Article

Culture

Re-enchanting

12 April 2023

4 min read

The falcon’s call

Awed by an encounter with a bird of prey high above a Texas river, Anthony Baker ponders both the place and his place.

Anthony Baker

Anthony Baker is a theology professor at Seminary of the Southwest in Austin, Texas. He is currently exploring the intersection of classical accounts of Christian holiness with current issues in ecology.

A view of a lightly misted valley to mountains in a desert area.

The view from the South Rim of the Big Bend National Park.

National Park Service Digital Image Archives, Public domain, via Wikimedia Commons.

Seeing God in Big Bend

The scream from the sky shattered the quiet calm of my cliffside campsite. I'd never heard such a sound—it was like a large crow had decided to try and quack. I rushed out of my tent, where I'd collapsed after making the seven mile trek up the mountain, to find the source of this alarming noise.

I was up on the rim of Big Bend National Park in southwestern Texas, where I'd come on a solitary backpacking retreat. The "big bend" is the abrupt L-turn of the Rio Grande river, as it changes course from southeast to northeast. At the heart of the park rise the stark and severe Chisos Mountains, and the crown jewel of the Chisos is surely the South Rim. A thousand feet beneath me, a sheer drop from where I've staked my tent, there is a whole other mountain range. And ten miles away to the southeast I could see gorgeously striped limestone ridges across the river in northern Mexico.

It's a place that puts you in the presence of the sublime. Everett Townsend, the pathfinder responsible for bringing the region under the protection of Franklin Roosevelt's government, was particularly awed by this view. As a biographer put it, the view from the South Rim allowed him to

"see God as he had never seen Him before and so overpoweringly impressed him that he made note of its awesomeness…"

What does it mean, though, to see God in a place? Do I need to be up high and far away, staring into sublime depths? The South Rim gives me the impression that I'm hovering like an eagle over the earth, not standing on it like a human. Why are these the places that we think we sense the divine?

I'd like to think that seeing God in a place can be just as much about close and near attention as it is about sublime distances. What does God look and sound like here, if I stand on the ground and pay as much attention as I can to what I see and hear around me?

The Falcon's cry

I had no Internet connection on the Rim, so when I heard that bird cry out over my head I tried to burn the sound into a mental audio file. Jumping from my tent, I saw a large predator bird shooting directly above me and out over the cliff's edge. The size and shape—a large flying crossbow—told me that I'd been hailed by a peregrine falcon. A sign near my site told me that the section of the ledge where I was camping—where the South and East Rims meet—is in fact a protected nesting ground for the birds, closing to human trekkers each spring.

The peregrine is the world's fastest animal of any kind. They can dive at 200 miles per hour. That means they can only hunt birds in flight, since if they attacked anything on the ground at that speed they would both wind up, as my Granny would put it, "nothing but a greasy spot on the pavement."

A display down at the park's visitors' center had already filled me in on the near demise of the remarkable bird. DDT, a killing-machine of a pesticide that Rachel Carson called out in her book The Silent Spring in the 60s, triggers an immuno-response in female birds who have ingested it into their bodies. This response limits the calcium they can supply to their eggshells. As a result, the eggs were too vulnerable to predators or simply weather, and the embryos were not surviving.

We gave the Nobel Prize to the scientist who discovered how to use DDT to kill insects. It made so much sense, after World War II, to find ways to kill the pests who were spreading disease among the wounded soldiers and other victims of the war. But we were not yet thinking, in those days, about what else we might be killing. Now we're at least thinking, even while we're still killing.

Sin and redemption on the mountain

What does the falcon, soaring off the Rim, reveal to me about God? Consider, for instance, the doctrine of sin. Taken as an abstraction, sin is what theologians call the manifold ways that humans can turn from their holy God. But what if we fill that doctrine in with attentiveness to the story the falcon tells us? Here on the Rim, sin looks like failing to be awed enough by this remarkable life form to notice, until almost too late, that we are killing it.

Similarly, redemption, in the Christian telling of things, refers to the way that God overcomes sin and restores holy relationship. Here on the rim, redemption looks like a shared grief over the damage we've done. It looks also like the effort to protect this space as a bird sanctuary—literally a "holy place." It looks like a hope that falcon and human, like the bird and its own prey, can find a balance of mutual respect and coexistence.

The warning call of God

When I came down the mountain, I got on the Wi-Fi at the lodge outside the park and went searching for bird calls. I found a match for the sound that I'd heard - that caw-quack of a scream. It was the warning call of a peregrine falcon who has found predators in its nesting grounds. The bird was talking about me! Maybe somewhere in her DNA she recognized me as one of the DDT users that ruined her ancestors' eggshells. Hearing that call, as the bird flew off into sublime depths and distances, I suspect I was hearing about the mystery of life, the damage of sin, and the beauty of redemption. In other words, I was hearing the voice of God.

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.