Euthanasia and psychoanalysis

The Assisted Suicide Bill in Scotland continues to chug its merry way through the Parliamentary process. According to the Parliament's website, oral evidence will go on being taken until the end of 2014 by the Health and Sport Committee. (I know. I can't help feeling that having a Sport Committee mulling over whether to kill people has oddly unpleasant science fiction resonances from films such as The Running Man. But modern, public Scotland is an irony free zone. We are Progressive and thus very busy about the world.)

The Care Not Killing petition is open: please sign here.

I've probably rabbited on about this before, but the decline of psychoanalysis in the British intellectual world fascinates me. From a position where everyone ('just everyone, darling!') was being psychoanalysed to one where no one seems to worry about their inner, deeper life and just gets on with it (badly). And it's not clear to me whether psychoanalysis was simply the last gasp of a better, more reflective world; or the beginning of a modern, less reflective culture where the inward is hollowed out in favour of getting and spending. Probably both...

Anyway, the French still love their Freud, so I suppose I shouldn't be surprised that I found a thought expressed in the Francosphere that I'd been struggling to express for a while:

The worst thing is perhaps that a number of doctors will find in this extended medical omnipotence a compensation for the feeling of frustration in the face of illness, he adds. Having failed to master the illness, they will have the supreme power of deciding death...They would lose their soul: a doctor cannot be at the same time the person who works to save you and the person with the power to kill you.

[My translation. From here.]

I don't think it's just doctors, but euthanasia as the emotional compensation of control over death for the lack of control over illness is certainly most dangerous in their hands. There's a fascinating piece on the BBC website where several medical supporters of euthanasia bemoan the way that attitudes to doctors and end of life care have been affected by Harold Shipman. Indeed. But rather than reflecting on the very complex emotions that those with power have with respect to those who do not (and, one might add, particularly in the area of life and death), they seem oblivious to the dangers of the Shipman within us all, and , particularly, within doctors precisely in this area of euthanasia. This complete lack of self-exploration, the desire to do rather than reflect, this insensitivity to the depths of our feelings about power and death, all are evidence of why doctors -and indeed the health system- cannot be at the same time the person who works to save you and the person with the power to kill you.

Eliding the past

                           
                                            Rational thought, religious style? 
                                     
'Faith' leaders unite to oppose euthanasia. [Here.]

I've retained enough of a memory of what it was like to be an atheist (or perhaps just enough common sense) to get a sense of how convincing the non-religious will find such an intervention. (Oh, go on, guess!) Indeed, it must have occurred to at least a few of us bronze age goat herd fetishists that, as soon as a sizable number of people hear that religious leaders think this or that, they'll go and do exactly the opposite. Although I hope that some of the proponents of euthanasia have thought about the issue a bit more deeply than this, I've come across quite a few who clearly regard the debate as mainly having a symbolic function in the extirpation of religion: whatever the religious think, they are agin it.

Putting aside the issue of euthanasia, it is quite odd to think that religious leaders of a wide variety of backgrounds agree on their opposition. I suspect that the New Atheists will simply explain this agreement along the lines of 'religion dumb, therefore dumb conclusion', but to anyone else, the agreement of widely different theologies and sensibilities in this area really ought to require a bit more explanation.

Well, here's my best go at it. In essence, we have here an opposition between tradition and modernity. Those religious leaders who oppose euthanasia hold fast to old, pre-modern traditions. Those who promote euthanasia (whether religious or not) tend to reject tradition and embrace the new. So what unites the 'religious' leaders is less religion and more adherence to traditional values.

Modernists have constructed for themselves a closed belief trap: in essence, a way of thinking that prevents them thinking their way out of error. The examples you often find quoted of this sort of trap are religious: 'Doubt is the temptation of the devil, therefore it's important to believe and reject evidence as Satanic.' But the secular equivalent of that are the hermeneutics of suspicion such as Marxism, Freudianism, Feminism and New Atheism that teach their adherents to reject any evidence from the past or from other cultures as tainted by patriarchy or neurosis or class interest or religion.

Focusing on religion for the moment, if you reject any moral guidance 'infected' by religion, you leave yourself an extremely narrow evidence base. Obviously, most other countries are infected by religion outside Western Europe so can be disregarded. Most Western European writers of the past thousand years have also been infected by religion or the reaction to it, so you're probably only safe with Irvine Welsh.

If you then reapply the critical filter with all the other versions of the hermeneutic of suspicion, you won't end up with much that's safe to read or pay heed to. And if you add into that the material restrictions of modern education (reduced patience in reading, lack of foreign and ancient languages, emphasis on utilitarian outcomes) you have some quite difficult fences to climb before you can access any perspective that might provide a serious contrast or check to modern 'chatter'.

Does this matter? Well, it does if you take the view that traditional values are like traditional skills: they embody the carefully accumulated experience of generations about what does and doesn't suit our human nature and condition. I won't attempt to defend such a view here but - unless you're absolutely sure that it's a mistaken view- the very obvious fact that we have systematically constructed a culture which is inoculated  against this sort of wisdom really ought to be very worrying.

Death doulas and assisted dying

                                           A bit of everything and nothing....


While the assisted dying/bumping off your granny debate continues in England and Wales over the build up to Lord Falconer's Bill, I'd like to put aside some of the broader issues and focus on one specific aspect of 'assisted dying' which, in Scotland, will be enshrined in legislation and, elsewhere, is now being routinely talked about as part of the euthanasia package: the end of life doula or death midwife.

             Tony Soprano: specialist in assisted dying and generalized taking care of people

My attention to this phenomenon was drawn by Bronnie Ware's article in The Guardian which specifically links the idea of a death doula with euthanasia. (The idea of a end of life doula is not necessarily linked with euthanasia: here for an interview with a practising death doula who -despite an eccentric obliviousness to the sprouting of vegetation from her head- seems a reasonably friendly sort who doesn't seem overly inclined to active pursuit of that final remedy for all ills.)

The proposed Scottish legislation (as I discussed before) proposes the role of a licensed facilitator to help you shuffle off this mortal coil. I think this provision hasn't received much attention up here yet probably on the grounds that it's seen (by both sides) as simply a piece of legerdemain to deal with attacks on the previously proposed legislation that it would undermine medical staff by involving them in the process. (It doesn't alter this aspect in substance: the whole process still involves medical supervision throughout.)

But the idea of a death doula/licensed practitioner does highlight two problems with the proposed euthanasia Bills in both England and Wales and Scotland. First, it highlights the way that the much vaunted idea of autonomy at the end of life is constructed (and perhaps more accurately, invented); and, secondly, it demonstrates how we are being driven towards a construction of that autonomy which will push us into euthanasia.

One of the key points of tension in modernity is that of consent. There is a tendency to reduce all moral questions to the simple test: did s/he consent to it? Do you want it? Now the problem with that is that, in general, it's often not clear to ourselves what we really want, and that, in the specific areas of sex and medical treatment, we are more likely than in most other areas to be conflicted and unsure. In the area of sex, the practices of seduction and wooing sit uneasily between a freely given consent and an overridden will: to be wooed (let alone seduced) is to be at least a little resistant. (I think a particular problem here is evident in the case of child sex: because the moderns wish to reduce everything to consent, they find it difficult to deal with an area which they think good (lots of sex) and yet where the will is inchoate (the child or adolescent). (I say a bit more about this in the combox on Mark Lambert's blogpost on Peter Tatchell's involvement with pro-paedophilia campaigns.) Much easier for traditional approaches: child sex is wrong regardless of any issues of consent.)

In the case of medical treatment, we are reliant on expertise. We need either to be persuaded to follow that expertise or simply to obey it: in either case, the idea of consent, let alone autonomy, becomes highly problematic.

Now none of this is to say that -in broad terms- there isn't much to be said for autonomy and for its facilitation. In business, for example, the idea of a contract is a way of creating a clearcut decision: by entering into a formal, legally binding contract, the murky depths of autonomy are avoided: consent here is reduced to a formal, (relatively) clearly identifiable procedure. This tendency to create a fictional and public simulacrum for the complications of autonomy can be found both in sex (the creation of a 'safe' word; 'no means no'), and, more centrally to present purposes, medical treatment: no end of forms to sign, none of which are really understood, but where complexity is reduced to the simple question of whether or not they were signed.

But serious illness -and particularly death- is one of those moments when our pretended autonomy dissolves: it is then that a mature culture instead celebrates and focuses on our vulnerability, our dependence on others rather than our independence. Instead, the machinery of medical killing covers up what should be an epiphany of the human condition and smears it with obscuring words as in the wriggling attempts to find a euphemism that manufactures autonomy  (from 'euthanasia' to 'assisted suicide' to 'assisted dying') out of our utter creaturely dependence. Even the title 'doula' shares in this obscurantism: it hints at δοῦλος (doulos) a slave/servant, but hides this desire for a tool at one's service behind the decent veil of a foreign language: a desired tool to effect my autonomy, but one whose true status is obscured by an orientalizing garb.


The doula/licensed practitioner is of course nothing like a slave: servus a non servando. Instead she is a guide, a shaman, another expert to guide your through a world that is hers, not yours. At the end of life, we need to trust and depend on the goodwill of others. With assisted dying, we are being encouraged to lie back and trust in the good will of others as they kill us. The doula disguises this and makes it more palatable with hints of patchouli and silks. But the unvarnished reality -at perhaps the most important moment in our life when we need to face truth without illusions- is that we have no autonomy and that our human need for companionship and spiritual counsel is being provided by a team of killers watching the meter to see how quickly they can unblock a bed for the next victim.


The Chair she sat in, like a burnished throne,  
Glowed on the marble, where the glass  
Held up by standards wrought with fruited vines  
From which a golden Cupidon peeped out
(Another hid his eyes behind his wing)  
Doubled the flames of sevenbranched candelabra  
Reflecting light upon the table as  
The glitter of her jewels rose to meet it,  
From satin cases poured in rich profusion;
In vials of ivory and coloured glass  
Unstoppered, lurked her strange synthetic perfumes,  
Unguent, powdered, or liquid—troubled, confused  
And drowned the sense in odours; stirred by the air  
That freshened from the window, these ascended
In fattening the prolonged candle-flames,  
Flung their smoke into the laquearia,  
Stirring the pattern on the coffered ceiling.

(The Waste Land)

Reply to Scottish euthanasia consultation NOW!

                                         Time to bury the Assisted Suicide Bill

The Scottish Government Consultation on the Assisted Suicide Bill ends this Friday 6 June.

Details of the Consultation are here.

Even if you don't feel able to respond in full, please at least email the Health and Sports Committee (oh the irony!) Healthandsport@scottish.parliament.uk with your opposition. I'd suggest the following:

a) I oppose the principle of Assisted Suicide as it encourages the view that illness should be treated by death and will profoundly and adversely affect the provision of end of life care.

b) The Bill is merely a cosmetic rewording of the Bill previously introduced and decisively rejected in 2010. It is an abuse of Parliament to continually reintroduce defeated legislation.

My previous blogpost analyzing the new Bill is here.

[Update: Care Not Killing's submission is here.]

Stephen Sutton: dying in public

                                         
                                                        Stephen Sutton

First, and most important: my condolences to Stephen's family. May he rest in peace.

One thing that Stanley Hauerwas has been banging on about for ages is that we need to learn to die properly as an example to others. As he puts in an interview:


Death scares us. We don’t want to be around it. But one of the gifts we give to one another is to be present to one another as we die. Learning to die is like everything else: it’s learning. You need to see people do it.

There was a whole tradition of ars moriendi, the art of dying. I think that we have to recover something like that. As I was saying, you have to be taught how to die. And somehow it got lost. I don’t know why. It’s always been at the heart of Christianity that we are taught to die in a way that we can be happily remembered. It’s a lovely thing to be happily remembered. I hope I’m going to die in a way that my friends can happily remember me.

Dying well doesn't have to be as public as Stephen's death. But in a society where death is invisible, where we try to erase it from our consciousness, his dramatically public dying reminds us that it is possible to die with courage and grace and even humour.

Hauerwas again:

When I lecture to lay audiences, I ask them how they want to die. For people in our society the response is fairly consistent: they want to die quickly, painlessly, in their sleep, and without being a burden. They want to die painlessly, in their sleep, and quickly because when they die they don’t want to have to know they’re dying. So now they ask physicians to keep them alive to the point that when they die they don’t have to know they’re dying – and then they blame physicians for keeping them alive to no point.

[...]

I think so-called medical ethics has put far too much emphasis upon the physician and not the patient. I think patients need to be trained to know what to ask for. And just like we need to learn how to die, we need to learn how to be sick. Currently people, I think, ask far too much out of physicians.

When we die, we narrate a story of death and life to those who watch us: how we die expresses values. As a result, our death is not just a matter for us: it part of our living and living on with other people, and the effects we produce are part of whether or not we have lived virtuously.

Stephen Sutton died well. That is a remarkable achievement for such a young man. I hope that, when I die, I may do it as well as he did. There is clearly a message here for the current debate on assisted suicide. However, I'll leave that for another time to avoid turning Stephen's death into a political stratagem.

Paedophilia and child euthanasia

Please use your own imagination for what a Google image search for 'Death and Sex' might produce....

     
So, on the one hand, we have the current brouhaha over the involvement of the National Council for Civil Liberties and the Paedophile Information Exchange, and on the other, we have the introduction of child euthanasia in Belgium.

Both cases reveal something of the difficulties reliance on consent hits when it comes across the big issues of life such as sex and death, and when it moves away from fully rational, completely informed adults as agents. Consent is a rather fiddly notion that only makes sense against a background of freedom. Which doesn't really help very much as freedom itself is an extraordinarily difficult notion...

In common-or-garden situations, consent is a socially constructed practice which is intended to slow things down at a time of a big decision. So, in the case of double glazing purchases, there are the formalities of documentation and cooling off periods etc, not so much to check in any deep philosophical sense whether we really really want some of those new PVC units, but to exclude some of the more obvious external tricks: rushing someone into a decision, lying to them, pretending they said yes when they really said maybe etc... The point here is that a reasonable person, in full possession of the facts, might want double glazing: it's a perfectly good and reasonable aim, and in constructing a social process of consent, we're just excluding some obvious abuses rather than exploring the depths of that consent. Which is quite a good thing, because it's not at all clear what the depths of freedom might involve here. (Is it possible, for example, to purchase double glazing with full autonomy unless you've read Marcuse on false needs?)

Since the 1960s, a dominant strand in thinking about sex is that intercourse is just a (really) pleasant feeling. Society has repressed sex and progress consists in liberating ourselves to enjoy this physical pleasure without regret. Someone who doesn't want free sex is really still in thrall to a (primarily religious) taboo. Increasingly, a similar picture is being accepted of euthanasia. A good death consists simply in slipping away without pain. Anyone who rejects the possibility of euthanasia is really still in thrall to a (primarily religious) taboo.

The child euthanasia law in Belgium is based on the importance of ensuring that children can access a great good (pain free death) and is therefore not terribly concerned about the depths of consent: like double glazing, it's only concerned to exclude some gross external abuse without troubling itself overmuch with what freedom in its depths might mean for an infant. As nice Dr Riddington puts it:

As a doctor, I am thankful that progress is being made to address the anguish of people, children included, who find themselves in utterly intolerable situations. 

So it's not really surprising, is it, when children are being deprived of an obvious good like guilt free sex, that progressives think it rather a good idea to get rid of those nasty (primarily religious) taboos which get in the way? In fact, I'm only surprised that they seem to have gone rather silent on this one, having abandoned their previous enthusiasm:

...paedophile interest groups emerged from the 1970s in numerous countries...In 1979, a petition to the Dutch Parliament calling for the legalization of consensual sexual relationships between children and adults was supported by the NVSH [Dutch Sexual Reform Organization], feminist organizations, and the COC, the oldest still-existing gay rights orgainization in the world...Around the same time, the Protestant Foundation for Sex Education (PSVG) distributed tens of thousands of copies of an information booklet with the title Paedophilia to Dutch elementary schools (1979-81).


[Not from some barking mad religious text, but Veronique Mottier's Sexuality: A Very Short Introduction, which gives other examples of 'progressive' campaigning for paedophilia round the world.]

If you think that painless death is a simple good, then why worry too much about consent? If you think sex is a simple pleasurable good, then why worry too much about consent? Come on, let the kids have some fun: it's only death and sex after all.

Margo MacDonald and euthanasia

Though with the death of a gladiator the bizarre and exotic show was not yet over. 
Two strange characters would enter the arena in one of the intervals, by which time several corpses might litter the floor. One was dressed as Hermes and carried a red-hot wand with which he would prod the corpses on the ground. The second man was dressed as Charon, the ferryman of the dead. He bore with him a large mallet, which he would smash onto the skulls of the dead. Once again these actions were symbolical. [Here]


I had been settling down to read the Scottish Government's White Paper on Independence (600+ pages) , as well as the Pope's Evangelii Gaudium (200+ pages). But Lallands Peat Worrier's post on Margo MacDonald's new euthanasia bill (PDF) dragged me away from this inviting Yuletide prospect...

MacDonald has returned to her attempt to introduce euthanasia into Scotland. Although it certainly isn't the same Bill as the one that was overwhelmingly defeated before, the issues are substantially the same: sicut canis qui revertitur ad vomitum suum sic inprudens qui iterat stultitiam suam.

Doubtless we'll be returning to this over and over again from different angles, but it's important to get at least some of the opening shots out of the way before sheer weariness at MacDonald's persistence sets in and MSPs are tempted to convince themselves that something very different is on offer here from the previous Bill. The Policy Memorandum (PDF) suggests that there are three main differences from the previous Bill:


12. While the current Bill builds on the work done in relation to the previous one, the policy 
has also been substantially developed.
13. In particular, the current Bill limits eligibility to those with an illness that is, for them, 
terminal or life-shortening or a condition that is, for them, progressive and either terminal or lifeshortening – but does not also include those who are permanently physically incapacitated, thus addressing concerns (disputed at the time by the member) that the previous Bill inappropriately targeted disabled people.
14. In addition, the current Bill is clear that the assistance it authorises does not include any 
form of euthanasia  – thus addressing a specific concern that the previous Bill would have 
authorised some forms of voluntary euthanasia in addition to assisted suicide.
15. The process that a person must go through has also been amended, removing some 
overly-complex aspects, while at the same time enhancing overall the set of safeguards it 
provides.  The main changes are the requirement for a preliminary declaration to be made before a first request, and provision for the training and licensing of facilitators, able to provide some of the practical assistance likely to be required.

To summarize the claimed changes:

1) Only those with life shortening conditions are included. (So not the disabled without shortening of life.)
2) No euthanasia.
3) Simplifying and enhancing process.


Some brief initial responses:

1) Many disabilities also shorten life. That some disabled people will be excluded from the new Bill who would have been included in the previous one does not remove the problem that disabled groups objected to: 'that certain people with disabilities would have been eligible for end-of-life assistance simply by virtue of being disabled, and that this stigmatised such people as having lives not worth living' (para 29, Policy Memorandum). Have a condition that shortens your life by a day (ibid, para 30), and you'll be eligible. (Watch out HIV sufferers and paraplegics.)

2) The Bill (section 18) states:

 Nature of assistance: no euthanasia etc.

(1) Nothing in this Act authorises anyone to do anything that itself causes another person’s death.

This section seems to be referred to in the Policy Memorandum:


14. In addition, the current Bill is clear that the assistance it authorises does not include any 
form of euthanasia  – thus addressing a specific concern that the previous Bill would have 
authorised some forms of voluntary euthanasia in addition to assisted suicide.

This seems to be mere puff without substance. Firstly, the concept of  'euthanasia' is not always distinguished from assisted suicide as noted by MacDonald herself in her evidence to the Parliamentary Committee respecting her previous attempt:

That is why, when we were drawing up the bill, it was difficult to decide whether to use the word "euthanasia". This might be entirely personal, but I maintain that euthanasia is associated with someone else taking the decision, rather than the requesting patient. I accept that some people think that, in the final analysis, it is euthanasia if the requesting patient cannot self-administer the drug and a clinician gives assistance at the very end.

Professor Laurie (Medical Jurisprudence, University of Edinburgh) in his evidence  (col 88) to that committee noted, concerning the difference between assisted suicide and euthanasia, that, 'From a principle point of view, it is difficult to draw the distinction.'

Laurence Hinman (a Professor of Philosophy at San Diego University) in his presentation on euthanasia (here, slide 18) includes assisted suicide in the category of 'active, assisted euthanasia'.

Now, my point here isn't that some rough distinction can't and hasn't been drawn between euthanasia and assisted suicide, but that, as a matter of principle, the distinction is quite hard to draw and even harder to draw in terms of a moral difference: simply announcing that the Bill doesn't cover euthanasia means nothing except as a branding exercise to make it sound nicer. The substance of the claim must rest on the gloss 'Nothing in this Act authorises anyone to do anything that itself causes another person’s death'. But here, we are simply faced with more philosophical fog. The precise role of the 'licensed facilitator' is

to provide, before, during and after the act of suicide (or attempted suicide) by the 
person for whom the facilitator is acting, such practical assistance as the person 
reasonably requests (section 19).

At one extreme -the paradigm of assisted suicide I suppose- we can imagine the licensed facilitator getting on with her knitting while 'the person' takes the pills. At the other extreme -the euthanasia end- we can imagine a Kervorkian machine. As it stands, the Bill is not clear that such a paradigm case of euthanasia is in fact ruled out. (It certainly doesn't seem to be by section 18 (3):That requirement is that the cause of the other person’s death must be (or, in the case of an attempt, would have been) that person’s own deliberate act.) Any assistance is part of the causal chain of another person's death: the question is what sort of causal intervention is acceptable, first, in terms of the Bill and, perhaps more importantly, morally. Despite all the sweet words, this is still a Bill about helping people to die.

3) MacDonald claims the Bill simplifies and enhances the process of (what I shall persist in calling) euthanasia. Her own description of these changes (in the Policy Memorandum, section 15) is:


The main changes are the requirement for a preliminary declaration to be made before 
a first request, and provision for the training and licensing of facilitators, able to provide some of the practical assistance likely to be required.


Frankly, the preliminary declaration isn't worth the paper it'll be written on. Its claimed value is that


anyone who is opposed in principle to the idea of assisted suicide can take reassurance from the fact that simply by never making a preliminary declaration they can disqualify themselves 
entirely from the process. (PM, section 23.)

Well, no one ever thought that you'd be bumped off without having signed some bit of paper first: the worry was that, in the process leading up to that signing, pressure (eg from a cash strapped NHS and a medical profession increasingly trained to regard killing as a suitable treatment) would lead to that signature being made. Nothing in the Bill changes these worries. At most, it delays death by a seven day cooling off period  (section 8 (3) (c)).

And as far as the 'licensed facilitators' are concerned, other than providing for some sort of Chartered Institute of Death (section 22), we don't learn much of any substance other than we seem to be creating a new sort of job opportunity for 16 years olds (section 21 (2)) who don't fancy supermarket checkouts.

Nothing of substance has changed in MacDonald's new Bill. Whatever the theatrical setting, this is still the moral equivalent of bumping off the sick with Charon's mallet. I've gone on about this before and doubtless I'll go on about it again, but it never ceases to amaze me that a campaign which so much emphasizes 'dignity' and 'autonomy' seems blithely unconcerned about setting up a bureaucratic monstrosity which allows people to be put down. That's symbolic of much that is rotten in the modern world.

Stupid atheists

                                Some Catholics are dunces, but are some Brights dull?

A while back, I managed to irritate a 44 year old atheist computer geek by suggesting (as he read it) that some atheists were dumb. (Ironically, in view of his protestations of smartness, he'd misread what I said -which was (in essence) that some types of atheism betray the sort of stupidity characteristic of smart but immature and narrowly educated young men- but put that aside.)

Putting away the sniping here, why should the suggestion that some atheists are not intelligent be regarded as such an insult? Certainly, I'm quite happy to accept that some Catholics aren't intelligent: indeed, I positively glorify in that fact. When I was becoming a Catholic, one of my wife's family declared that the only people in her family who were Catholics were the servants. Quite apart from the factual oddities here (Mrs L is hardly blue blooded) I remember thinking that this was as good a reason as any for going ahead: what sort of Christianity wasn't for the servant and the master, the bright and the stupid? Whatever else is clear from the New Testament, it is perfectly clear that you don't enter the Kingdom of Heaven via diplomas and a healthy bank balance.

The only entry ticket for Catholicism is being human. It starts from conception and ends with the death rattle. You can be mentally disabled or a genius: it doesn't matter. How you contribute to the Body of Christ will be affected by your talents, but there is a place for everyone.

Atheists, at least of the New Atheism variety, seem heavily invested in their (individually) being smart. Dennett's adoption of the 'Bright' label is the most obvious symptom of this, as is the obvious smarting of the 'smart' commenter at my jibe. But behind this is the foundational illusion of New Atheism: they are out to free people from the tyranny of religion so they can think for themselves. That's fine if you're a public school educated Oxford academic (well, you'd think so anyway) but what of those less well endowed? And frankly that's really all of us at some time: no one is smart throughout their life; no one is completely master of all fields of knowledge. New Atheists seem compelled to pretend to a greater knowledge than they actually have; Catholics sooner or later admit that we fall back on faith and authority. We are, as MacInyre puts it, 'dependent, rational animals'.

New Atheism really seems to substitute a new, rather ill-imagined authority structure for old, rather more thoughtful ones. As a Catholic, there is a very explicit authority structure on which I rely: its very explicitness allows me to assess and critically engage with it. New Atheists have a very inexplicit authority structure, but one which is just as real: a set of slogans; a set of heroes; a set of holy writs.

So what should stupid atheists do? Is there any room in the Bright new tomorrow for the fool or even the slightly below average intellectually? Or is the solution a final one: that when you are a suboptimum child, you are aborted? When you are disabled, you are  euthanized? And when you can no longer read even The God Delusion with complete understanding, you ask nurse for the final remedy for all cognitive failure?

Suicide and euthanasia

                                                          Et in Scotia ego....

I've been re-reading Copleston's History of Philosophy recently. In the first volume on the ancients, I was struck by the following:

It is a great mistake to suppose that the Greeks were happy and careless children of the sun, who only wanted to lounge in the porticoes of the cities and gaze at the magnificent works of art or at the achievements of their athletes. They were very conscious of the dark side of our existence on this planet, for against the background of sun and joy they saw the uncertainty and insecurity of man's life, the certainty of death, the darkness of the future. 'The best for man were not to have been born and not to have seen the light of the sun; but if once born (the second best for him is) to pass through the gates of death as speedily as may be,' declares Theognis, reminding us of the words of Calderón (so dear to Schopenhauer), 'El mayor delito del hombre, Es haber nacido' [The greatest crime of man is to be born]. And the words of Theognis are re-echoed in the words of Sophocles in the Oedipus Coloneus, 'Not to have been born exceeds every reckoning' .....

Now this drive towards death really ought to be the common recognized stuff of human experience. But perhaps one of the oddest elision of modern Western culture is the pretence that  it doesn't exist. Instead of the reality that the fascination of death and the quiet desperation of life bubbles up constantly and unpredictably in everyday existence, there is the pretence that the normal condition of humanity is one of good cheer, only interrupted by unwelcome foreign intrusions such as disease in old age.

It's this naive narrative which lies behind much of the pro-euthanasia lobby. If life is just one untroubled smile, when pain finally hits you in the face of incurable disease, then the only remedy is, indeed, 'to pass through the gates of death as speedily as may be'. But if life is, as the best minds of the past knew and as the Salve Regina has it, something we pass through as a place of exile, 'mourning and weeping in this vale of tears', then grappling with death becomes, not a single, unrepeatable event, but something that colours every moment of our life. And how we face that last moment becomes of a piece with how we face every single living moment.

I loathe Stephen Fry: he presses far too many of my buttons, from tweedy Oxbridge superiority to smug Hampstead socialism, from atheistic Humanism to being a Wagnerite. I am, however, extremely glad that he survived his latest suicide attempt: loathing, particular of an omnipresent media type, is a relatively harmless hobby; rejoicing in the actual death of a fellow human being is an expression of the deepest vice. The typical narrative is that he is diseased: suffering from bipolar disorder, we simply need to up the dose, and we'll have nice old Stephen back again. But what then of Dominique Venner's suicide, apparently as a political protest against same sex 'marriage'? Well, however sympathetic I am to the despair he felt at the measure, I am completely unsympathetic to his killing himself: that is simply not how you deal with despair, however profound.

I've known quite a few people who've killed themselves over the years. Whatever sympathy I have for their internal state -how they felt- none of them objectively had a good reason for doing so. Most of them left grief stricken family and friends to deal and live with their own consequent despair. Classic Western culture both acknowledged the pull of death, and absolutely ruled out suicide or euthanasia as a solution: like an alcoholic finding excuses to drink, human beings will always find excuses to kill themselves, but an older and wiser culture both produced an awareness of this tendency and means for dealing with it. Modern Western culture pretends that death exerts no attraction and also encourages the view that killing yourself is an adequate solution to life's woes. It is from the combination of naivety and willingness to kill as a remedy that one of the greatest dangers to human flourishing in the modern West arises.

To be honest, I've lost track of where Margo MacDonald's regular attempt to introduce a euthanasia Bill at Holyrood or Lord Falconer's similar efforts in Westminster are at the moment. (The Care Not Killing website seems to suggest that Falconer is currently busy in the Lords. No idea what Margo is up to.) But it's clear that this is one of those issues that isn't going away. Until we're able to recognize the way that life, from minute to minute, is lived in the shadow of death, rather than pretending it is simply a matter of facing up to pain in the last phase of life, then any discussion in this area is going to remain at the level of the nursery.

Anyway, to round matters off -and nicely illustrating the complexities of eros and thanatos- the ever cheerful Morrissey:


https://youtu.be/icXQxumuHAE?si=W86yS4_WiJNl88-N

Success in Scottish midwives abortion case

The Court of Session decision to support the right of conscientious objection in the case of the Catholic midwives is extremely welcome (even though the case is highly likely to go to the Supreme Court for a final decision):

Giving the decision, Lady Dorrian said: “In our view, the right of conscientious objection extends not only to the actual medical or surgical termination but to the whole process of treatment given for that purpose. The right is given because it is recognised that the process of abortion is felt by many people to be morally repugnant...it is a matter on which many people have strong moral and religious convictions, and the right of conscientious objection is given out of respect for those convictions and not for any other reason. It is in keeping with the reason for the exemption that the wide interpretation which we favour should be given to it.” (The Scotsman here. SPUC comment here.)

The comments section of The Scotsman is already attracting the sort of 'if they don't want to kill babies they shouldn't be midwives' response which has typified much of the pro-abortion lobby on this. As I've argued before, it is the mark of a liberal society to encourage diverse attitudes and 'experiments in living' in a society, and, in general, conscientious objection is part of this. Moreover, it is perfectly possible to recognize that the deliberate taking of human life is an area which is 'morally charged': in the last war, even those who believed in the rightness of the  fight against Nazism recognized that those with a conscientious objection to killing were recognizing a shared value -that of the sacredness of human life- even if their reaction to that value in those precise circumstances of a just war was wrong.

One of the (many) problems with the politicization of any issue is that nuances and areas of agreement are ignored in the rush to present a viable campaign and opposition. I don't think that pro-abortionists, on the whole, are morally blinkered, thoroughly evil supporters of murder. I think they're morally wrong, but I understand that they are reacting (albeit, as I would see it, inadequately) to the sort of values that I too recognize, in particular, suffering and the treatment of women. But equally they should recognize that the anti-abortion side is reacting to a value that they too should acknowledge: that the deliberate killing of a human being where, in normal circumstances, that death would be regarded as a tragedy and a cause for sympathizing with a mother's loss, is a bad thing. 

I'm not a pacifist. My own view of conscientious objection in the last war is that it was a mistake and even a failure in the moral duty of protecting innocent life from aggression. But I don't think that conscientious objectors were insane or thoroughly evil because I understand and even share their motivation -up to a point. That's why it's right that, where possible, their views and consciences were respected. From the point of view of the pro-abortion lobby, I appreciate that the midwives too are mistaken. What I find rather more difficult to understand is the desire -how widespread it is I'm not sure- to compel them to kill against their deeply held beliefs where there is no overwhelming necessity to compel their participation.

[Update: Neil Addison gives a legal analysis here.]

Happy New Year

                                             Our Lady of Holyrood, pray for us!

There are, of course, all sorts of rather troubling things to be faced in 2013. In Scotland, and elsewhere in the UK, the bandwagons of euthanasia and same sex 'marriage' will trundle on. The independence referendum campaigns will continue and doubtless increase in heat as 2014 approaches. And all this besides what will no doubt be a deteriorating economic situation.

And yet...

Although Catholics in Scotland had better get used to being seen as the only bigots in the village, we also live in a time when Scotland's foremost composer, James MacMillan and Scotland's foremost philosopher, John Haldane, are both well-known here for their faithful Catholicism. Over the pond in the diaspora, Alasdair MacIntyre continues to demonstrate both his Catholicism and his position as one of the foremost thinkers of the modern age. Given the historical marginalization of Catholicism within Scotland and modern secularization, the continuing strength of orthodox Catholic intellectual and artistic life, both in the well-kent figures I've mentioned and in other artists and intellectuals throughout the nation is remarkable. Their very existence is a reminder that Catholicism is a life lived in the fullness of the good, the beautiful and the true.

So, as my New Year's present to you all, a suggestion for a thoroughly Scottish and Papist welcoming in of the New Year. Sit down, read John Haldane's interview 'Aquinas among the analytics' (extract below), listen to MacMillan's 'Tu es Petrus'

and toast the New Year in with that traditional Benedictine treat, a bottle of Buckie (preferably drunk al fresco, of course):

There is also a general tendency to think that human failings can be righted by introducing structures and regulations, but while these have a role they cannot of themselves produce understanding, and often they are the enemy of it. Secularists, in the modern sense, tend to depict religious believers as dumb and angry; while believers incline to the view that atheists are shallow and bullying. This kind of opposition feeds on itself and leads to deeper animosity. One way of halting the process is to engage in discussion, recognising that there may be reasonable disagreements, I mean possibly intractable differences expressing reasonable outlooks. This is not to endorse relativism but to recognize that our takes on things tend to be partial and it is very difficult to get to a comprehensive understanding. That is not impossible but it takes the full resources of philosophy, and goodness of heart and will besides. John Haldane (full interview here).

Happy 2013!

Edinburgh times for Our Lady of Czestochowa

As previously blogged, the icon of Our Lady of Czestochowa arrives in Edinburgh at 5pm today.

Although the Carfin and Glasgow schedules are now up on the Ocean to Ocean site, the Edinburgh times don't yet seem available anywhere on the internet. Anyway, for what it's worth, the following are taken from the details given out on Ocean to Ocean leaflets in the Archdiocese:

Monday 12 Nov:

5pm: Icon arrives Welcome ceremony
5.30pm Rosary (Joyful mysteries)
6pm Mass with Homily
7.30pm Exposition of Blessed Sacrament
8pm Act of Entrustment to the Blessed Virgin Mary
9pm-10pm TBC
11pm Church closes

Tuesday 13 Nov:

9am Church opens Rosary (Luminous mysteries)
10am Mass
10.30am The Jesus Prayer
11.30am Rosary (Sorrowful Mysteries)
12.45pm Mass
1.15pm Rosary (Glorious Mysteries)
3pm: Chaplet of Divine Mercy
3.15pm TBC Closing ceremonies
4.30pm (approx) Icon leaves for Carfin.

All times are marked as provisional and subject to change.

Visit of Black Madonna of Czestochowa to Scotland

The copy of the icon of Our Lady of Częstochowa is visiting the UK on 5 November as part of a worldwide pro-life pilgrimage:

The peregrination of the Czestochowa icon "From Ocean to Ocean" through the world in defense of life is a joint initiative of pro-life movements from many countries and the international organization Human Life International.  The copy of the Czestochowa icon, which was touched to the original and blessed at Jasna Gora, is a gift of the Polish pro-life movement to the Russian movement.  The leaders of the movement in the east are Orthodox, while the majority in the west are Catholic.  They have gone to their bishops, asking for their blessing and acceptance of the pilgrim icon in defense of life.  For that reason, the Orthodox church is hosting the Czestochowa icon in Russia, but in Belarus, both churches together decided on the route and locations of meetings.  The Catholic Church will host it in Poland, Hungary, and in Spain.  To the extent possible, the icon will also visit Orthodox churches in the west.  The cult of the Mother of God in the Czestochowa icon and the defense of human life and its dignity are powerful elements uniting both churches. (From FAQ.)

The Scottish leg of the pilgrimage is scheduled (provisionally) as follows:


Mon 12 to Tue 13:  Edinburgh
Metropolitan Cathedral of Our Lady of the Assumption Mon, 17:00 Icon arrives Mon 18:00, Holy Mass (English) Tue, 17:00, Icon departs Other details to be confirmed

Cathedral website: http://www.stmaryscathedral.co.uk/

Tue 13 to Wed 14: Carfin, Motherwell
National Shrine to our Blessed Lady Tue, 18:30 Icon arrives, detail to be confirmed
Wed, 15:00, Icon departs

Shrine website: http://www.carfin.org.uk/home.aspx

Wed 14 to Fri 16 Glasgow
St. Andrew’s Cathedral Wed, 16:00 Icon arrives Detail to be confirmed

Cathedral website: http://cathedralg1.weebly.com/


(The above details are taken from the From Ocean to Ocean website timetable  with a correction from the St Mary's Cathedral website (ie English Mass rather than Polish Mass 6pm Monday 12 November). At the time of writing (1 November) so far as I can see only the St Mary's Edinburgh website is carrying local details (under the 'news' section).)

Further information:

Worldwide pilgrimage website: http://www.fromoceantoocean.org/
UK website: http://www.fromoceantoocean.org.uk/



Act of Entrustment of the Protection of the Civilisation of Life and Love Into the Hands of the Most Blessed Virgin Mary

O Blessed Virgin Mary, Chaste Mother of God, Immaculate Virgin.
Into your hands we entrust the great cause of protecting the civilisation of life and love.
We live in a difficult time of a massive global attack by the civilisation of death.
Very many innocent people are perishing - unborn children, the aged and the sick.
The number of victims already exceeds two billion human beings.
Each day an additional 50 thousand children die in their mother’s womb.
Many people do not want to have any children at all.
Means of destroying fertility and life are becoming more and more common.
Infertility of married couples is increasing.
The human child is becoming a product of modern technology, a donor of cells and organs.
Children “are produced” with designated attributes, subject to selection.
Hundreds of thousands of frozen embryos are preserved between life and death in liquid nitrogen.
International man made law denies legal protection to the life of the unborn child.
More and more countries are legalising euthanasia.
The attack on marriage and the family is increasing.
O Holy Mother, we promise you that we will defend human life,
Especially the small and defenceless, with all our strength.
We stand before you, Mother of Our Redeemer,
fully aware that alone we are unable to win that global struggle.
Stand at the forefront of the defence of life movements and lead us.
Protect life! Save the family! Strengthen us!
Obtain from your son the victory of the civilisation of life and love!

Are proponents of euthanasia Nazis?

Translation of (Nazi) poster above: This cogenital invalid costs the community 60,000 Reichsmarks in his lifetime. Comrade, that's your money as well!

Paper on medical ethics discussed previously on this blog: While we feel the best interests of the child in question are paramount, the interests of society—including the other children who might have used this valuable resource—cannot be ignored

Official abstract of paper on infanticide published in Journal of Medical Ethics: the authors argue that what we call ‘after-birth abortion’ (killing a newborn) should be permissible in all the cases where abortion is, including cases where the newborn is not disabled.

Mary Warnock:  The veteran Government adviser said pensioners in mental decline are "wasting people's lives" because of the care they require and should be allowed to opt for euthanasia even if they are not in pain. She insisted there was "nothing wrong" with people being helped to die for the sake of their loved ones or society.

                                                              ----------------------------------


So, are supporters of euthanasia Nazis? No. Do they have lessons to learn from the history of euthanasia in Nazi Germany? Yes.


The front page of the Sunday Herald on 2 September contained as its single item the bold headline:

Outrage as lobby group links right-to-die campaigners with Nazis. 

(Hard to do the graphic presentation of this justice without an image. It was big. It left you in no doubt this was the main business of the day.)

The reader was referred to an inside 'exclusive report' (online version here) about the Care Not Killing conference in Edinburgh which did indeed discuss 'The lessons from Nazism'.

The article is full of outraged pro-euthanasia supporters:

Jane Nicklinson said of Care Not Killing's agenda: "I think it is totally ridiculous and total nonsense. How you can compare [the right to die campaign] to a Nazi death camp I will never know.

"It is scaremongering, pure and simple – half the things they say are nonsense. They will say something like that and then people who don't know much about it will think, 'We can't have that'. It is irresponsible – they are not giving people the true facts."

And:

Yesterday Independent MSP MacDonald accused Care Not Killing of "cheapening" the issue: "This is improper behaviour on their part," she said. "If they want to have a conference on Nazism and particular aspects of that creed, then I suggest to them that they separate it from a conference about assisted dying, because the two have nothing in common. They have cheapened their campaign."

My favourite was:

Raymond Tallis, former professor of geriatric medicine at the University of Manchester and chairman of the group Healthcare Professionals for Assisted Dying, turned angrily on Care Not Killing for making comparisons with Nazism.

"The idea that lining up thousands of people to shoot them is the same thing as acceding to someone's settled wish to die when they are terminally ill and mentally competent indicates how morally blunting it can be when you have religious beliefs."

The Sunday Herald followed up with an editorial which, in the gloriously smug way of such things, said:

...any debate on the question of legislation for assisted deaths needs to be conducted in an enlightened, intelligent and civilised fashion. There is no room for bullhorn rhetoric or arguments based only on sentiment or passion... Another opportunity presents itself this week with a conference in Edinburgh organised by Care Not Killing (CNK), an alliance of healthcare professionals and faith bodies. It is opposed to euthanasia and claims to base its arguments on reason alone, "by avoiding any appeals to extremism". However, it has also claimed that euthanasia can never be acceptable as "we need to learn the lessons from Nazism".

Language of that kind is never helpful and in this case it is inflammatory.

So what to think?

Arguments ad Nazism are pretty common. Sometimes they amount to little more than vulgar abuse; sometimes they make a logical point by taking an extreme case ('If you think moral relativism is correct, does that mean Nazism was morally right?'). In both cases, the reference to Nazism is inessential and often does amount to rhetoric, good or bad.

But sometimes reference to Nazism is simply part of the need to reflect historically on how one of Europe's most civilized and modern countries ended up doing what it did, and how to avoid it happening again. There is absolutely no doubt that Nazism did introduce euthanasia for the disabled and ill: this is separate from the 'Final Solution' that Raymond Tallis seems to be thinking about when he talks of 'lining up thousands of people to shoot them'.

The key historical interest here is how Germany went from a general view that some lives were not worth living to the use of enforced euthanasia. The details of that process are outlined in an excellent article here by Mark Mostert. A particularly interesting aspect is the way that particular, emotionally charged cases were used to effect a change in public opinion:

The Knauer child was a frail child with several severe disabilities. While the case has become quite mythologized, it seems that she was blind, without one leg and part of an arm, severely mentally retarded, and suffered from chronic convulsions (Friedlander, 1995; Lifton, 1986; Proctor, 1988). Her father petitioned the Nazi authorities to grant her a "merciful death" but received no official response. Subsequent to this request, in the winter of 1938-1939, the Knauer child was admitted to the University of Leipzig's pediatric clinic after attending physicians discussed her plight with her persistent father. Aside from the child's obvious physical and intellectual disabilities, the father asserted that the child, by remaining at home, was causing his wife significant psychological and emotional stress. He requested that the physicians proceed by "putting it to sleep." Initially, the doctors refused, reminding the father that such action was against the law. Undaunted, the father, encouraged by the child's grandmother, petitioned Hitler directly to sanction the child's death (Gallagher, 1990). Arguably, the persistence of this one man became the catalyst for official genocide.


The Sunday Herald article is clearly part of a softening up campaign in favour of euthanasia that is the precursor to Margo MacDonald's attempt to reintroduce a bill into the Scottish Parliament in this area. Putting aside whether it's right to keep banging away at legislation in this area when it was only recently overwhelmingly rejected by the Parliament, all of us, on whatever side of the argument, need to be familiar with the history of euthanasia, particularly in Europe. A key aspect (but not the only aspect) of the pro-life case is the claim that there is a slippery slope between assisted suicide, voluntary euthanasia and involuntary or non-voluntary euthanasia. Examining the history of how such slippery slopes actually occurred in the past is an important part of the debate. To dismiss such historical studies out of hand is itself a sign of irrationality.

Children, withdrawing treatment, and religion

                                            What do you mean you've got theological objections?

The Journal of Medical Ethics article 'Should religious beliefs be allowed to stonewall a secular approach to withdrawing and withholding treatment in children?' (press release here courtesy of Echurch blog (with full text in combox)) is an odd fish.

The main substantive conclusion, tucked away in the middle of the paper, appears to be:

We suggest it is time to have a default position in that it is presumed that parental religion is not a determining factor in decision-making for the child until the child is ‘Gillick competent’ to choose to consent to be part of the parent’s religion; thereby recognising that religion is important to the parents but should not influence the management of their child.

The conclusion at the end of the paper is:

We suggest it is time to reconsider current ethical and legal structures and facilitate rapid default access to courts in such situations when the best interests of the child are compromised in expectation of the miraculous.

I draw from this that the main substantive conclusion of the paper is that:

1) In end of life care, parental views based on religion should be disregarded.
2) Where parents disagree with doctors on the management of a child based on a religious belief, especially that in the miraculous, legal procedures should be in place to avoid extended dialogue in favour of a rapid decision overriding the parents' views.

I think that's what they're arguing, although it's a rather muddled, badly argued paper (which is worrying in itself). As the 'ethics review' comment puts it at the bottom (ie the Journal's description of the type of paper):  'Not really a ‘study’ but a review of cases referred, and no identifiable clinical details provided.' It's more of a think piece, not much engagement with academic literature; no attempt to engage with the details of the cases referred to.

The cases under discussion are those where 'withdrawal or limitation of invasive therapy was recommended' (by medical staff). These amounted to 203 cases over 3 years. Of these, 186 were resolved by agreement (92%). Of the remaining 17, 'extended discussions' did not result in agreement:


We reviewed the case notes and found a predominant theme of expression of strong religious belief influencing the family’s response to the critical illness of their child. Of these 17 initial cases, 6 were resolved by considering the best interest of the child, further time for the families and ongoing multidisciplinary discussions. However, 11 (65%) involved challenging protracted discussions, largely based upon the belief in the sanctity of life as a result of the parents’ religious convictions.

Of course, a 'review' which finds a 'predominant theme' is highly impressionistic particularly where (as I shall go on to argue, the bias of the reviewer is evident): did all the cases display this theme? Or was it just particularly striking given the forcefulness of a few cases? Who knows?

Anyway, of the 11, 5 were ultimately solved  ultimately 'with the help and support of hospital and local religious leaders'. Pause there. Nearly half the cases were solved by religion playing a positive role in the resolution of the conflict. So by taking account of the parents' religion, by thinking through and using the authority structures and language of the religion, half of the really difficult cases were solved, quite apart from the positive role it may have played in any of the other cases. That fact merits careful consideration -but it ain't getting it in this paper. On it trundles.

That leaves 6 cases. Less than 3% of cases. 2 per year in what is the major centre (Great Ormond Street Hospital) for dealing with severely ill children in the UK, and one based in a cosmopolitan city where the possibility of cross cultural misunderstandings (the relevance of which I'll make obvious below) is likely to be at its greatest. So a handful of cases. Not really analysed. No examination of the positive role of religion. And yet we get the general conclusion: advocating that, 'it is presumed that parental religion is not a determining factor in decision-making for the child'.  Hhmm.

Anyway, back to the six cases. These all apparently involved 'fundamentalist' religious beliefs. ('In cases in which religion was not a fundamentalist factor all ultimately had successful local resolution.') Of these, most were evangelical African Churches. ('Of those in which resolution was not possible, Christian fundamentalist churches with African evangelical origins featured most frequently, though other religions also featured.') Of the (indeterminate) number which involved Christian 'fundamentalists', 'the parents did not engage in exploration of their religious beliefs with hospital chaplains and no religious community leaders were available to attend meetings to help discuss or reconcile the differences. The parents had their own views or interpretation of their religion and were not prepared to discuss these tenets.'

So we really have absolutely no idea why families acted the way they did, because they weren't prepared to discuss them. Clearly, extremely awkward for a doctor, but hardly a good basis for a medical ethicist to construct an argument. However, not daunted by any lack of information, the paper goes on:

All these families were explicit in their expectation of a ‘miraculous cure’ for their child, and as such all felt the medical scientific information was of limited use. Although ongoing daily dialogue continued between the family and the teams there was no change in the family’s view that aggressive support must always be continued waiting for God to intervene.

So, on the one hand, we have a description of the inability of the family to engage in exploration of their beliefs; and on the other hand, we have a claim that dialogue continues. (It really can't have been much of a dialogue.) Anyway, of these six cases, one survived with profound neurodisability, four died after leaving the intensive care unit (were they booted out?) and one died after the hospital went to the High Court for suspension of treatment.

What are we to make of this? First, I have complete sympathy with the medical practitioners involved: if I were a doctor, confronted by a family who were making completely irrational decisions, and who continued to despite an extended attempt to engage them in dialogue, I would be looking round for a solution. But none of that removes the fact that, as far as a piece of ethical reflection is concerned, the paper is muddled, and erects on the basis of a very few extremely difficult cases, a proposal to disregard parental beliefs that would impact on a great many more cases in ways that the authors seem to have no concern for.

It's very difficult to imagine a more fraught scenario. A child is seriously ill and dying. You are a family with a very different cultural background with no advocates able to articulate your concerns in a way that mediates between the NHS secularized culture and your own ('no religious community leaders were available to attend meetings').   It's difficult to imagine such a position ever going well, and certainly never easily. I'm surprised that there are only a couple of cases like this every year. So one thing that needs to be said is that we shouldn't expect any system in such circumstances to work without problems. If change is being advocated, then there has to be a sense of what the moral costs of that change will be. No sense of this sort of realism in the paper.

Second, despite (because of?) the involvement of a Chaplain in writing the paper, the understanding of religion is simplistic. A favourable reference to Richard Dawkins ('As Dawkins suggests, should we refer to the ‘child of Christian parents’ rather than a ‘Christian child’?') as an interpreter of the complexities of these issues is not promising. Moving on, there is the category of 'fundamentalism' that is bandied about: 'Fundamentalism is defined here as the expectation that specific theological doctrines will be maintained.' I guess that means I'm a fundamentalist, but being quite a cunning, educated one, I bet I could disguise it far better than a family of African immigrants. (I even disguise it from myself since I believe that my ethical position is based on the exercise of reason applied to human nature.)

Given the lack of dialogue already noted, nuances are going to get stripped out. (No sensitivity to this in the paper.) But even within the limits of what is said, it's quite clear that the authors are overlooking nuances present in the families' positions. They equate, for example,the  'expectation of a ‘miraculous cure’  with 'waiting for God to intervene'. Well, I expect, with absolute confidence, God to intervene, but I only hope for a miraculous cure. If the authors can't even notice this difference when writing up the work for publication, then what hope is there of noting it in the fraught conditions of a dialogue that is not a dialogue?

It's hard to read this paper without concluding that a massive conclusion is being erected on the flimsiest of argument. It's hard to read this paper without concluding that the authors have a cloth ear when it comes to cultural sensitivity and religious sensitivity. What, for example, are we to make of the following:


Yet followers of one of the world’s largest religions within our society, which is accused of
being secular, would defend this proclamation from their spiritual leader and expect to have their view accepted and consequently this particular practice is condoned. So in this alleged secular society in the UK, we have a tendency to be more accepting of some religions and their practices more readily without questioning them.

Yes, fellow bead rattlers, it's us and our bonkers Pope again:


Numerous healthcare groups in this secular society might feel empowered to criticise any religion that in their view advocated illogical practices, for example, prohibiting the use of condoms in the face of the spread of HIV and AIDS.

Add that to the Richard Dawkins' remark, and it's difficult to see the authors as anything more than hopelessly ill-equipped to deal with what is, in any case, going to be an extremely difficult set of cases.

The general run of medical ethics is much, much more sensitive to the difficulties of ethical decision making in cases like this. (See eg here for a summary of current methodologies.) Perhaps the most worrying aspect of the paper is the way that practising clinicians seem to have let an understandable impatience with what may well have been families making poor decisions prompt them towards a dismissal of religion from any sort of rational exchange.

Schubert, atheism and death

Dietrich Fischer-Dieskau is dead and another milestone in my own journey to death. I remember very clearly the thrill of buying a cassette of one of his performances of Winterreise as a teenager, significant as part of my development of a cultural space separate from that of my parents. There are a few other pieces that  I remember from around that heady time, but very few others that whispered 'death' so clearly in my young mind and have gone on whispering it throughout my life. And now I'm an age where, although I don't expect to die in the immediate future, enough of the occasional tumours or heart attacks or accidents have occurred among those I know for me to realize that the whisper is for me and not just a conversation between others on which I'm eavesdropping.

Schubert of course isn't just the minstrel of death, but, quite apart from the explicit treatments of death in his songs, the constant themes of parting, failed love, and journeys, combined with his early death (at 31), have always made this, at least for me, his major theme. And now, the man who was Schubert's Lieder has died.

All this made me revisit Terry Pratchett's vision of the good death:


Sir Terry, who was knighted in the 2009 New Year Honours, said in an article in the Mail on Sunday: 'I intend, before the endgame looms, to die sitting in a chair in my own garden with a glass of brandy in my hand and Thomas Tallis on the iPod.

Why Thomas Tallis? Why not Schubert? Well, here's one answer. With Tallis, you have the certainty of a Catholic composer that (as the text of Spem in alium has it):


I have never put my hope in any other but in You,
O God of Israel
who can show both anger
and graciousness,
and who absolves all the sins of suffering man
Lord God,
Creator of Heaven and Earth
be mindful of our lowliness

Catholics have that hope in the Other. And drugged by fine brandy, consoled by the firm belief of a system we really don't believe in but can pretend to for the few minutes we are conscious, we atheists can screw our courage to the sticking place and swallow the poison.

Would you go out with Schubert on the ipod? After all, Schubert, unlike the loony Catholic Tallis, was an atheist. So why not face up to death and parting and the end of earthly love in all the clarity of its truth? Why look for consolation to the sky fairy believing Tallis when you have Schubert? I suspect that the answer here is that Schubert, genius that he is, portrays the death of the human being as simple creature: he gives no consolation because, really, for an atheist, there ought not to be any consolation, but merely the bleakness of ends and unsatisfactory partings.

Anyway, would you die with Schubert on the ipod? Here are two test pieces. The first, Der Leiermann, is the final song of Winterreise, and the desolate end of a desolate journey:

Way behind the hamlet 
stands an organ man 
and with freezing fingers 
grinds the best he can.


Barefoot on the snowbank 
swaying to and fro - 
and his little plate has 
ne'er a coin to show.


No-one comes to listen, 
no-one comes to greet, 
and the dogs are growling 
at the old man's feet.


And he lets it happen, 
lets it as it will - 
cranking - and his organ 
never staying still.


Strangest of the Ancients, 
must I walk with you? 
Will you grind my Lieders
on your organ, too? 




The second, the final song of Die Schöne Müllerin, Des Baches Wiegenlied, where the brook calls the young man to suicide:

Good rest, good rest,
Close your eyes!
Wanderer, tired one, you are home.
Fidelity is here,
You shall lie by me,
Until the sea drinks the brooklet dry.


I will bed you cool
On a soft pillow,
In the blue crystal room,
Come, come,
Whatever can lull,
rock and lap my boy to sleep!


When a hunting-horn sounds
From the green forest,
I will roar and rush around you.
Don't look in,
Blue flowerets!
You make my sleeper's dreams so troubled!


Away, away
From the mill-path,
Away, away,
hateful girl!
That your shadow might not wake him.
Throw in to me
Your fine handkerchief,
That I may cover his eyes with it!


Good night, good night,
Until all awake,
Sleep out your joy, sleep out your pain!
The full moon climbs,
The mist fades away,
and the heavens above, how wide they are!


Modern atheism, in Pratchett's version, ignores the depths of human death and love displayed in Schubert's music in favour of the stolen consolations of a religion it denies: it is death (and thus life) stripped of complexity and reduced to a lifestyle choice. For a Catholic, Spem in alium promises the hope of paradise but the reality of judgment, the probability of purgatory and the possibility of hell. It is, moreover, merely part of the lifetime of a journey through the hard religious discipline of the Church: if it is a consolation, it is one that has been paid for and one that has depths.