Article

Culture

Politics

Re-enchanting

21 March 2024

6 min read

Re-enchanting councils - and glum councillors

Local government could be a place of humanity and beauty more than lifeless language and procedures.

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 marbles staircase rises on four sides of a chamber.

Glasgow City Chambers' staircase.

Michael D Beckwith, CC0, via Wikimedia Commons.

At the local level in politics, I have found there is a stereotype that persists more than that of the corrupt politician. It is the glum councillor, the pothole poser, or sometimes the councillor looking glum while pointing at potholes. These are the photos that turn up on election leaflets, and in local news, and there are lots of them here in Devon because potholes are numerous and huge.

When I was a district councillor, I tried to push back against this image – I would smile, avoid photos with potholes, share the good stuff found in the community alongside working to improve what wasn’t working. But, looking around the council chamber, it was hard to deny. Sometimes the glumness would slip into sleep; I’ve seen councillors prodded awake ahead of important votes that impact tens of thousands of people. That is not just glum councillor, that is irresponsible, disengaged councillor.

And though the responsibility lies with them, this never surprised me. In my four-year term, I too felt a disillusionment creep in. And I am perennially hopeful; my default is to see possibility. But four years in a context of budget cut after budget cut, endless bureaucracy, lifeless language, and an aversion to trying things differently, even I started to slump in my seat. I never fell asleep, but sometimes my soul did.

Author-farmer Wendell Berry – who speaks with much affection and wisdom about the importance and strength of local community – said that

“unlike the local community, the government and the economy cannot be served with affection, but only with professional zeal or professional boredom.”

I have seen that professional boredom in the language, in the sterile council chamber bare of life, where processes and procedures rule more than humanity; where passionate members of the public would attend meetings only to be told they couldn’t input because they hadn’t pre-registered; where a meeting that finished before the allocated time was seen as successful, regardless of content. I’m sure it should feel more hopeful, more vision-led, more life-giving to be involved in local decision-making – it should be about placemaking more than simply ticking boxes and balancing budgets.

There are, of course, councillors who care deeply, and there are councils where local decision-making is being reclaimed by to serve the local community, economy, identity – like the independent councillors elected onto the town council in Buckfastleigh in South Devon who made it more plain-speaking, more accessible and more engaged; and the Flatpack Democracy movement started in Frome Town Council that has sparked similar local ‘revolutions’. But I think there is something else needed, if local government is to replace lifelessness with hope and vision. Something more upstream of the how.

When the spirit of the age feels like cynicism more than delight, more than beauty, more than possibility, it impacts our relationships and the places that should thrive on good relationships like local government.

In his essay The Joys of Storytelling, Ben Okri says, “In a fractured age, when cynicism is god, here is a possible heresy: we live by stories, we also live in them...if we change the stories we live by, quite possibly we change our lives.” I would often imagine a story of local government that makes space for enchantment. Former monk Thomas Moore speaks of reenchanting as a reawakening to the depth of soul that embraces us and the world. Councils, like lots of spaces, feel disenchanted. Perhaps much of our current disenchantment is symptomatic of our alienation from ourselves, from each other, and from our shared humanity – and from the belief that this shared state of being is strong enough to take the weight of our world, even as heavy as it feels now. When the spirit of the age feels like cynicism more than delight, more than beauty, more than possibility, it impacts our relationships and the places that should thrive on good relationships like local government. Everything dulls; we disconnect from our spirit-breathed humanity, we forget that we were pulled from the soil by a gardener God who made us to be with each other, surrounded by beauty and life.

In the book Faith, Hope and Carnage, the musician and writer Nick Cave says that the “luminous and shocking beauty of the everyday is something I try to remain alert to, if only as an antidote to the chronic cynicism and disenchantment that seems to surround everything, these days. It tells me that, despite how debased or corrupt we are told humanity is and how degraded the world has become, it just keeps on being beautiful. It can’t help it.”

Cave’s words echo Dostoevsky who wrote in The Idiot that ‘the world will be saved by beauty’, which in turn, echoes earlier sentiments from the likes of Plato, Aristotle, and Thomas Aquinas who taught that God is truth, goodness and beauty. In the Bible, Jesus pointed again and again to these things too – in people, in creation, in God. They feel like good things to point the way now; more timeless and apolitical than any current ‘vision’ in government, more tangible than a distant government, more life-giving than purely balancing budgets as a goal. Of course, local government also needs better and more reliable funding, more efficient processes, passionate people, and lots more – but I think these things are more likely to come, in part, from a re-enchanted local government that draws on the “luminous and shocking beauty” of the everyday, and of local people and places. To start to make space for that re-enchantment, government could experiment with three things (which, more than funding, need people willing to try, to think beyond business-as-usual, to take existing resources and think about how they can be used even slightly differently).

It may not need to overcome death, but local government could embrace local people, their humanity, their aliveness.

First, it could move away from language that is detached from emotion and care and life. The word ‘enchant’ has its root in words – cantare means ‘to sing’ – Councils could aspire to make language beautiful more than bureaucratic, clear instead of obscure. It could invite local people into decision-making using life-giving and locally meaningful words and ideas, rather than excluding them with jargon and lifeless language. For this, we’d need the help of local storytellers, poets, writers, speakers – people who can wake us up with the power of words.

Second, local government could bring that “luminous beauty” into the space, rather than sealing conversations and processes away in characterless buildings. Meetings I’d go to were usually in bland rooms, with beige walls, nylon grey carpets, lukewarm coffee. Letting even some of the beauty of this world in – perhaps with colour, architecture, art; perhaps with stories and creativity and food; perhaps with some meetings outdoors in the beauty of the world – would, I think, breathe life into the space, and into relationships, and so into what becomes possible.

Lastly, re-enchanting local government must include re-humanising it, because humanity at its best is relationship and soul and care; it contains the same possibility that was present in Eden when all this was dreamed up. If, as Christians believe, humanity is made in God’s image, then God is endlessly creative; God is about the detail of our lives as well as world-shaking stories; God is about life – life that is so alive it overcomes death. It may not need to overcome death, but local government could embrace local people, their humanity, their aliveness; it could ask them to show up as themselves, with all their strengths and weaknesses, their ideas and hopes and fears, rather than shut them out because they cannot bend to inflexible meetings and procedures and language. It would not shy away from these things; it would use them to create new life and thriving places.

Re-enchanting local government could, I think, bring us closer to beauty, to the goodness of each other, to the truth of people and places. From there, I think it becomes possible to restore relationships, to imagine what government might be at its best, and to view it as a place-based way of knowing and actually serving people. I think it becomes easier from there to look downstream – to re-think processes, the voting system, and the rules of ‘business as usual’ – and perhaps even to fix potholes and the glumness that goes with them.

Article

Assisted dying

Care

Culture

Death & life

20 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.