Review

Culture

Politics

Trauma

1 October 2023

6 min read

The tragic heart of British politics

As political party conferences commence, Belle TIndall is riveted and repulsed by the scandals, toxicity and true tragedy at the heart of Rory Stewart’s memoir.

Belle Tindall

Belle is the staff writer at Seen & Unseen.

A suited politician stands looking pensive, framed by two out of focus audience members.

Rory Stewart at a 2018 diplomatic conference.

Foreign and Commonwealth Office, CC BY 2.0, via Wikimedia Commons.

11/22/63 is Stephen King’s masterful alternative-history novel; crafting a world where JFK had not been assassinated. The Man in the High Castle is Philip K. Dick’s offering, painting the literary picture of a world where the so-called ‘Axis States’ won WWII. And then there’s Kim Stanley Robinson who imagines what the past five centuries may have looked like had 99% of the European population been wiped out by the Black Death (as opposed to the far more factual 35%) in The Years of Rice and Salt.

These books re-imagine the past, the present, and the future through the lens of two expansive words: what if.

While reading Rory Stewart’s Politics on the Edge, I found myself constructing an alternative present, one where Rory Stewart is our Prime Minister. Now, I’m not comparing the 2019 Conservative Leadership Contest to the Black Death (although, it’s a little tempting), nor am I comparing myself to Stephen King. It’s just that those two words – what if – have been harassing me. What if Rory Stewart had won that contest?

Where would our relationship with the EU currently stand? How might the heights of the Pandemic have been handled? And how might our country have recovered from it differently? What about the refugee crisis? The economy? The war in Ukraine? The war in Artsakh? The climate crisis?

How would these things be different, for better or for worse, if Rory Stewart wasn’t currently the politically-exiled co-host of (the ridiculously successful) The Rest is Politics podcast, but was instead our head of Government? I don’t hold the answers, just a large heap of curiosity.

It’s a foolish kind of curiosity though, because Rory Stewart was never going to be our Prime Minister. And he’s generously offered us a 417-page-long explanation as to why.

The book is magnificent. There’s no two ways about it. Annoyingly, Rory Stewart can add ‘natural wordsmith’ to his impressive assemblage of titles.

At the age of just 37, Rory could already call himself an Oxford graduate, a soldier, an author, a long-distance walker (admittedly this title doesn’t sound as interesting as the others, but I assure you that it is), a Governor of a province in Iraq and a Harvard Professor. Surely these achievements meant that he already had material enough for six pretty interesting memoirs. But Rory had his sights set on the British political arena, which I suppose is a natural aspiration for a man who recalls that,

‘the only thing that had ever really motivated me since I was a small child was the idea of public service’.

With the benefit of a decade worth of hindsight, such a line makes you want to scream ‘DON’T DO IT RORY’ into the page. You can’t help but pre-emptively wince at the inevitability of this man’s naïve heart shattering, can you? After all, these words sit forebodingly in Chapter 2.

But, scream at the book all you want, a bright-eyed Rory Stewart walked into Parliament in 2010. And that’s where this tale of an eccentric, well-meaning, albeit overly romantic, ‘boy-ish man’ (his words, not mine) becomes ‘an excoriating picture of a shamefully dysfunctional political culture’ (Rowan Williams’ words, not mine).

The book is magnificent. There’s no two ways about it. Annoyingly, Rory Stewart can add ‘natural wordsmith’ to his impressive assemblage of titles. He doesn’t simply re-call his experiences, he re-crafts them. This means, for example, that instead of his first encounter with David Cameron reading like a download of the meeting’s minutes; readers are treated to knowing that Cameron was late, that his smile was notably ‘easy’, his hair notably ‘fine’, and his understanding of the situation in Afghanistan notably limited. We also get to smugly enjoy that he began the meeting (in Kabul) with a naff joke about William Hague that had tumble weeds rolling across the international boardroom. We relish this while pretending, of course, that we haven’t had those excruciating moments ourselves, which we all have, just with the luxury of not having Rory Stewart in the room. Rory’s writing abilities invite readers into those rooms and those moments, all of which are usually out-of-bounds. Which brings me onto the second reason why this memoir is an utterly gripping read: it holds almost nothing back.

Rory places his former bosses (who just happen to be our former Prime Ministers), former colleagues, and friends – many of which I worry will also be in the ‘former’ category once they read of their appearances in this memoir – on the alter. He sacrifices any confidence that they may have once held in him in the name of necessary exposure. He pre-empts their rage, simply responding that

‘Our government and parliament, which once had a reasonable claim to be the best in the world, is now in a shameful state… and generally, given the choice between discretion and honesty, I have chosen the latter.’

His most brutal exposures (although I don’t doubt that many will argue that ‘exposure’ is an unfair word to use here, seen as we only have one unverified account of things that happened) are that of David Cameron, Liz Truss and, of course, Boris Johnson (Theresa May actually comes off rather well in comparison).

David Cameron comes across as a factory-made career politician; with learnt confidence and charm, rigidly rehearsed opinions, and an ensemble of old Etonians ‘with floppy hair and open-necked white shirts’ at his side. Rory’s depiction of Liz truss, on the other hand, can be adequately summed up in his recounting of one particular instance. After telling her that his father had just died, Truss ‘paused for a moment, nodded, and asked when the twenty-five-year environment plan would be ready.’ And then, of course, there’s Rory’s ultimate archnemesis – Boris Johnson - who appears to be the epitome of everything that Rory Stewart believes to be toxic and shameful about the current state of British politics. He is ‘ever the punchline,’ the man who, upon hearing the outcome of the Brexit referendum, advised Rory that he ‘mustn’t believe a word I am about to say’ before ambiguously offering/un-offering him a position in his cabinet. A cabinet which did not yet exist, of course.

And that’s not to mention his opinions of Micheal Gove – who somehow comesoff even worse than Boris. The characterisations in this memoir are blistering, to put it mildly. All heroes need a villain, after all. And Rory considers these villains to be ‘senior enough to bear responsibility’.

Reading this book, and enjoying it, is a disconcerting experience. One cannot help but lap up the drama, while simultaneously despairing over it. It is a great read, but I don’t want it to be. I don’t want a book this scandalous, with characters this toxic, and storylines this riveting, to be about the place and people who govern my country, and therefore, me. Of course, the book is not wholly damning. Rory assures us that there were/are people within the system that genuinely do their best for the sake of public service – but they’re fighting against the tide. On the whole, it’s a bleak (albeit enthralling) picture that Rory paints.

Genuine virtue, humble introspection, and noble altruism are no longer workable attributes. Public service for public service’s sake will not get you the top job.

So, back to those alternative history ponderings. How would, how could, Rory have changed things from the top of the pyramid? The King of the Middle-Ground. The Voice of Reason. The Hope of the Centrist. What would it look like for him to have had his way?

Frustratingly, it doesn’t much matter – because, as I say, this man was never going to be the UK’s Prime Minister. Not wholly because of any one individual, or any one leadership campaign, but because if (and we must bear in mind that it’s a big if) Rory’s perception of high office in Parliament is accurate – there’s no place for someone like him. Authentic humanity, in all its varying forms, is unexpected, unappreciated, and certainly unwelcome in those spaces. According to this book, genuine virtue, humble introspection, and noble altruism are no longer workable attributes. Public service for public service’s sake will not get you the top job.

And that is the true tragedy at the heart of this memoir. The book that I revelled in. The book that I wish didn’t exist.

Oh, that future Rory Stewarts would leave a decade of politics with nothing interesting to write about. One can dream, I suppose.

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.