Review

Culture

Music

23 September 2023

6 min read

Imagining our heart’s fragile condition

The songs and sketches of Paul Simon and Charlie Mackesy invites us to seek out sacred answers. Belle Tindall reviews their Sevens Psalms collaboration.

Belle Tindall

Belle is the staff writer at Seen & Unseen.

A illustration of a boy sitting in a field with his back to us, above him is a heart shaped cloud.

Paul Simon’s Seven Psalms – Illustrated by Charlie Mackesy.

No.9 Cork Street Gallery

Paul Simon and Charlie Mackesy are the duo we didn’t know we were missing. Well, their collaboration means that we need miss them no longer. In their joint exhibition in Mayfair, Charlie’s artwork is a visual tool with which to ponder Paul Simon’s latest body of work.

Simon and Mackesy

I once read that if you’re looking for the answer to the meaning of life in a pop song, look to Paul Simon. I think whoever wrote that is right. His best-known songs are now decades old, but it doesn’t seem to matter - they’re timeless. And maybe that’s why; he has always written of permanent and universal things.

For example - You may think that he’s crafted an ambiguous tale about two mischievous childhood friends who used to wreak havoc 'down by the schoolyard’, but what he’s actually offered us is a song that gives language to the unexpected and unknown aspects of life. The times that feel like a pathless expanse, the moments that knock us off course, the occasions where we are forced to admit that ‘we don’t know where we’re goin’, but we’re on our way… ’.

And what may, at first glance, appear to be a direct message to an iconic character in The Graduate (Mrs Robinson) or a New York Yankees player (Joe DiMaggio), is actually a song that mourns a loss on behalf of us all. It laments the disappearing of ‘grace, dignity, privacy and fidelity’ in public life – the attributes that ‘our nation turns its lonely eyes to…’

You get the sense that Paul Simon tells the truth, even when he’s spinning a tale.

And then, every now and again, he strips away the fictitious and releases the hymn-like ‘Bridge Over Troubled Water’ or the haunting ‘Sound of Silence’, reminding us that he is concerned with the deepest and truest aspects of existence. His latest body of work, Seven Psalms, is one such offering. But before delving into it, there’s Charlie Mackesy to consider.

Mackesy is an artist who diagnoses our wounds and heals them all at once. As discussed at length in a previous article about his immense impact, his work offers an antidote to our loud and crowded lives. His modern fable - The Boy, the Mole, The Fox, and the Horse - allows us to escape into a fictitious world that feels so much kinder than our own, while also acting as a tool for deep introspection. Charlie puts language and image to our heart’s beautiful yet fragile condition.

And this is undoubtedly why his work has garnered such incredible success. His film is Oscar-winning, his book is best-selling, and his paintings are a fixture of this cultural moment. Charlie’s thoughts adorn therapy waiting rooms, his words are taught in school classrooms, and his images are simply everywhere. It’s hard to think of someone to whom the world is more openly and obviously grateful.

And there we have it: the duo that dreams are made of (it feels appropriate to give Art Garfunkel an honourable mention at this point - what is it with Paul Simon and iconic twosomes?). Now, without further ado, onto their recent collaboration.

Seven Psalms

Seven Psalms is a thirty-three-minute-long body of work. I reference the length, as opposed to the number of tracks, because Simon has released it as one continuous suite of songs; un-skippable and un-shuffle-able. The album makes the most sense as a whole, as a continuation, as a journey. The listener is not in control of how it is listened to, rather, they are tasked with letting it wash over them. They must surrender to Simon’s stream of thought and follow his ponderings to their end. It’s interesting how much un-learning that takes.

I’m no music critic, so I will leave the delineation of the technical details and musical mastery to Rolling Stone, and instead focus my attention on the profoundly spiritual dimensions of this body of work.

And with such, it is hard to know where to begin. There is not one song, in fact, there is not one line, that is not dripping with theological thought. I’m not sure how to sum it up, except to re-iterate Paul’s own understanding of what he has crafted – he has written seven Psalms.

The first song in the interlinked line-up is ‘The Lord’. The chorus of which goes like this:

The Lord is my engineer

The Lord is the earth I ride on

The Lord is the face in the atmosphere

The path that I slip and slide on

These four lines, a re-working of which re-appear as interludes throughout the album, are not pondering the existence of God (which, as Francis Spufford often says, ‘is surely his most boring characteristic’), but the nature of God. This album assumes God’s existence, in fact, it completely hinges upon it. Therefore, it is questions such as - How does he work? How is he present? How do we experience him? How can we perceive him? – that are held within these lyrics.

It seems to me that those are also the questions that Charlie is pondering in the drawings that adorn the walls of Frieze Gallery. Each one is unmistakably a ‘Mackesy’ piece, he is easily identifiable, it is as if he leaves a piece of himself in every frame. What I found particularly interesting about this collection of work, all of which were created in response to him listening to Seven Psalms, is his use of clouds. They are not an uncommon feature in Charlie’s work, but in this context, they caught my attention afresh.

Both the songs and the accompanying sketches create an atmosphere that invites us to seek out sacred answers, to take the time (thirty-three minutes to be precise) to ponder truth and ask the most vulnerable of questions. We see strikingly simple silhouettes of people doing just that in Mackesy’s work, and they’re almost always doing so underneath an imposing canopy of clouds. Clouds that look dark and heavy, clouds that look so light they’re touchable, clouds that are formed in the shape of a heart, even. They vary, but they’re almost always there. I could be wrong, but I don’t think Charlie thinks that we ponder such things alone – his drawings make it seem as though whoever is ‘above’ stoops down to engage in our pondering. If there is a God, he listens in. If Heaven exists, it comes close.

And that, just from his use of clouds. I could write a whole other piece on his use of ‘posture’, and then another on colour. But perhaps you should just go and see for yourself.

Seven Psalms asks the permanent questions, the ones that transcend time, space, and matter. But it doesn’t exist in a vacuum. On the contrary, it is time-stamped for this moment. One of the most striking lines declares that ‘the Covid virus is the Lord’, as is ‘a meal for the poorest of the poor’, ‘an open door to the stranger’ and ‘the ocean rising’. The questions that Paul Simon asks of God directly relate to the questions he then asks about us and this earth we call our home – social justice, ecology, community – his perspectives on such things all seem flow from who the ‘Lord is’. Or perhaps it’s the other way around, the genius is that we’ll never know.

Again, Charlie’s sketches of bustling refugees all walking in the same direction or a mother hitchhiking with her child on what looks to be a bitterly wintry night, lead us to sit with the very same thoughts.

Truthfully, I am all too aware of how inadequate this, or any, review of this collaboration is doomed to be. Paul Simon knew this album transcended words, that’s why he called upon the genius of Charlie Mackesy. So, do yourselves the most profound of favours and spend thirty-three minutes in their company. I say thirty-three minutes, be warned, the impact of their work will reside with you for far longer.

‘Seven Psalms: Illustrated by Charlie Mackesy and Inspired by the Words and Music of Paul Simon’ is a free public exhibition that is running Tuesday-Saturday until the 27th of September 2023, at Frieze Gallery, No.9 Cork Street, Mayfair, London.

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.