Our human tribe

A famed photographer's exhibition about Amazonia prompts Jane Cacouris to consider the wider issues.

Jane Cacouris

Jane Cacouris is a writer and consultant working in international development on environment, poverty and livelihood issues.

Amazonia from the air.

Neil Palmer/CIAT, Wikimedia Commons.

'What drew me back to the Amazon? …it was to savour afresh the unparalleled beauty of this vast region. For me, it is a last frontier, a mysterious universe of its own, where the immense power of nature can be felt as nowhere else on earth.'

These are the words of world renowned Brazilian photographer, Sebastião Salgado, in the foreword of his book, Amazônia. Over a period of six years, Salgado travelled around the Brazilian Amazon photographing its sweeping landscapes: forests, rivers, mountains, as well as the people who live there. A photograph of a Yanomani tribe on the edge of a vast vista with a towering mountain shrouded in cloud in the distance is an extraordinary snapshot of his travels. Salgado documented the daily lives of a dozen indigenous tribes, capturing on camera their warm family bonds, traditional dances and rituals, the artistry of their body painting and means of survival – hunting and fishing. Although Salgado was unable to communicate by speaking to the tribes he visited, he describes vividly how the human emotions he shared with his hosts - to love, laugh, cry and to feel happy or angry – served as their common language. He says:

I felt at home in my own tribe, that of all humans, where myriad systems of logic and reason are interwoven with my own, with those of Homo Sapiens.

During a recent trip to Rio de Janeiro in Brazil, I visited Salgado’s Amazônia exhibition at the Museu do Amanhã (Museum of Tomorrow) in the centre of the city. The photographs are awe inspiring, all in black and white. They depict lush rainforest vegetation, winding rivers and waterfalls. Beautiful people with dark eyes, mainly naked, dressed, feathered and painted according to their tribal traditions sit against a black canvas backdrop or are portrayed in their natural surroundings. Salgado’s talent lies in capturing the epic beauty of the region’s landscapes, but also the delicate detail of the individual faces of the people he photographs. Each person looked straight at the camera lens – and as I looked back at them, it was as if I could see a little of their soul and personality. To the right of each portrait is the name of the person, and a note about their role in the tribe; a reminder that each face is not just a stunning photograph, but a human being who is valued and respected.

But Salgado’s portrayal of the Amazon rainforest, often referred to as “the world’s lung,” is not simply remarkable visual artistry. It is a powerful reminder of a number of issues that we collectively face today as a global tribe of human beings.

For over 10,000 years, humans have enjoyed an inter-connectedness with our natural environment, tending and living off the land. And this is still the case with the Amazonian tribes who rely so tangibly on tapping into the rainforest’s renewable wealth and provision – its animals, fruit, nuts and medicinal plants. A growing body of evidence shows that globally, indigenous people are especially good at sustainably protecting their territories. This is no exception in the Amazon; the indigenous reserves legally ringfenced by the Brazilian government are the areas that are most pristine. The areas where tribes have been driven out have been damaged irretrievably.

With our human quest to develop, the past two hundred years has seen a slow positive global trajectory towards eliminating absolute poverty, reducing conflicts and improving human rights. Encouraging on paper. But this positive change has come at a huge cost to our environment. Ironically, the same expanding global economy which has driven improvements in development and social justice, is based on fossil fuels and high consumption of natural resources causing climate change, mass extinctions and pollution. The results of these changes are hitting the world’s poorest communities the hardest – those who have done the least to cause them. The delicate balance that has existed between humans and our natural environment for millennia is being thrown out of kilter.

COP27, the annual UN global climate conference took place in Egypt at the end of 2022 and the impact of the climate crisis on vulnerable countries was finally on the agenda. It is promising to see growing public support from across the world for action. More people than ever before – including Christians and churches – are speaking up for climate justice, campaigning, joining marches and praying for change. Christian NGOs and pressure groups, such as Tearfund, Christian Action, and World Vision to name a few, are often at the forefront of climate campaigns.

So why are Christians calling for climate action? First, it’s an issue of ownership. As campaigner Ruth Valerio explains: the Bible tells them that creation was made by Jesus, through Jesus and for Jesus. Therefore, this world that was made brimming with abundance and vitality has immense value to God. The world is not ours to do with as we please, it belongs to its creator who has entrusted it to humans to care for. Second, it’s an issue of justice. The outworking of climate breakdown, such as global temperatures rising, floods, drought and extreme weather events has a disproportionate impact on people in poverty and who are already vulnerable, affecting their livelihoods, health and security. Christians believe that we’re all made ’in the image of God’. This speaks powerfully of equality between each one of us within our global human tribe.

Therefore acting justly means responding to the needs of our global neighbours, not only our immediate communities. The Bible says ‘Speak up and judge fairly; defend the rights of the poor and needy’. Christians – especially those living in privileged countries with social safety nets and funds to invest in climate resilience – are asked to stand up for equality and justice, calling on those in positions of power to make decisions that protect those who are more vulnerable, as well as this Earth that belongs to God.

At COP27 these Christian groups joined with countries vulnerable to the impacts of climate change to call for justice in climate financing. It’s a simple but radical case of compensation; rich nations who have already used far more than their fair share of carbon to develop their economies should now pay for the unavoidable “loss and damage” experienced by those whose homes, livelihoods and even lives are being lost as a result of the climate crisis. The protection of the Amazon also remains a critical theme.

Addressing the COP27 conference, Brazilian President Elect Lula said,

There is no climate security for the world without a protected Amazon.

Visiting the Amazon rainforest with my family in 2019 I was stunned, like Salgado, by its majesty and magnitude. Sleek, dark waters teeming with fish and crocodiles, trees with trunks that curved and curled, and the cacophony of sounds and song – amphibians, birds and beasts - that accompanied the sudden blackness of the night that fell like a curtain. This is creation as God meant it to be – in all its life and vitality. Can our vast human tribe, scattered and concentrated across the earth, who all laugh and cry and love under this single sky, unite and make the critical decisions needed to care for each other and our world? The protection of Amazonia is only one part of the solution, but it’s an integral part. So will we act? Before it’s too late and Salgado’s extraordinary photographs become simply a segment of history showing future generations the way it used to be?

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.