My conversation with... Molly Worthen

Belle TIndall is fascinated by the intellectual fascination that drove Molly Worthen’s inquiry into faith.

Belle Tindall

Belle is the staff writer at Seen & Unseen.

A woman seated at a table gestures with both hands while talking

Can you think your way into Christianity?

Can your mind lead the way into something that transcends understanding?

Is it possible to ‘fake it until you make it’ when it comes to belief in God?

These are the questions that hold our conversation with Molly Worthen together. Molly, for those of you who aren’t yet acquainted with her work, is a journalist and associate professor of American history at the University of North Carolina at Chapel Hill. For the past decade, her intellectual sweet spot has been the religious and intellectual history of North America. Flowing from her fascinating research are books such as Apostles of Reason: The Crisis of Authority in American Evangelicalism, as well as pieces for the New York Times, The Atlantic and The New Yorker.

Intellectual fascination was her gateway into faith. She used homework, deadlines, schedules and challenges as tools with which she worked out and fine-tuned her beliefs.

In this episode of Re-Enchanting, Molly very generously walks us through her own story; from a child who would cover her ears when being read Bible stories, to a young adult who could relish the oddity of religious experience from a distance, to a journalist investigating various Christian communities, to a baptised Christian attending a mega-church. It’s quite the journey, but I shall leave it to Molly to unpack the full story, seen as she tells it with the vigour and detail of a historian.

I find Molly’s story captivating for many reasons, the primary one being that her intellectual fascination was her gateway into faith. She used homework, deadlines, schedules and challenges as tools with which she worked out and fine-tuned her beliefs. She says herself, ‘I needed to process to be rigorous’. How interesting is that?

Reflecting on the conversation that Justin and I had with Molly, I realise that there are three, rather distinct and yet wholly common, misconceptions about faith that she shatters. I don’t think that she was intending to, I’m not even sure that she was aware that she was doing it. But her fascinating crossing from agnostic to Christian has some interesting philosophical by-products.

She asserted that she didn’t want to ‘convert out of cowardice’ nor was she interested in succumbing to ‘a bribe’.

Firstly, the focused methodology with which Molly approached theism in general, and Christianity in particular, simply dispels the notion that a belief in God must render logic and reason redundant. On the contrary, Molly took step after considered step into her new-found set of Christian beliefs. Her story is one of measured assurance, of ‘not being 99.9 per cent’, but being ‘far north of 51 per cent’.

Secondly, Molly challenges the assumption that faith is sought out as a method of opting-out of the harshest parts of reality. That it’s held as some kind of cosmic ‘Get Out of Jail Free’ card – the ‘jail’ being whatever un-graspable, un-controllable, un-bearable aspect of reality sits most heavily upon us. There’s a common notion that religious people have found a coping mechanism, that they’ve institutionalised their denial and spiritualised their escapism. I’ve often found that notion an interesting one, mostly because I wish that it were true. But it doesn’t quite work that way. Believing in an all-seeing, all-knowing, all-loving God does not mean that one can avoid looking directly at suffering, pretend that it isn’t there, or that it somehow doesn’t ultimately matter. On the contrary, it often requires one to look at it, and wrestle with it, for longer. Nick Cave and Sean O’Hagan’s masterful Faith, Hope and Carnage is an ode to a belief system that resides in the midst of Nick Cave’s pain, as opposed to pulling him out of it. Molly, perhaps from all of her years of research, seemed to know this. She asserted that she didn’t want to ‘convert out of cowardice’ nor was she interested in succumbing to ‘a bribe’. Surely you are convinced by now that Molly Worthen is about as fascinating as it gets?

And finally, it was interesting to hear Molly speak of the choices, both micro and macro, that have led her to where she now finds herself. After all, faith is a choice. It reminds me of the philosopher, William James, who proposed that there are certain beliefs that can’t be evidenced until they are believed. For example, you cannot determine whether a chair will hold your weight until you sit on it believing (at least to a reasonable extent) that it can. This is partly (but profoundly) true of God; while one can ponder the empirical evidence for the existence of God for a lifetime, it is often the case that experiential evidence for God is available once you believe it. This doesn’t mean that belief must be a wholly blind choice, that would only negate my first point, but it is a choice. Again, Molly wonderfully encapsulated the tension of this notion in recalling that,

“what was really preventing me from engaging with this evidence is my own commitment to materialism and my own deep epistemological groove. But if I’m willing to suspend that, what happens?... You can walk right up to it and get to the point where you’re still faced with a leap of faith, but it’s no longer a ten-mile leap into the dark, it’s a leap based on a pretty reasonable body of evidence. And it turns out that to reject that leap is itself and act of faith.”

This episode of Re-Enchanting is a personal, and therefore profoundly interesting, one. We speak to Molly, not of how her field of work has been re-enchanted by the mystery and wonder of the Christian story, but how she has. And that makes this episode incredibly worth your time.

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.