Review

Culture

Masculinity

19 September 2023

5 min read

Well, what about men? Caitlin Moran’s love letter to masculinity

Gender writing that’s gracious and full of hope. Krish Kandiah reviews Caitlin Moran’s What about Men? Part of the Problem with Men series.

Krish Kandiah

Krish is a social entrepreneur partnering across civil society, faith communities, government and philanthropy. He founded The Sanctuary Foundation.

Four men stand silhoutted against a sunset, One stands apart on their phone.

Meilisa Dwi Nurdiyanti on Unsplash.

The first time I met the award-winning Times columnist Caitlin Moran, it was in her home, and she cooked me soup. She couldn’t have been more hospitable, which was particularly appreciated as we had met to talk about advocacy and hospitality for refugees. I found her personable, funny, helpful, and extremely well-connected.

Despite my deep respect and appreciation for Moran and her writing, I have to admit to being sceptical about her latest book What about Men? published by Ebury Press. It’s a brave thing for a woman to write a book about men. As a married Asian man I wouldn’t dare to even consider writing a book about what it means to be a woman, or white, or single. Yet somehow Moran has done the impossible: she has written a book that is both feminist and masculinist, both refreshing and disturbing, both gracious and frank.

For a start Moran makes no apology for being a woman, or for writing a book aimed squarely for white straight men, or for dropping the “F bomb” on almost every page, or for speaking explicitly and frequently about sex, genitalia and orgasms. She delves into thorny and controversial issues such as toxic masculinity, rape culture, false allegations, and pornography, as well as giving her opinions on men’s health, communication, loneliness, friendships and fear of death. Moran writes with unshockable candour and yet somehow does so with a lightness of touch, humility and generosity.

Moran shows us that we don’t live a zero-sum game: in order for women to win men don’t have to lose and vice-a-versa.

Here are the five main things that I appreciated about this book:

1. It is laugh out-loud funny

There’s no denying it, Caitlin Moran is a brilliant writer. Some of the chapters read like observational comedy resonating rather too accurately with my own experience. Moran has made great use of her large Twitter following and wide male friendship group to provide testimonial and anecdotal evidence for the issue in question, inserting their stories with the perfect comic touch.

2. It is uncannily resonant

Despite being born in Des Moines, Iowa, Bill Bryson has become a national treasure in the UK, writing not just one, but numerous books about the English. His outsider perspective helps us Brits to see ourselves through the eyes of those around. Similarly, Moran’s book about masculinity is so brilliant exactly because she is not a man. She cuts through what others would overlook, asking more interesting questions, and pointing to wholly different ways forward.

3. It makes peace in the gender war

Moran’s honesty and humility offers us a model of how to transcend the culture wars without avoiding the difficult conversations. Her book suggests that men and women can bring the best out of each other by celebrating our differences. Moran shows us that we don’t live a zero-sum game: in order for women to win men don’t have to lose and vice-a-versa. She offers a vision of a different way for men and women to relate to each other. As a firm believer in the power, possibility and pursuit of peace whether in the Russia-Ukraine war or the politically-driven culture war or the subtleties of gender war, I sincerely appreciated her efforts.

4. It celebrates good masculinity

Moran believes our society will be happier and healthier if men and women find ways to celebrate and appreciate one another. It was this line in her book that struck me as a vital perspective:

“There should be no shame in being a man. Being made to feel shame for how you are born is something every other progressive movement is trying to remove and trying to impose it on the one group that didn't until recently feel shame; straight white men, benefits no one.”

5. It is hopeful

It’s been a long time since I have read something about gender which was as full of hope as this book is. Sadly, many books in this field are written in a bid to fight one’s corner, including those coming from the church. Moran’s posture offers us a much-needed challenge. If an outspoken feminist, who claims to have only stepped inside a church once in her life, (apparently for Rev Richard Coles’ last service in his parish) has no fear of showing support to men and their rights, or of promoting a Christian sexual ethic of commitment before sex, or of seeking to find a peaceful resolution to the gender wars, how much more should Christians be willing to do the same?

My one and only issue with the book was when it tended to lapse into stereotypes. Being the sort of man who doesn’t like to fix things (I wish I did and I could), and who doesn’t find it hard to express emotions (have I overshared already?) and who does care about my appearance (check out my latest charity shop find!) I sometimes felt a little misunderstood. Or even worse, unintentionally pigeonholed as not really being Caitlin’s idea of what a man is. This is one of the biggest challenges of anyone writing about gender, how to do so without either reinforcing stereotypes or ignoring genuine difference.

My overall impression is that this book reads like a love letter to masculinity. Take this powerful paragraph from Moran’s last chapter:

“I wish for any man, or boy, everything I have wished for my daughters: that they can be proud of who they were born as; that this will never be a burden to them; that they can appear as they like; that they understand both their own pain, and that of others; that they can love out loud with their whole hearts, because they understand that love is a verb – a doing word; and that they never belittle or destroy what they envy, but recognise it for what it is: almost certainly, a future you wish for yourself.”

That quote reminded me of St Paul’s defining of love in a letter to Corinthians. It sets a high bar, but I believe it is both aspirational and achievable. I would love to see sentiments like this coming out of the church too, with similar books that can transcend the cultural flashpoints and offer great hope to all who need it.

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.