Review

Confession

Culture

Grenfell disaster

Penitence

7 May 2023

7 min read

Watching Grenfell: the lost art of penitence

As the Grenfell Inquiry reports, Graham Tomlin recalls a remarkable film that brought home the horror of what happened

Graham Tomlin

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

An aerial view across West London towards Grenfell Tower

Courtesy the artist - Steve McQueen, Grenfell, 2019, via Serpentine Galleries.

The camera looks down over fields, the green and pleasant land of England far below. It moves slowly over the landscape until gradually it begins fly over the streets and parks of North London, past Wembley Stadium with its well-known arch, curving into the sky and back down again, and finally, as the urban sounds grow louder, it begins to home in on a small dark rectangular spot in the centre of the screen. As it gets closer, the familiar outline becomes clear. It is Grenfell Tower.

Today when you go past the Tower, just off the Westway, a major road artery into central London, the Tower, or at least the remains of it, is covered in white plastic sheeting. It’s a kind of compromise between those local people who can’t bear to look at it every day, and those who want it to remain visible as a stark monument to the injustice and greed that led to the fire that killed 72 people in June 2017.

Steve McQueen is a Londoner, a well-known filmmaker, Director of 12 Years a Slave and winner of the Turner Prize. As the plastic sheeting was about to go up to hide the grim nakedness of the Tower, he wanted to ensure the story of Grenfell was not forgotten, so filmed the building in January 2019 just as the ghostly shroud begun to creep up the side of the building. His remarkable film, simply called Grenfell, has been showing at the Serpentine Galleries in Hyde Park. He recently voiced dismay that few politicians had come to see the film, despite being invited. They really missed something.

As the camera revolves around the Tower, there is no sound, no commentary at all, as if there are no words to describe what happened here.

The camera homes in on the tower, and gradually begins to rotate slowly around it. We peer into the rooms of this tall, charred block, standing like a black cliff face, a literal tomb in the heart of London. Behind it, there is the gleaming shining face of the Westfield shopping centre, cars driving up and down the slick dual carriageway that flows past it, but the focus is relentlessly on the horror of the Tower in front of us. The camera goes round and round, occasionally drawing out, but then being drawn back in, mesmerised by the blackness, the darkness, the shell of the Tower and the ghosts of the lives it destroyed.

Watching it brings on a mixture of fascination and nausea. Nausea from the relentless circular motion of the camera. Fascination at the details – pink plastic bags of debris in what was someone’s living room; the remains of a kitchen cabinet that had somehow survived the inferno. And for me personally, as the Bishop of Kensington at the time, memories of being there on the day, watching the tower burn; talking and praying with dazed survivors, evacuated from the blocks around Grenfell; listening to firefighters with the agonising dilemmas of trying to reach the highest floors, with breathing apparatus that wouldn’t allow them to get there. As the camera revolves around the Tower, there is no sound, no commentary at all, as if there are no words to describe what happened here. We see into the flats that were once homes, with kitchens, bedrooms, toys and family mementos. We look into the haunting floors at the top of the tower in which many of the victims died, pushed upwards by the flames and the advice to stay put until help came, but of course none ever did.

It doesn’t annul the pain, doesn’t offer easy, facile optimism, pretending that the awfulness doesn’t matter. Yet it makes contemplating it bearable.

Watching the film reminded me of standing before a medieval painting of the crucifixion, such as Grünewald’s famous Isenheim altarpiece. Pilgrims would stare for hours at such paintings to bring home to their hearts and minds the consequences of their sins, and to help them resolve to live differently. We don’t do penitence well in our culture. This is a penitential film, and it’s what the politicians who didn’t turn up to watch it have missed.

an altarpiece depicts the crucifixion of Christ.

The Isenheim altarpiece

Steve McQueen, just like Matthias Grünewald, wants us to look hard at the reality of what we have done - innocent life lost in the most horrific way. The altarpiece focuses on the intense suffering of Christ, the stretched sinews, the blood pouring from the wounds, the agony of those helplessly watching on. Just like this film that keeps your eyes fixed on the shattered shell of a building, the painting doesn’t let your eyes stray from the grim reality.

Yet there is a difference. Just faintly in the dark distance of Grünewald’s painting are the glimmers of dawn. On the horizon, the sky lightens, just a little. It is of course a reference to Resurrection, just around the corner. It doesn’t annul the pain, doesn’t offer easy, facile optimism, pretending that the awfulness doesn’t matter. Yet it makes contemplating it bearable. It allows you to focus on the revulsion, yet makes it endurable by offering the hope of Resurrection. And as Christian thinkers and pray-ers have insisted over the years, you only get to Resurrection through death, not by avoiding it.

At the time of the fire, I remember doing numerous media interviews with news outlets from across the world, with journalists hungry for some words to satisfy the global fascination with this tragedy. What could I say? What could possibly make sense of such a thing? I resolved that in every interview I would try to acknowledge the dreadfulness of what had happened, but also to strike a note of hope - that that despite what had happened, lives could be rebuilt, a community could find healing, then there was a road out of pain, one day, to peace – all because I am a Christian, and therefore have to believe that resurrection follows death.

Steve McQueen's brief film is compulsive watching. If you get a chance, you really should see it as something that brings home the horror of Grenfell more than anything I have seen. It is Grenfell’s Good Friday. Grenfell’s altarpiece. Watching it with Christian eyes, however, I kept looking for the glimmers of dawn.

Grenfell has been subject to a huge amount of commentary since the fire. There are those on the left who see it as a monument to corporate greed and capitalist rapaciousness. They demand Justice for Grenfell, which for many, means locking up or punishing the guilty. There are those on the right who see it a simply a dreadful accident that could have happened anywhere. One side calls it a crime. The other calls it a tragedy. Which was it?

The Left is perhaps rightly consumed with anger, demanding justice, legal convictions as resolution. Many on the Right look for a while, yet eventually avert their gaze, thinking it of it as one of those things, just an awful tragedy. I remember a Council official saying to me: “Well, one day, we just have to move on from Grenfell.”

What happens beyond lament? It is one thing to grieve those who died. It’s also something else to critique the failures that lead to it. Issuing prison sentences to the guilty may satisfy the desire for justice, but doesn't in itself bring about a new, hopeful, common life that renders simply unimaginable the pattern of moral compromise and sheer carelessness for the safety of others that led to Grenfell. On the other hand, simply consigning it to the category of awful accidents doesn't take seriously the grievous sins that led to the fire, and fails to give due recognition to the suffering of those who died.

Neither left nor right can offer us a sure way forward. That is where we are short of vision at the moment. An event like Grenfell easily falls off the radar of public attention because we don't want to look at it. Any maybe that is because we're not sure it will ever get any better. We need a way to keep looking at something painful until it is healed. That is the point of penitence - to go back to painful places in our lives to find healing. Yet you can only really do that if you believe healing can be found, that death ends in life, not the other way round.

The Christian story that holds together death and resurrection, Good Friday and Easter Sunday enables us to look at death and tragedy and horror full in the face as this film so eloquently enables us to do. It enables penitence to be hopeful, not hopeless. Yet, it also enables us to bear it, because alongside it, it says that there is a reality beyond both crime and tragedy, that is not just retributive justice but a deep underlying trajectory of the world that is headed for life not death.

Of course, the Resurrection is not a political solution. It doesn’t convict the guilty or dictate future housing policy, important as those are. But it points us to the deeper reality - that perhaps what we need today is not so much political but spiritual renewal. We need a deeper vision of life and death that gives us a reason to hope, that offers a future. We need a bigger story, a story that kindles hopefulness, that can stir hopeless hearts and the glimmers of dawn, even in the darkness of a world filled with so much pain.

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.