassingly high association with mass shootings, far more than whichever county manages to claim an ignominious second place. Whilst it is unlikely tanks and attack helicopters will surround the White House anytime soon, the casual spirit of violence that has overtaken American society already fosters a level of violence far above the threshold any twenty first century democratic state should tolerate.

I watched this film as a proud American and as a committed Christian, a faith I share with many of my fellow American citizens. My Bible, and theirs, does say we are “citizens of heaven” destined to enjoy an eternal posterity in a New Creation marked by perfect peace and prosperity. However, until Christ returns, and God remakes the cosmos, Christians do have a vital role to play in their everyday civic communities. Whilst Civil War offers a grim view of America’s immediate political future, that message of Christ contains the content needed to cure the gravest challenges bedevilling the United States. I remain optimistic.

Not all Americans identify as Christians or even with organised religion; nevertheless, twentieth century history confirms that states that altogether ignore God will soon wither into an ecosystemic abyss of state-sponsored moral relativism that endorses the use of violence for an increasing, arbitrary range of unsuitable, injudicious, and illegitimate purposes. The message of Christ applies to theocracies and secular states alike. Every state, regardless of its attitudes toward religion, has an interest in its people living together peacefully. Humans need a moral system to provide them (as well as their societies at large) with at least a perceived sense of moral structure. Christ’s message articulates a concept of civic love that challenges the existing worship of civic and political violence. Christ argues that violence in moments of disagreement or dismay is never the appropriate option; the mark of genuine Christian devotion is revealed in the avoidance of violent action even when the use of violence would not categorically be condemned by observers.

Civil War explains how multiple, competing Americas exist. These Americas have different cultures, economic capacities, and sociopolitical ideologies. It teaches that America’s main problem is Americans only love other Americans like them. A number of enclaves exist across American society. Cut off from each other, the development of these enclaves has led to the emergence of micro-Americas so distinctive from each other that some of them no longer view formal geopolitical ties with other micro-Americas as in their best interest.

The same enclavisation portrayed in Civil War exists in the nonfictional, real-life America. However, unlike in the America depicted in the film, the real-life America still has time to solve its sociopolitical troubles and stop the American state from collapsing. I recommend Civil War to anyone interested in being entertained and warned by what a dystopian, worst-case-scenario of near-future American political activity might actually look like.

Article

Assisted dying

Care

Culture

Death & life

20 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.