Article

Attention

Culture

Weirdness

Wildness

26 November 2024

6 min read

Take a walk: the world is weirder than you think it is

Psychogeography and the dark alleyways of the mind.

From Mockingbird

Mockingbird connects the Christian faith with the realities of everyday life.

A backlit person at twilight holds a hand out towards the camera, holding some fairly lights

Riccardo Annandale on Unsplash.

This article, by Blake Collier, first appeared in Mockingbird. Published by kind permission.

Entre chien et loup.

The phrase literally means “between dog and wolf” and has most immanently been used to describe the twilight hour where day and night intermingle before night fully takes hold.

Jean Pruvost, a linguist who has studied the expression, gave some background on ‘entre chien et loup.’ He says it comes from a Latin phrase, intra hora vespertina inter canem et lupum, that dates back to at least the seventh century. And it refers to the time when the daylight dims and you could mistake a dog for a wolf.

One could imagine before the advent of electricity and modern public lighting how ambiguous this time of day could be as the landscapes around your small village were being consumed by the darkness — the human eye not fully able to calibrate fully for day or for night, hence the inability to distinguish between a friendly pet and a looming threat.

This is what is popularly known as liminal space in our current epoch. This liminality is always present, however, not just at dusk. As we move through the worlds we inhabit, whether natural or built, we are constantly finding ourselves within transition or transformation. Psychogeography is a broader term that is often used to investigate the liminal movement of bodies through space. In its most simplistic form, it is how our mind interacts with and processes the physical landscapes that we inhabit and how those landscapes affect our mind. The actual history of the term is much more complicated — honestly, convoluted — however at its core it is scratching at the nebulosity of things like entre chien et loup.

At the outskirts of a city or town, one begins to see the fraying of the edges, those areas where we have yet to fully enact our illusory control over the land.

About seven or eight years ago at the height of my running prowess, I got up one Friday morning very early and started a ten-mile run I had planned around nearly the full border of my hometown of Canyon, Texas. I did not know if I would make it the whole way, but the intent was there and the map was set. However, something interesting happened as I began plodding down my route. Those lines that show up on our maps often engender varying qualities of trails. Most of the time I was hitting asphalt and sidewalks, but when you are following a broad circle around a town, it’s not uncommon to find ambiguous stretches between incorporated and unincorporated parts of the town. Somewhere within the first mile or two, one of the “roads” I had included on my path ended up being nothing more than a worn trail through prairieland behind a group of houses.

I bring this story up because, though I did not know it then, I was enacting a psychogeographic practice. Iain Sinclair, who is probably one of the most well-known proponents of modern psychogeography, walked the M25 around London in seven different treks over a time period. The M25 is a 125-mile loop around London and is considered one of the busiest highways in the world. As he ambled along the highway — sometimes on asphalt, sometime “around” the trace of the highway — he would take note of what he saw, and he eventually wrote the book London Orbital. This practice allowed him to see London in a new way because at the outskirts of a city or town, one begins to see the fraying of the edges, those areas where we have yet to fully enact our illusory control over the land. They have neither been captured by urban sprawl nor have they been renovated and gentrified. These lacunae are ambiguous regions between the built and unbuilt (or decayed). Once again, we are placing ourselves intentionally into places where we attend to the ley lines which connect the physical markers to the perceived or imagined topographies of the places where we exist.

To put it bluntly, being intentionally attentive to surroundings can trigger investigations into the seen and unseen powers that hole up in our built environments and the natural world that pushes back against it.

The path through the prairieland I spoke of earlier ended at a concrete curb and a recently repaved residential street that ran right next to a Catholic church, almost like the church was posting itself on the fringes of the town to warn of impending threat, or perhaps giving a welcome sight to a weary traveler. I suppose it depends on how you look at it.

Yet it is exactly this work of attending to where we live and reacquainting ourselves with it that is, I believe, at the heart of this purposeful ambulation through space. Our lives fall into banality most of the time. We take everything for granted and we see our lived environment through that myopic lens. But take a walk on the outskirts of where you live, without a phone or music or any other technological mediation, and just look around the space and pay attention to how it embroils your emotions. I can nearly guarantee that you will find the place you live is much weirder than you thought it was, and you might even learn a thing or two about what your place values. I knew that Catholic church was in that general area of that path, but I didn’t realize how that path would empty me out before its hallowed presence.

However, as I thought about it, it made sense that in this community the Catholic church would be found on the edges of the town. There are somewhere around ten other churches in a town of about 17,000 all of which are Protestant. However, if you go just ten or eleven miles west to the town of Umbarger, the roles are reversed. There is still one Catholic church, but as far as I know no Protestant churches. Merlin Coverley, in his book tracing the history of psychogeography, finds that “contemporary psychogeography as closely resembles a form of local history as it does a geographical exploration.” One could take the observations from their ambulation and dig into their place’s past to see why this might be the case. However, this is very much the chien of this psychological study of environment.

What about the loup? Psychogeography has always had connections to the occult and the weird. Coverley continues later in his book,

“Here, then, we find all the features ascribed to psychogeography today: the mental traveler who remakes the city in accordance with his own imagination is allied to the urban wanderer who drifts through the city streets; the political radicalism that seeks to overthrow the established order of the day is tempered by the awareness of the city as eternal and unchanging; and the use of occult symbolism reflects the precedence given to the subjective and the anti-rational over more systematic modes of thought.”

All of this is to say that what we might find out about the place we live in when we give ourselves to its fringes and walk its shores might have a darker tone which implicates local politics and powers. Perhaps we will even find ourselves confronted by a metamorphosis which changes the very way we live, work, and move in these places.

Sinclair’s earlier work Lud Heat in 1975 set out to remap London by way of connecting London’s churches built by eighteenth-century architect Nicholas Hawksmoor and their odd loci to numerous prominent murders like the Radcliffe Highway Murders and those by Jack the Ripper. There is a thread that ties some of the imagery Hawksmoor used in his churches to ancient Pagan symbolism. To put it bluntly, being intentionally attentive to surroundings can trigger investigations into the seen and unseen powers that hole up in our built environments and the natural world that pushes back against it.

If nothing else, this study of the ambiguous transgressions between mind and place helps us bring a new profundity to our existence. It psychologically brings us back to a place where our intellectual, physical, and technological prowess cannot protect us from the hairs that stand on the back of our necks. Because everything, if attended to perceptively, can be seen as a dog or a wolf. And that should give us great pause in the everyday grind of our lives.

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.