Essay

Culture

Re-enchanting

11 April 2023

7 min read

A place on Earth

Pondering the power of a place, Elizabeth Wainwright believes it roots us and asks us to play our part here and beyond.

Elizabeth Wainwright

Elizabeth Wainwright is a writer, coach and walking guide. She's a former district councillor and has a background in international development.

A ploughed field of red soil is in the foreground, sloping down into a valley with a track and green fields beyond

Red Devon soil near South Hams.

Tony Atkin, CC BY-SA 2.0, via Wikimedia Commons.

“Different places on the face of the earth have different vibrations, different polarity with different stars. Call it what you like, but the spirit of place is a great reality.”

DH Lawrence

I hoped it would be a David and Goliath story – big national developers, small local community, the community wins, the developers leave town. Instead, the application for almost 300 uninspired and loveless houses passed despite concerns over affordability, wildlife enhancement, and lack of green infrastructure. As an elected District Councillor, I spoke my concerns alongside residents. Some improvements were made, but the story is now a familiar one: the planning committee recognised the concerns, but felt their hands were tied – if they refused permission, the wealthy developer would appeal, and probably win, and our District Council would have to pay costs from its ever-dwindling budget.

Developers are invested financially in a place, but not relationally or ecologically. The land becomes a blank canvas; the otters, oaks and fertile soils are an inconvenience which can be replaced with some token tree planting and bat boxes afterwards, in the name of ‘development’ (a slippery idea that is often interpreted as profit rather than value). The layers of the place – of farming and memory, of community and care and stories through seasons – are invisible to distant developers, but not to those who have eyes to see.

I have been trying to see the layers in these Devon lands where the soils are red, and where the farmers are still “buried deep in their valleys, in undateable cob-walled farms…connected by the inexplicable, Devonshire high-banked, deep-cut lanes…” as poet Ted Hughes observed. Unearthing the layers of a place can lead to topophilia – a bond we feel with its emotion, memory, geography, heritage. I’ve felt pulled instantly to places before – Scottish islands, Zambian savannahs (the pull to Zambia eventually led me to live and work there, and now I feel folded into its red soils just as I am into the red soils of Devon). But I think topophilia is different, more gradual, a slow intertwining of roots as a place becomes known to us. Whether instant pull or slow-burning topophilia, I’ve been thinking about place, and why it matters.

When the global is often more glamorous than the quiet hush of the deeply rooted local, knowledge of and respect for place feels rebellious but vital.

God’s first words to humans were to Adam and Eve in the Garden of Eden near the Tree of Life: “Where are you?” They were hiding, ashamed of their nakedness. He could not find them. Where are you? In an increasingly remote and rootless age, with access to everyone and everything 24/7 yet loneliness still on the rise, perhaps this question is one to consider anew. When borderless corporations can be more influential than governments, and when the global is often more glamorous than the quiet hush of the deeply rooted local, knowledge of and respect for place feels rebellious but vital. Kentucky farmer and author Wendell Berry knows this:

“…one cannot live in the world; that is, one cannot become, in the easy, generalizing sense with which the phrase is commonly used, a "world citizen." There can be no such thing as a "global village." No matter how much one may love the world as a whole, one can live fully in it only by living responsibly in some small part of it. Where we live and who we live there with define the terms of our relationship to the world and to humanity.”

I have long admired Berry’s writing, and his choice to care for a patch of Kentucky land. His is no bucolic rural idyll – his, for decades, has been a cry for re-rooting and for neighbourliness, because “it all turns on affection” and because that is how the world is made and remade; through imperfect places and the encounters in them. We are situated in a landscape, and it is through this particularity that we engage with creation. We exist at the scale of human relationship, in this place, amongst these people, in this time. The grass may seem greener elsewhere, but the grass here is green nonetheless – and greener still when I stare at it, and get curious about it, and get to know the many years and hands that have tended it, and take part in tending it myself.

The cornerstone of the Christian story is that Jesus came into the world as a human. And humans exist in place. In the short documentary Godspeed, Alan Torrance – a giant, kilted, red-haired Scottish man – shared that the reason he came to believe in Jesus as an adult was not because of theology or preaching, but because of the scale of the map in the back of a Bible. The map depicted the area where Jesus lived – the north edge of the sea of Galilee. It was the same scale as the place Alan lived in Scotland. He knew that relationship and community mattered (“we’re not rich folk, but to me you’re poor if you cannot offer hospitality”) – he knew that Jesus would have been found out if he were a fraud. God didn’t just come into the world; he came into a place built on relationships. It wasn’t theology that changed Alan’s mind about Jesus, it was a map of a particular place.

Nature writing… a genre that explores the natural world, often through authors’ relationship to particular places, and often touching on the numinous and unseen.

In the Bible and I think in life, God – or some sense of the divine – is often encountered not only in a particular place, but in the natural world there – a garden, a burning bush, a desert wilderness. Throughout the Bible from Genesis on, we are called in different ways to care for the natural world, to treat it as a gift, to treat it as if God might be found there. But it is often the secular world that most passionately calls us to reconnect, to care, to pay attention to the natural world. I’ve seen this in campaigns, in popular media, and in ‘nature writing’ which takes a prominent place in bookshops; it’s a genre that explores the natural world, often through authors’ relationship to particular places, and often touching on the numinous and unseen. The Bible could easily be classified as nature writing, or place writing, or poetry – writing of wonder that might re-enchant us in a tired age – but instead it is restricted to the religion or theology shelves, and its wild rooted transcendence goes unheard by people of faith and no faith.

That rooted transcendence that I see in the Bible is something I see in the places I know too. The root of the world ‘parish’ links to both ‘neighbour’ and ‘soujourner’ – ideas that speak simultaneously of being here and reaching beyond. My parish in Devon asks me to listen, to know, to be known – to be a neighbour. But it also asks me to use the nourishment of these deepening roots to reach, to not cling too tightly to ideas of ownership, to face the world and offer love. Berry says,

“I take literally the statement in the Gospel of John that God loves the world. I believe that the world was created and approved by love, that it subsists, coheres, and endures by love, and that, insofar as it is redeemable, it can be redeemed only by love. I believe that divine love, incarnate and indwelling in the world, summons the world always toward wholeness…"

I think knowing our place is important today – because it roots us, and asks us to play our part in the ongoing incarnation of love.

The wholeness and healing of the world depends on love incarnate and indwelling. Love is not a theology, or a card on Valentine’s day, or any of the other packages it gets squashed into. Love created the world, and has the power to keep doing so if we let it. Love dwells incarnate in a place, in the people and encounters in that place – it can be messy and confronting as well as life-giving and transforming. We draw from and add to its deep well, and by doing so, heal the world starting right where we are. That’s why I think knowing our place is important today – because it roots us, and asks us to play our part in the ongoing incarnation of love, and so in the ongoing becoming of the world.

My discovering the world has included travelling and working throughout it – but now the discovery comes through a small imperfect parish in a district in Devon that is shining and struggling all at once, where stories run deep. My husband and I and our soon-to-arrive baby are beginning to hear them. I feel layers of emotion, history, and memory here; I am trying to invest in its hope and reality, to be present in its here-ness and now-ness. I will always love visiting new places and feel a pull to other places. But in this place, when I look and listen and know and be known, I find love indwelling and incarnate. It’s in the hedges, the neighbours, the birds that sit and sing about things we can’t hear, the communities that come together to resist placeless loveless development. It’s in the foodbank, the fields, the relationships that can start off challenging but which soften and deepen over time and despite difference. At a time when I think God is asking us again “where are you?” how good to be able to answer, here, in this imperfect place, where love dwells.

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.