Article

Character

Culture

Leading

Virtues

19 September 2024

6 min read

What is Putin thinking? And how would you know?

The self-centeredness of modern culture is antithetical to strategic thinking.

Emerson Csorba

Emerson writes on geopolitics. He is also a business executive and holds a doctorate in theology.

Preisdent Putin stands behind a lectern with a gold door and Russian flag behind him.

What is Putin thinking?

In a world of Google Maps when walking on city streets, or of Waze when driving, it is difficult to ever become lost.

The AI algorithm provides us with the shortest route to our destination, adjusting whenever we make the wrong turn. We do not need to think for ourselves, technology instead showing the way forward.

But there are times where it is possible to get lost. This happens less in a city with its clearly set-out streets, and more so when taking the wrong turn in open expanses: hiking in the mountains, traversing farmers’ fields or while navigating at sea. In each of these situations, a miscalculation may lead to peril.

It is in these situations that we must carefully think through our steps, determining how to proceed, or whether to turn back. Often, these situations are ambiguous, the right way forward unclear.

Much of life – perhaps more than we wish to acknowledge – is like this, more akin to a walk across an open field with multiple possible routes forward, than a technology-enabled walk through a city.

When making important decisions, our grasp of a given situation, of others’ intentions and motives, and the networks facilitating and constraining action, are less evident than we may initially think.

This acknowledgement of uncertainty is no reason for delay, but rather a basis for careful deliberation in determining what to do, and how to proceed. It is necessary if we are to pursue what we believe is right, in a manner that may produce positive results.

In a recent interview with the BBC Newscast podcast, University of Durham Chancellor Dr Fiona Hill – who previously served as White House National Security Council Senior Director for European and Russian Affairs, and currently as Co-Lead of the UK’s Strategic Defence Review – provides listeners with a powerful reminder on how to proceed within ambiguous situations, especially in navigating the choppy seas, or rocky terrains, of human relationships.

Strategic empathy requires self-restraint when natural impulses urge a person to make rapid conclusions about the reality of a given situation – the default human tendency.

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Dr Hill uses the term “strategic empathy” to consider how the political West might proceed in its relationship with Russia, and specifically with Vladimir Putin.

Strategic empathy is a serious commitment to understanding how another person thinks, considering their worldview, their key sources of information (in other words, their main three or four advisors, who have a person’s ear), and other emotional considerations that underpin decision-making.

It is much more than just putting oneself in other’s shoes, as is often said about empathy. The approach is one of realism, suspending judgment based on self-protective or self-aggrandising illusions, in favour of what is actually the case.

In the case of Putin, Dr Hill helpfully reminds listeners that his worldview is drastically different than that of Westerners, and that significant intellectual effort (and specifically, intellectual humility in setting aside one’s own default frames of reference) is necessary to consider decisions from Putin’s perspective, and so make the right decisions from ours.

Technology is here an assistant but not a cure-all. Whereas AI might – based on a gathering of all possible publicly available information written by and about a particular person – help to predict a person’s next move, this prediction is imperfect at best.

There are underlying factors – perhaps a deeply engrained sense of historical grievance and resentment in the case of Putin – that shapes another’s action and that can scarcely be picked up through initial conversation. These factors may not make sense from our perspectives, or be logical, but they exist and must be treated seriously.

This empathy is strategic, because effective strategy is the “How?” of any mission. Whereas a person’s or organisation’s mission, vocation or purpose (all words that can be used relatively interchangeably) is the “Why?” of a pursuit, strategy is the “How?” which itself consists of the questions “Who?” “What?” “When?” and “Where?”

To understand how to act strategically requires a prior effective assessment of reality. This requires going beyond what others say, our initial perception of a situation, any haughty beliefs that we simply know what is happening, or even the assessments of supposedly well-connected and expert contacts.

Dr Hill’s strategic empathy is an appeal to listeners to ask questions – digging as much as possible – to arrive at an assessment that approximates reality to the greatest degree possible. This exercise might be aided by AI, but it is at its heart a human endeavour.

Strategic empathy requires self-restraint when natural impulses urge a person to make rapid conclusions about the reality of a given situation – the default human tendency. The persistent asking of questions is difficult – requiring mental, emotional and intellectual endurance.

There is considerable wisdom in Dr Hill’s reflections on strategic empathy, which extend well beyond the fields of intelligence, geopolitics or defence. The idea of strategic empathy helps show us that in much of modern culture – which glorifies the self, individuals putting their wants, needs and desires before those of others – developing strategy is very difficult.

The key then, when deliberating on potential right courses of action in ambiguous situations, is to not begin believing that the right way is clear. It rarely is.

Why is this the case? When popular culture favours phrases such as “You do you,” the you becomes a barrier to asking questions, with some aloofness to the situation, necessary for understanding how another thinks. People are encouraged to focus on themselves at the expense of others, and so fail to understand others’ worldviews and ways of operating.

Simply put, the self-centeredness of modern culture is antithetical to strategy. It impedes deliberation, which involves patience in the gradual formation of purpose for action. It wages war against the considered politics or statesmanship that many want to see return. In place of this is crisis or catastrophe, in which self-focus leads to clashes with others that could otherwise be avoided or worked through carefully.

The Biblical story of the serpent in the garden is another vantage point for the idea of strategic empathy. Soon after Adam and Eve eat the apple in the garden and become “like gods, knowing good and evil,” God searches for them and asks “Where are you?”

It is right after individuals try to become the judges of good and evil – “like gods,” that Adam and Eve find themselves lost: God’s “Where are you?”

Put differently, when a person is convinced they are right, but without asking questions, they make mistakes, they likely suffer unnecessarily because of this, and then become anchorless – the “Where are you?”

This applies to countries as much as it does to people: the more they moralize, seeking to become the judges of good and evil in a complex geopolitical landscape, the more they drift from their sense of purpose.

The key then, when deliberating on potential right courses of action in ambiguous situations, is to not begin believing that the right way is clear. It rarely is. A belief in evident rightness often leads to error, whereas the ability to suspend such judgment helps reveal – often gradually – the right path forward.

The strategic empathy approach requires both assertiveness – in asking good questions and maintaining persistence in doing so – and self-restraint in the face of believing that the right answer is clear.

The glue between assertiveness on the one hand and restraint on the other is faith, which helps a person to move forward in a trusting manner, but without exerting oneself so much so that they become the centre of the situation.

So, while Google Maps, Waze or other technologies might be at our disposal in our travels, both real and metaphorical, these technologies only get us so far.

The right way forward is seldom initially clear when navigating ambiguous situations, the frequency and stakes of which increase as we embark boldly – with faith – on the adventure of life.

Dr Hill’s strategic empathy – asking questions, listening carefully, suspending a self of sense, seriously considering diverging worldviews, and adjusting as necessary – helps us to achieve the understanding and direction we need.

Indeed, this approach is fundamental to a more effective and resilient political West. It is necessary for sounder deliberation, better strategy and statesmanship, in an increasingly ambiguous world.

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.