Essay

Culture

Middle East

Politics

24 April 2024

7 min read

Democracy and the authorities that exist

Should we insist on democracy in the Gulf?

Andrew Thompson

Andrew Thompson MBE is an Anglican priest who served in Kuwait and the United Arab Emirates.

Three members of the Oman Shura sit in it's chamber and hold their hands in prayer

Members of Oman's assembly - the Shura.

I once participated in an American University forum looking at Gulf states and the development of democracy. Underlying the barely disguised criticism of political processes in the Arab world were three assumptions. Firstly, that there was an assumption that everyone understood which model of democracy was being referred to. Secondly, that this model should be a desirable universal goal for all nations to aspire to. Finally, that democracy works and is ‘good’.

The first assumption is quickly undermined when one does a brief survey of democratic processes in European countries. There are no two countries which have a similar modus operandi when it comes to conducting elections. Which democratic model should one aspire to?

On the second assumption, I was reminded that the very concept of democracy as touted by Plato was already flawed. In Ancient Greece, the public decision-making process excluded women, peasants and slaves. The elite Athenian men who got to occupy the space of power on Pnyx Hill, were already wealthy and privileged.

Similarly, the US constitution, with its line “All men are born free and equal, and have certain natural, essential, and unalienable rights” did not include women and slaves, thus undermining the slogan ‘a government of the people by the people’.

It would seem that even today in the west, the democratic process still favours the elite and excludes certain categories of people.

Their emphasis is on values-driven leadership; these values predate Islam and were forged in the harsh climate of the desert.

So how do we define democracy?

While academics cannot agree on one definition, there is a recognition that most democracies have one main feature: that they include a transparent, accessible and inclusive process by which citizens can appoint their governments.

Free and inclusive elections are not a feature of Gulf states. The authorities in Gulf countries are often criticized for their suppression of their political opponents and flagrant abuse of human rights. While several Gulf countries do hold elections, they tend to be limited in terms of who can participate, and once elected their roles in office tend to be more advisory rather than that of a decision maker.

So how do governments in the Arabian Gulf work?

Each Gulf state is led by a ruling family who secure their position within a rentier state economy, by sharing their largesse from the oil industry with their citizens. Failure to be generous with their tribal allies would lead the ruling family into a potential conflict. A future challenge is what happens when the oil runs out. How will ruling families secure the loyalty of their citizens?

In the United Arab Emirates (a federation of seven semi-autonomous regions headed up by a ruling sheikh), I have learned their style of governance is rooted in centuries of tribal wisdom. Their emphasis is on values-driven leadership; these values predate Islam and were forged in the harsh climate of the desert.

Bad leaders generally don’t last long in tribal societies.

The quintessential Arab leader should serve their people with humility, wisdom, integrity, courage and generosity; these personal leadership qualities have underpinned Arab tribal culture for millennia. The eminent historian and pioneer sociologist, Ibn Khaldun (1332-1406) describes in his seminal work The Muqaddimah, observes the importance of ‘assabiya (public consensus or group cohesion) as the glue that holds successful societies together. He went onto describe how Arab societies achieved consensus. The most common form was the council of elders or a shura, in which the representatives of the tribes came to a common decision. It was a shura which appointed the first Caliph after the death of prophet Mohammed. This concept exists to this day in modern Oman, whose government describes their version of parliament as a shura. It is a matter of debate as to how representative of the people the shura is, but the point is that in Islam there is a process which exists which seeks to reach consensus or ‘assabiya. It is worth noting that the concept of ‘assabiya is reflected in Rousseau’s political philosophy of working towards the common good and will of the many. For the record, Rousseau was not a believer in democracy.

It is ‘assabiya which leads to tribes offering their allegiance to a ruling sheikh, once they are persuaded of the legitimacy of his ‘fitness’ to lead. Although Gulf dynasties have been established for several generations, it is not automatically a model of primogeniture. For example, the position of the Emir of Kuwait is supposed to be shared between two alternate branches of the Al Sabah family. On the other hand, the de facto ruler of the Emirates was the first son of the third wife on account of his political acumen and clear leadership skills.

Upon the death of a ruler, the family will seek to identify an elder within the family who displays the merits and qualities desired in a leader. These qualities are essential in holding the allegiance of most of the tribes. An incompetent, selfish or vicious ruler will swiftly disrupt the ‘assabiya and lose the allegiance of the tribes. There is a system of sorts, of checks and balances to ensure for the most part a benign ruler who will hold the best interests of their people to heart.

And it works well, as attested by the common man on the street. in the UAE there seems to be a genuine respect, even affection for many of the ruling families.

The Gulf States would be the first to say that they are not democracies, but their histories have demonstrated that overall, their countries have flourished, and political stability has been consistent. Bad leaders generally don’t last long in tribal societies.

Yet, there is still a conviction held by western governments that life in the Gulf states would improve if they adopted democracy as a way of life. While this sentiment may appear to be admirable, in reality, when democracy has been hoisted on Arab states it has not ended well.

Western politicians simply do not understand the context in which hostile, militant and organized Islamists lurk.

Kuwait was the first Gulf state to adopt a semblance of democracy and their media are among the most independent in the region. Yet the country’s commitment to move towards democracy, as an attempt to integrate with the global economy, has backfired. The Kuwaiti democratic processes have enabled a highly organized and elected Islamist group which has consistently paralyzed the Kuwaiti parliament and thwarted their pro-western policy ambitions.

It is ironic too, that where Middle Eastern countries have embraced democratic processes, the elections have been won or successfully contested by political parties who would be seen as threats to the Western world. Hamas in Palestine, the Muslim Brotherhood in Egypt, the Hirak Islamist group in Algeria and the AKP in Turkey. All these supposedly democratically elected parties have faced opposition and concern from Western nations. In some cases, western powers have actively conspired to bring down elected governments in order to defend their interests. Iran is a case in point.

It would seem that democracy in the Middle East is only acceptable in the west if the ‘right’ people win it.

The democratic experiment in Iraq came with a high cost in terms of loss of lives, and the jury is still out on whether the Iraqi parliament can deliver a national agenda in which security and prosperity can be enjoyed by all their citizens.

It is for this reason that a senior Emirati leader recently explained at a press gathering, that the pressure to adopt democracy as a model of government in the Middle East is unreasonable. Western politicians simply do not understand the context in which hostile, militant and organized Islamists lurk.

“Why would anyone want to buy into a system that would inflict a country with the likes of the leaders you have now?”

That said, things are changing. The UAE sponsored Marrakesh Declaration which seeks equal citizenship in Muslim majority countries for religious minorities is clearly a step in the right direction for ensuring protection for all.

Should we then insist on democracy in the Arabian Gulf?

For thousands of years, the Arabs have had their own mechanisms of selecting leaders. They do not see the need to adopt western democratic procedures which are potentially likely to disrupt the economic prosperity and security of their citizens.

St Paul once wrote the following words in the context of an oppressive Roman Empire, ‘the authorities that exist have been established by God’. While Christians cheerfully apply this teaching to support their democratically elected leaders, it is worth asking, ‘should this not apply to the leaders of the Gulf states too’?

Meanwhile, back in the American University, a bewildered Emirati student whispered to me during a particularly strident presentation on the virtues of democracy, “Why would anyone want to buy into a system that would inflict a country with the likes of the leaders you have now?”

His words gave me pause for thought and led me to question what we assume to be a self-evident truth, that democracy should be the aspiration of all countries. Should we insist that Gulf states adopt democracy as their mode of governance? Would democracy work in the Arabian Gulf economy and culture?

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.