Article

Attention

Culture

Digital

Ghosting

Psychology

2 July 2024

5 min read

Ghosting is not immature, it’s plain cruel

The dehumanising behaviour hiding in plain sight.

Belle Tindall

Belle is the staff writer at Seen & Unseen.

On a dark street someone checks their mobile phone for messages.

‘Do you really believe that the moon only exists when you look at it?’

It’s a great question. Do you know who asked it? It sounds rather Shakespearean, doesn’t it? It’s got a touch of the – ‘that which we call a rose by any other name would smell as sweet’ - about it.

But not so.

Interestingly, it was Albert Einstein who asked this question. He asked it again and again – unable to relax into any answer his contemporaries could offer him. He thought, at least initially, that he was asking a question about quantum physics. But he wasn’t; not really. Einstein was asking what it means to exist, what it means to be.

And that means that he was actually asking a theological question. And I, for one, would appreciate it if we would get into the habit of asking it too, just phrased a little differently. I’d like us to ask something a little like:

‘Do you really believe that the person only exists when you text them back?’

Yes, I’m imploring us all to take an Einstein-esque approach to the phenomenon of ‘ghosting’.

Ghosting, just to make sure that we’re all one the same page, is the act of abruptly and completely cutting off all forms of contact with another person, offering no form of prior warning nor any kind of subsequent explanation. To ghost someone is to perform a social cut and run, a relational dine-and-dash, if you will. This, of course, can happen in all kinds of contexts – in work situations, in friendships, and in the most niche of circumstances. There’s an incredibly popular podcast, the title of which – ‘My Therapist Ghosted Me’ - is a tongue in cheek reference to one of the presenters being inexplicably cut off by their own therapist. Ouch.

And so, ghosting causes a social injury, it inflicts a heart wound. Being ghosted, we are coming to realise, is a rejection of the most absolute kind.

But where this phenomenon is reaching astounding heights is in the context of romantic relationships. The technological age in which we live, where the majority of romantic relationships are now being initiated and established online, has meant that we’ve got ghosting down to a fine art. It’s become all too easy. And apparently, nobody is immune.

Just recently, Billie Eilish – Oscar and Grammy award winning musical genius and all-round cultural icon - explained how she had recently been the victim of an almighty ghosting. She said,

‘it was insane. I was like – “did you die? Have you literally died?” It was somebody that I’d known for years, we had a plan (to meet) and the day of… nothing. I never heard from him again.’

Imagine being ignored so suddenly and completely that your first instinct is that the person must have died, only to realise – they hadn’t died, you were just disposable to them. This is happening all of the time, there’s a generation of people who are having their sense of self and of the ‘other’ defined by this very phenomenon.

What’s incredibly interesting is that in the span of a few short years, psychologists and relationship therapists have gone from speaking of ‘ghosting’ in terms of emotional immaturity, conflict avoidance and a lack of communication skills, to regarding it as a form of cruelty and even abuse.

It is not primarily the intent of the ‘ghost’ that is causing psychologists to speak of ghosting in increasingly serious terms. Most ‘ghosts’ are cowardly, perhaps, but not sheer evil. Rather, it is the extraordinary depths of hurt that the behaviour inflicts (intended or not) upon the person who has been victim to it.

We are learning that there are all manner of harmful things that ghosting does to our brains and all kinds messages that it sends to our self-esteem. Namely, that we weren’t enough for that person, that we’ve failed somehow, that we’re disposable, that we misread the situation, that we misread them, that we’re deficient in almost every kind of way.

These lies inevitably fill the gaps left by the silence of the other person. False explanations, usually of the most self-depreciating kind, take advantage of that fact that no explanation was offered by the person who hurt us. The bewilderment itself becomes a form of torture. And so, ghosting causes a social injury, it inflicts a heart wound. Being ghosted, we are coming to realise, is a rejection of the most absolute kind.

Ghosting is the symptom of a society in which we kid ourselves into thinking that people only come to life when our thoughts turn to them or our eyes rest on them.

But I think there’s even more to it. And this is where I return to Einstein’s question, and my modern, admittedly much less cosmic, re-imagining of it. Because underneath it all, I think that ghosting is a theological issue.

To ghost someone is to act as if they do not exist because you have averted your gaze from them. It is, therefore, to deprive them of the fullness of their existence. Or, at least, to deny it. It is an act of deep diminishment. Do we really believe that the moon only exists when it is looked upon? Ghosting forces us to similarly ask – do we believe that we only exist when we are looked upon?

So, you see, it goes deep. It cuts to the core of what it means to be.

Ghosting is the symptom of a society in which we kid ourselves into thinking that people only come to life when our thoughts turn to them or our eyes rest on them. If we can’t see the suffering we’ve caused, it isn’t happening. If we’ve cut someone out of our life, they aren’t existing. At least, we can behave as if they aren’t.

One could argue that it’s a form of dehumanization, one that’s hidden in plain sight.

And that, alongside all of the other reasons (or perhaps undergirding them), is the reason that I think being ghosted cuts us to the core; it brings into question the very reality of our existence.

‘Do you really believe that the moon only exists when you look at it?’

Einstein’s question may feel a little abstract but it’s actually as tangible and personal as it gets.

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.