Status, grievance and resentment: C.S. Lewis on the surprisingly modern business model of hell

60 years after its author’s death, The Screwtape Letters image of hell as an unscrupulous business is still relevant. Simon Horobin tells how C.S. Lewis came to author the influential bestseller.

Simon Horobin

Simon Horobin is Professor of English Language & Literature, Magdalen College, Oxford University.

A comic book style cartoon of a small squat devil looking quizzed in hell.

A scene from Marvel Comic's version of The Screwtape Letters.

November 22nd is the sixtieth anniversary of the death of C.S. Lewis, an event that was overshadowed by the assassination of JFK on the same day. Although he is best known today as the author of the Narnia stories, the obituary that appeared in The Times newspaper a few days later noted that it was in fact The Screwtape Letters which sparked his success as a writer.

Initially published as a series of letters in the church newspaper The Guardian, The Screwtape Letters appeared in book form in 1942. The idea came to Lewis during an uninspiring sermon at Lewis’s local parish church in the Oxford suburb of Headington, in July 1940. Provisionally titled ‘As one Devil to Another’, the book would form a series of letters addressed to a novice devil, called Wormwood, beginning work on tempting his first patient, by an older, retired devil, called Screwtape. In finding Screwtape’s voice, Lewis was influenced by a speech given by Adolf Hitler at the Reichstag and broadcast by the BBC. What struck Lewis about the oration was how easy it was, while listening to the Führer speaking, to find oneself wavering just a little.

Lewis dedicated the volume to his friend and fellow Oxford academic, J.R.R. Tolkien. After Lewis’s death, having read an obituary in the Daily Telegraph claiming that Lewis was never fond of the book, Tolkien noted drily:

‘He dedicated it to me. I wondered why. Now I know.’

Despite Tolkien’s misgivings, the public devoured the work and it quickly became a bestseller. Although, as Lewis pointed out, numbers of sales can be misleading. A probationer nurse who had read the book told Lewis that she had chosen it from a list of set texts of which she had been told to read one in order to mention it at an interview. ‘And you chose Screwtape?’, said Lewis with some pride. ‘Well, of course’, she replied, ‘it was the shortest’.

Not all readers approved of its sentiments. A country clergyman wrote to the editor of The Guardian withdrawing his subscription on the grounds that much of the advice the letters offered seemed to him not only erroneous but positively diabolical. The confusion no doubt arose from the lack of any explanation surrounding their circumstances; in a later preface Lewis gave more context, though refused to explain how this devilish correspondence had come into his hands.

Its publication by Macmillan in 1943 brought Lewis to the attention of readers in the United States; when Time magazine featured an interview with him in September 1947, it carried the title ‘Don v. Devil’. A picture of Lewis featured on the magazine’s cover, with a comic image of Satan, complete with horns, elongated nose and chin, and clutching a pitchfork, standing on his shoulder.

For Lewis, the war did not present a radically different situation, but rather aggravated and clarified the human condition so that it could no longer be ignored.

The Screwtape Letters are the product of the war years, during which Lewis wrote many of his most popular works. It was in 1941 that he delivered the first of his broadcasts for the BBC Home Service, which launched his career as a public apologist for the Christian faith. In 1942 Lewis published Perelandra, the sequel to his first space travel novel Out of the Silent Planet (1938), in which his hero, Elwin Ransom, a Cambridge philologist – another nod to Tolkien – is summoned to Venus to prevent a second fall. Although it was published in 1950, The Lion, the Witch and the Wardrobe begins with four children being evacuated to the countryside to escape the London blitz. In setting his stories in outer-space or the fantastical world of Narnia, Lewis could be accused of writing escapist fiction that avoided the realities of a world in conflict. Lewis, however, believed that the war had not created a new crisis, but rather brought into clearer focus an ever-present struggle between good and evil.

For Lewis, the war did not present a radically different situation, but rather aggravated and clarified the human condition so that it could no longer be ignored. As he remarked in the second of his Broadcast Talks:

‘Enemy-occupied territory – that is what this world is. Christianity is the story of how the rightful king has landed, you might say landed in disguise, and is calling us all to take part in a great campaign of sabotage’.

The key point, writes Screwtape, is to fix the patient’s attention on ‘real life’ – but don’t let him question what he means by ‘real’.

Lewis’s message to a country living in fear of occupation by German troops was that the invasion had already happened. They had been summoned not to their country’s defence, but to its liberation. When the Pevensie children stumble into a snow-covered Narnia under the control of the tyrannical White Witch, they are told in hushed whispers of the rumours of Aslan’s return: ‘“They say Aslan is on the move—perhaps has already landed.”’ It is a reminder that Aslan enters Narnia as a rebel, intent on overthrowing the Witch and installing the rightful kings and queens on the thrones of Cair Paravel.

The Screwtape Letters do not ignore the war during which they were written; Wormwood’s patient is killed in the London bombing. But, for Screwtape, a war is of no value unless it results in winning souls for his Father Below. His advice to his nephew is concerned with diverting the patient from engaging with universal questions by distracting him with everyday preoccupations and sense experiences. While these might involve the immediate conflict, they could also be the excitement of a new romance, a falling out with a friend, the prospect of promotion, or an obsession with food. If the patient should begin to speculate about spiritual matters, Screwtape advises Wormwood to deflect him with academic theories and philosophies that avoid confronting the question of whether the Christian faith might actually be true. The key point, writes Screwtape, is to fix the patient’s attention on ‘real life’ – but don’t let him question what he means by ‘real’. It is ironic, Screwtape observes, that, while mortals typically picture devils putting ideas into their minds, their best work is done by keeping things out.

Despite numerous requests for sequels, Lewis was reluctant to twist his mind back into the ‘diabolical attitude’ and revisit the spiritual cramp it produced. Numerous spin-offs have appeared to fill the void, with Screwtape emails, audio and stage performances and even a Marvel comic book adaptation. Despite this, readers continue to turn to the original work. After all, Lewis’s depiction of hell as an unscrupulous business concern, whose employees are perpetually concerned about their own status, nursing grievances and resentment, speaks to our modern age just as much as it did to Lewis’s own.

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.