Autonomy, killing and medicine

                                                I am the master of my fate:
                                               I am the captain of my soul.

Margo MacDonald’s attempt to reintroduce legislation in the Scottish Parliament for killing off the sick was not unexpected (I blogged previously about it here) but is still unwelcome.

Doubtless this one will rumble on and on, but reading blogger Caroline Farrow’s harrowing account  of her current problems reminded me of what autonomy is really like when exercised in a situation of illness and the imbalance of power that is built into a medical relationship. It also reminded me of a part of Stanley Hauerwas’ paper ‘Timeful friends: living with the handicapped’ (in the volume Sanctify Them in the Truth) which deals with what it’s like to exercise agency on behalf of the mentally handicapped:

…as every parent of the mentally handicapped knows, […] they are caught in what seems an irresolvable conundrum. In order for your child to receive appropriate care they must be labeled –retarded, handicapped, Down’s syndrome- but the labels can become self-fulfilling prophecies; or worse, the labels can legitimate the intervention of others into their children’s lives that often only benefits the agents of intervention. This becomes particularly troubling when the agent of intervention is an institution called the state.

The experience of trying to articulate needs in a vocabulary that is not yours and in a situation where all the power is held by another and you exist as a petitioner is not unusual. Moreover, there is a peculiar vulnerability where you are acting as advocate for another –a sick child or a sick, dependent relative- where there is a tendency on the part of authority to suspect a divergence between your interests as advocate and the real interests of the individual you claim to be acting for. Add to that a tendency to regard Christians as deluded and Catholics as particularly potty and you have the sort of experience described by Caroline:

So into the midwife’s room I trot with two children in full-on meltdown, eliciting lots of sighs and huffing and puffing. Can’t you get someone to look after them for you, she asked. I explain that they have been ill and so aren’t allowed in nursery. Don’t you have anyone else to help you she asks. No, I reply, I don’t. What about family? No – one set in Wales, the other in Oxfordshire and a sister with 4 children of her own in Northampton. I’m not from Brighton, I don’t have any close friends here, only having moved here a few years ago and then having to move house just having got to know a certain area.

Well you’re clearly struggling she said, life isn’t going to get any easier for you with another baby and three small children, are you sure that this is the wisest option? I don’t agree with abortion, I replied, so this isn’t a discussion that I want to have. Well, alright, fair enough, but I’m just very concerned for you. Thanks, I appreciate it, what I need is some help, do you think you might be able to arrange that for me? No, sorry, you’ll have to speak to the health visitor once the baby is born. […]

Tut, tut, tsk, tsk, tsk. All the while the children are in meltdown. There are no toddler toys in the consulting room because they constitute a risk of contamination. I am asked why I didn’t bring anything to entertain them. I explain that I was in a rush, it was a difficult morning and I was trying to rush out of the house as quickly as possible. Tsk, tsk tsk. Tut, tut, tut. Then – what are you going to do about contraception once the baby has been born. I explain that we are either going to abstain for as long as it takes or we are contacting the couple-to-couple league for a belt and braces method […] Tsk, tsk, tut, tut, tut. That is not good enough. Natural contraception just does not work. You cannot be in this situation again (as if I don’t know) what about sterilisation? I explain, briefly that contraception is out of the question for us as a couple. I don’t go into any detail, just explain that due to cultural beliefs we cannot use it. Well that’s ridiculous she says, you have to do something. I can’t, I tell her, it’s out of the question. Well in that case, I think I need to refer you to counselling. No, I don’t need counselling I tell her. Yes, you do she tells me, I have here in your notes that you suffer from ante-natal depression and there’s a huge risk of post-natal depression, unless you use contraception you are going to be very very ill and you need to understand that, as does your husband. Oh, he understands that alright, he understands that I am more than just a bit “sad” at the moment, but even IF I accepted what you are saying about contraception, which I don’t, if I get sterilised or use contraception behind my husband’s back, my marriage will be effectively over. We will never be intimate again and our marriage will be under huge strain. How will that help anyone, particularly the children? Well he needs counselling to make him understand. No, he doesn’t and nor do I, as a couple, contraception is OUR choice and OUR business, not for one person to hector another and given the situation, I hardly think we are going to take any future risks.

So it’s all a barrel of laughs so far.

Well, so what, I hear you ask? Pretty unpleasant experience, unsympathetic medical practitioner –what’s new?

Well, remember that it was only in 1930 that the Lambeth Conference allowed the use of contraception to manage fertility. Up till then, the view that contraception was immoral was mainstream. Moreover, the view that contraception was a bit iffy –not quite nice- survived much longer, certainly into the sixties and beyond. But now you have the situation where Caroline struggles to articulate what was once a mainstream view in a way that the midwife can understand –quite apart from accepting. (Note the understandable attempt to frame it as a ‘cultural belief’: much easier for the secular world to deal with cultural minorities rather than moral disagreement). Moreover, the sort of help available is now reduced to persuasion under the title of counselling rather than anything practical which might actually make a difference.

But no harm done, perhaps. Caroline wasn’t forced to compromise her position. Only a few hurt feelings then…

Now imagine a similar case of ‘assisted suicide’ thirty years down the line if Margo MacDonald gets her way. Imagine the cold, hard gaze of secular sanity confronted by a rather sad, clearly deluded believer in sky fairies. Imagine trying to frame your reasons for not wanting to spare your parent/child/spouse an agonizing death, where there exists an easy, pain free alternative. Imagine being offered counselling to bring you round to a sane point of view and where no other palliative treatment exists. (Why would it? It’s expensive and it’s irrational.) Imagine that, in the case of euthanasia, how much easier it is for a doctor to kill you than it is for a doctor to force you to use contraception.

This is what a slippery slope looks like. What was a possibility in 1930 becomes the irresistibly sensible in 2012.

Catholicism and the Refarmation

Having recently had a rather illuminating exchange on sola scriptura with  Cath prompted by Aelianus' post (follow up here), I thought I'd lower the tone by referring you to by far the best summary of the historical differences between Catholicism and Protestantism that I am aware of on the web (as well as a splendid example of the use of Scots (albeit of the Ulster Scots variety) in serious academic discussion) courtesy of Professor Billy McWilliams of 1690 an' all thon. (Be warned, the good professor, despite his elevated academic status as "Visitin' Lekturer at the Ulster Scots School o' Dancin', Ballymena" tends to the Rabelaisian in language -so read no further if this troubles you.)

Whit was the Refarmation?

As the word "refarmed" wud suggest, the Refarmation involved the farmin' o'er again o' somethin' that had already bin farmed afore, namely Presbyternianism. Frae ma lengthy studies oan the matter, includin' a short stint as Professor o' Religious Things at Annahilt Sunday School, Ah hiv larnt thit the o'er surt hid taken the pure Christian faith an' added stuff ontil it. Stuff like the Pope, purgatry, nat atin' mate o' a Friday, Blood Transfusions an' sayin' haitch instead o' aitch. They were clean gettin' away wi' it fur they made the Bible intil Latin an' kept the ordinary folk unnerinformed on matters, til a German Pastor called Martin Luther King Sr suddenly wised up an' decided fur til rectify matters. Thus in 1517 he writ a big thing an' started the whole Refarmation when he nailed his Testes to a church door in Wittenburg.

Whit the Pope did.

The Pope wasnae tae pleased about the Testes incident, an' summoned Luther King Sr til a big meetin' where he tried fur til make him eat Worms. He refused, an' thus invented pratestin'. Prior tae this naebody had ever pratested aboot anythin', mainly just gettin' a wee bit pished aff an' the like, an' sae we get the term Pratestant. Ah amnae tae sure whit happened next, fur it gets wile complicated, but it saims thit a wile lock o' important German folk agreed with Luther King. Afore he knew it, half the country was pratestin', he'd translated the Bible intil German, had accidentally gat married an' the Pope was rippin'. This in turn led til the Counter Refarmation, which Ah cannae even be arsed til think aboot whilst sober.

For the full dissertation, and much other good sense, see here.

Scottish Catholic Observer on Independence

                                      His Father, who was self-controlled,
                                      Bade all the children round attend
                                     To James's miserable end,
                                     And always keep a-hold of Nurse
                                     For fear of finding something worse. 

The Scottish Catholic Observer contained an article this week on prominent Scottish Catholic commentators’ reactions to Independence. (Shortened form of the article here.)

The chief arguments in favour of independence seem to be:

1)      Scotland already has a strong cultural identity. Independence is the natural development of that.

2)      There is a sense of frustration within Scotland at being unable to exercise national autonomy over many political issues. Independence would satisfy that frustration.

The chief arguments against independence seem to be:

I)       It would be economically disastrous.

II)     Scottish independence would threaten Catholics in particular.

That strikes me as a fair representation of the sort of thoughts which must be buzzing around many Scottish Catholic minds just now, and I’ll doubtless be returning to them over the course of the next couple of years. But for the moment, I’m going to focus on II): that in some way, Independence would pose a particular threat to Catholics. (Teuchtar has already provided a response from a Nationalist point of view here.)

The first point to be stressed here is that we must be talking about risk and predicted consequences here. The modern SNP is clearly not advocating anything like an extirpation of Catholicism in Scotland, so any fears in this area are not about a clear and present danger, but about the always tricky assessment of remote consequences which would follow upon a declaration of Independence. We’re all guessing and bloggers in the privacy of their studies are guessing more than most.

But putting that aside, it strikes me that the reasoning displayed in the SCO article falls into two main kinds:

a)      The claim that post independence Scotland will be different and (certainly for a while) more fluid politically and thus there is a possibility of change in areas that affect Catholics.

b)      The claim that Nationalism, the SNP in particular, or Scotland as a whole has a tendency to anti-Catholicism and thus there is a likelihood of anti-Catholic effects.

Taking a) first, it’s certainly true that Independence will have ‘thrown all things about’ and that there is going to be increased unpredictability in Scotland’s politics. In terms of policies, that means that there is going to be increased unpredictability in areas such as the liberals’ attempt to undermine social institutions such as marriage, and in the provision of Catholic schools. So here the question is going to be: Do we have much reason to believe that the climate of politics in the UK as a whole would be any more favourable to Catholics on these issues than the climate of opinion in post-Independence Scotland? Mebbe aye, mebbe nae.

Four reasons for thinking UK politics might be more favourable than Scottish ones are, first, the greater number of Church of England schools in England: unlike Scotland, where the provision of Church schools is essentially a Catholic vs everyone else question (and hence particularly vulnerable to attack), in England, any attempt to dismantle religious education would have to take on the Established Church as well various minority religions. (How relevant this is to Scotland given the already devolved status of education is a moot point.) Second, the presence and rather greater prominence of the Church of England in political and cultural life in England than the Church of Scotland here suggest, at least for the moment, that Christianity is more clearly entrenched in the cultural institutions of the UK than it would be in an independent Scotland. Third, there is a greater political and intellectual self-confidence amongst English social conservatives than there is among Scottish ones. For example, on same sex ‘marriage’, there appears to be the very real possibility of a backbench revolt in the Conservative Party. (Any sign of something similar in Scotland after John Mason and Bill Walker were given a good kicking for merely suggesting the possibility of conscientious objection?) Finally, the existence of a greater ethnic diversity in the English population, with a corresponding need on the part of politicians to placate (eg) Muslim and Pentecostal voters perhaps offers a greater guarantee of the presence of social conservatism as a view in UK politics rather than Scottish politics. 

Turning to b) and the question of whether there is something particularly anti-Catholic in the DNA of Scottish politics or culture, it’s undeniable that there are anti-Catholic strands in Scottish society. So the only question is how important these are. In terms of good old fashioned anti-Catholic, sectarian hatred, I’m genuinely not sure. Enough of it exists so that it would be perfectly understandable if some Catholics, particularly around Glasgow, were wary of the emotions that the referendum itself, quite apart from its result, might churn up. I’m equally certain that very little of it exists in the current SNP leadership, whatever may have been the case in the past. Perhaps the more obvious risk is the sort of dumb secularism that has been much in evidence during the same sex ‘marriage’ debate so far, coupled with the emotional resonances left by traditional anti-Catholicism. If you come from a tradition that has been telling you for five hundred years that Catholics are moronic, child abusing, anti-Scottish bigots, the cultural patterns of such views will survive rather longer than the Presbyterianism that once supported them, particularly when combined with the adolescent male braggadocio of the New Atheists. 

Certainly, as I blogged previously, wandering through the Scottish media and blogosphere during the same sex ‘marriage’ consultation was a peculiarly depressing experience. It left me with the feeling that I certainly wouldn’t like to be left in a darkened room with some of these people, and I’m not sure that I’d like to be left in a small country of only five million or so either. (Particularly in the absence of the obviously socially conservative allies I’d find in England –see above.)


To sum up then, on this one argument –the risk to Catholics in an independent Scotland- I’m inclined at the moment to agree that there is a real challenge here for the Nationalist case. That challenge isn’t unanswerable and may in any case be outweighed by the other, pro-Independence arguments. As I’ve blogged before, will Catholics have a seat in the new Scotland? Personally, I’ll be looking at how the Scottish government and indeed the wider society handles the results of the same sex ‘marriage’ consultation quite closely and I suspect many other Catholics will be too. Judging by the signs up till now, I’m not that hopeful.