Sisyphus Revisited Edition
Suffering, suicide, and human dignity.
Note for the reader: this post discusses suicide.
Suicide is obviously not a new question. Some have gone so far as to call it the “one truly serious philosophical problem” since if we cannot find firm ground on which to judge life worth living, nothing else matters. But it has taken on renewed urgency with the growing controversy over euthanasia and end-of-life care.
I have been hesitant to write about this because I doubt I have much new to say. What’s more, suicide demonstrates a social contagion effect and while I don’t think it should be off limits to talk about I personally don’t wish to do so lightly. But the public health protocols that are now being advanced—and the views of human life they rest on—are inescapably a matter of public import. Many if not most of us will be confronted sooner or later with how to navigate such questions for ourselves or the people we love. It’s important to get clear on, and not only because Camus says so. Though that’s a good reason.
In December of last year, Alexander Raikin’s investigation into Canada’s euthanasia program, Medical Assistance in Dying (MAID), revealed major weaknesses in the safeguards put in place to qualify those suffering from terminal or incurable illness. He found that the obligatory medical diagnoses and mental health evaluations have been treated as perfunctory box-checking exercises. What’s more, internal training documents demonstrate that MAID patients have repeatedly appealed to factors such as poverty, lack of housing, inability to afford treatments, or loneliness as the driving reasons for their request to end their lives.
As perhaps the world’s most permissive euthanasia regime, MAID was already controversial. But scrutiny is ramping up now because eligibility was set to expand this year to include those suffering from non-life-threatening mental illness. That move has drawn broader opposition, including from leading MAID practitioners. Implementation has been paused. Advocates meanwhile want it further expanded to minors, in line with Belgium and the Netherlands.
Raikin’s piece and other reports are quite convincing in showing, at the very least, that the program’s limits as originally conceived are being eroded by a medical bureaucracy that is either unable or unwilling to enforce them. That is troubling news for the sort of well-meaning centrist who hopes for a stable compromise, in which “vulnerable people who want to die for the wrong reasons will be encouraged to live, as they always have been—while people who want to die for the right reasons will have their autonomous decision upheld.”
Everything rests on this purported distinction between “right” and “wrong” reasons. But it’s very unclear if this line-drawing exercise makes any sense at all. Is there any coherent principle that could distinguish between “legitimate” and “illegitimate” reasons for taking one’s own life? Setting aside my own moral commitments, which understand suicide as an intrinsically wrong act, I can’t see one.
For instance. The MAID system and others like it are, on the one hand, based on the idea that the right to die is tied to some set of objective criteria, some measurable threshhold of suffering, which can be defined by the medical profession and which must be verified by it. (Let’s ignore the obvious difficulty that those “objective” criteria continue to shift.) On the other hand, advocates consistently advance a much more categorically affirmative view, in which individuals have an unquestionable right to “take control of their own deaths,” with “unwanted suffering” as the only criteria. Based on that, who could be denied? Under this view, I don’t think anyone could be.
Most supporters don’t admit to that in public for understandable reasons. But there is at least one man willing to loudly take the logic to its bitter ends, and perhaps we should thank him for it. It is unintentionally instructive.
Richard Hanania’s full-throated defense of MAID—except insofar as he criticizes it for not going far enough—is not particularly coherent. It swings wildly from reassuring us that very few people are choosing euthanasia to hoping that many more do so. It mocks those who worry about the normalization of suicide as purveyors of a “moral panic”—and then chastises them for not getting out of the way of it becoming normalized fast enough. But by the end he has cut through the dilemma I just posed by effectively affirming that there is no such thing as an “illegitimate” reason. The desire alone is what counts.
Ross Douthat summarizes Hanania’s lurching path:
He begins with a moderate argument that seems calculated to reassure people who want to be permissive on the edges, but also want the old Christian taboos on suicide to mostly be upheld. He moves from there to a more expressly libertarian perspective that sweeps biblical religion away entirely. And then he actively infuses this libertarianism with a kind of pseudo-Roman, pagan, pre-Christian case for suicide as a positive good, an appropriate service to the gods of the city and the hearth.
I don’t feel like mincing words—It’s an ugly essay. I think intentionally so. Not that Hanania’s trolling, exactly. Rather you get the sense he feels he has some duty to shock us out of our complacency, and thus his swaggering enthusiasm for allowing the herd to self-cull in the name of “cost-benefit analysis.” I think it would be uncharitable to tar other MAID supporters with his eugenicist views on, for instance, the worthlessness of disabled life. I have no reason to think most hold those views. But I do think it is an all-too-easy place to end up once you start down the road of judging the value of life based on economic productivity and physical health.
An interesting aspect of this is Hanania's belief that we actually value individual life too much, that the so-called “culture of life” has gone too far. This is a view shared across various forms of collectivism (which he mistakes for the common good) and which is ironic coming as it does right after he passionately defends individual liberty. But it's true that end-of-life care can go too far, and for what it’s worth the Church agrees: it holds that there is no obligation to pursue “extraordinary measures” to put off unavoidable death.1
That is not equivalent to euthanasia, however, because there is no deliberate intention to end a life. There is only a recognition that further action is fruitless. There is a relinquishing of control over life and death rather than a perverse assertion of control.
Throughout the essay Hanania trips over the role of intention like this, conflating risk tolerance with deliberate killing. He compares, for instance, euthanasia with Covid lockdown opposition, meaning to say, presumably, that the latter also involves some loss of life. But of course, supporting a higher-risk public policy does not require accepting, much less intending, the death of anyone, even if it can be foreseen that some may die. A better analogy for that would be, not euthanasia, but a patient who undertakes a risky but hopeful procedure despite being informed that there is a good chance he may die; if he dies, though it was reasonably foreseen, neither he nor his doctor is guilty of it. The point of the procedure was cure, not death.2
Christian moral reasoning places a great deal of emphasis on intentionality, and in real life everyone understands this to be true: manslaughter vs. murder is determined by mens rea, the intention. Blindness to this is a common failure mode of utilitarian reasoning.
Maybe this is counterintuitive and worth emphasizing—a “culture of life” is decidedly not one that irrationally seeks to avoid death or injury at all costs like some hermetic bubble boy. It means properly respecting life, not worshiping it. Life is sacred and a gift of God, it bears the image and imprint of God, it is a sharing in the outpouring of God’s creative spirit, but it is not itself God. Indeed, too much risk aversion threatens to turn life into an idol. I would argue that much of the life extension fervor and the culture’s larger health-optimization obsession shades into being anti-life in this sense. Not wanting life but control over life, wanting to play God.
Hanania and other euthanasia supporters are on stronger ground when speaking of the problem of pain. Their most undeniable claim is that suffering, more than just a difficult reality, is in some deep sense inexplicable, offensive, outrageous. That the absurdity of suffering, the excruciating and seemingly pointless pain of terminal and chronic sickness, cries out not just for relief but for explanation. A narrative that places control of our suffering back into our own hands, even if those hands administer death, can appear to answer that need.
The problem is that making the elimination of suffering the highest goal quickly shuttles the calculus toward the position that there is more utility in avoiding life altogether. The guaranteed downside outweighing the potential upside. That’s how you get to a belief in net-negative lives. It’s not unfair to call that a culture of death, even if it flows from a sincere if misguided desire to improve life.
For good or ill, that premise is wrong. The worth of life is not a naive linear function of happiness minus suffering, which is fairly clear to most people who have avoided too much education. There is a much more straightforward and genial counter-narrative, if we want it: that we are not God and we are freed from trying to be. We are not responsible for the cosmic abacus of life and death. We are but shepherds and gardeners of vast and interlocking realms that we have only barely begun to comprehend, much less improve upon. Our role as Auden knew is only to learn to praise it, love one another, and die well.
Such a recognition is not limited to the Anglicans: Hanania handwaves vaguely toward a pagan virtue of self-sacrifice but it was the Greeks who handed down the ancient prohibition against physicians taking innocent life. Nor am I at all sure that more modern pagans would be very receptive to Hananian surrender: that is certainly not amor fati. Nietzsche the yea-sayer could affirm that a single moment of goodness justifies and overwhelms an eternity of night. As for me, long before I discerned its fullness in the Christian revelation, that challenging truth was first gifted me by the happy pagan Camus: “There is a will to live without refusing anything life offers: the virtue I honor most in this world.”3
People wonder what the use of metaphysics is, and yet here we see how massive is the practical gulf between false and true axioms. Step false and your very existence is a mistake; True means that your life has intrinsic, infinite, inviolable worth. Even if you’re not productive, even if you are a “burden” on others, and even when you are sick and in pain and abandoned and have no hope of recovery. Even when the remaining life will be too short, or too long. Even in times of extremity—especially then, when it really hurts and it’s not going to stop. That’s when we need to hear the truth. When we have no power to fix or heal but only to witness, and accompany, and share in each other’s suffering. That’s when it’s hardest to hear, and hardest to say. That’s why the rot starts there first.
I don’t know who out there needs to hear that. What’s worse, I don’t know who has the credibility to say it. Not me. Only suffering borne with love bestows that credibility, that’s what the saints are for. Perhaps as always I am simply talking with myself. I know a younger version of me needed to hear it but could not, and surely an older version, if I am blessed with long life, will need to again.
Hanania to his credit doesn’t deny human dignity but he does misplace it. He like other euthanasia advocates roots it in choice, specifically the ability to choose the time and manner of one’s own death. Here again we see that what’s at stake is not primarily the avoidance of suffering but the maintenance of control: if unchosen suffering robs us of our dignity then only the right to dispose of our life at will can restore it.
Setting aside the metaphysical incongruity of restoring something to someone who no longer exists to receive it, our dignity is in fact not contingent on our circumstances. It is an inherent attribute of each individual. It is inalienable, an endowment from our Creator, as a prominent thought leader once put it. Not sickness nor disability, not sin nor suffering diminish it.
Attaching our dignity to our health or our achievements buries its light under shame and the fear of weakness. Under the false belief that we have to meet certain standards or be able to perform certain tasks in order to be worthy of life. That otherwise we will be doomed to be, as Hanania puts in his most revealing passage, defective:
The idea that I might accept [being paralyzed] would for me be even more reason to commit suicide, lest I get used to accepting a defective version of myself.
Nota bene: he is not only saying he would rather die than be disabled, he is saying he would rather die than accept himself as a disabled person. Amid the flurry of statistical and philosophical justifications, this is the core of it: he couldn’t bear the horror of needing help. It’s heartbreaking. It so profoundly misreads the purpose and value of our lives. We are put here to help bear each other’s burdens, to accompany each other on the pilgrimage. That’s the whole dance.
It’s understandable, though. This misunderstanding permeates the culture. Who can escape it? I can’t, really, in practice. Hanania’s shame at the prospect of ever being dependent on others—that is, the basic condition of existing as a human being—is deeply relatable, to me and probably to many. He is, surely, no less defective than the rest of us. But we may assure him even against his own protestations that his life is worth none the less for it.
Man can accept himself only if he is accepted by another. He needs the other’s presence, saying to him, with more than words: ‘It is good that you exist.’
—Benedict XVI
Links.
Christian Wiman on hope and mental illness. “To compare the novelist to God is an old habit, but a better comparison is between a failed novelist and God, who seems conflicted about how—or whether—to finish us.”
Painter Jadé Fadojutimi wonders: Can We See the Colour Green Because We Have a Name for It?
Philosopher John Gray’s prescient 2020 piece on how capitalism creates the conditions for the surveillance society.
Alasdair MacIntyre asks: Catholic instead of what? Each age has its predominant errors, and each such error draws out and thus helps illuminate, dialectically, providentially, the corresponding truths that overcome them. MacIntyre identifies ours as scientific naturalism. I might suggest that has been eclipsed by transhumanism, the faith that we can overcome the givenness of the body and thus the world. This is actually a rather mystical error in comparison with the scientific materialism of the preceding two centuries. It sees human identity and intelligence as exclusively immaterial (not to say “spiritual”) which is why it can be separated, both conceptually and literally, from our bodies.
Revisiting Hume and Smith via economic historian István Hont: “Marxism, Blairism, Thatcherite neoliberalism [all] shared the mistaken conviction that the fundamental problems of modern politics were in the process of being solved. Hont looked to the 18th century for a more skeptical approach.”
Pope Benedict was no conservative. “The young Ratzinger was very much at home in this new world, one in which Edmund Husserl and Jean-Paul Sartre were treated as authorities on the same level as the early church fathers.”
That time the Irish invaded Canada.
Teach me to accept myself—my own temperament, my temptations, my limitations, my failures, the humiliation of being myself, as I am.
Allow me, Lord, all my life long to accept both small suffering and great suffering, certain that both, through your love, are redeeming the world.
And in communion with all men, and above all with you, let me accept joyfully death and the fear of death—my death and the death of those whom I love—not with my will but with yours, knowing that you have changed sorrow into joy, and that you have changed death to life.
—Prayer of Caryll Houselander
Happy February. We’re almost through.
As ever,
J
“The dignity of the human person entails the right to die with the greatest possible serenity and with one’s proper human and Christian dignity intact. To precipitate death or delay it through ‘aggressive medical treatments’ deprives death of its due dignity. Medicine today can artificially delay death, often without real benefit to the patient. When death is imminent, and without interruption of the normal care the patient requires in such cases, it is lawful according to science and conscience to renounce treatments that provide only a precarious or painful extension of life.” Letter on the care of persons in the critical and terminal phases of life, September 22, 2020.
One doesn’t get the impression that Hanania has looked too deeply into what the Christian ethical reasoning actually is in these matters, though in that he would not be unique. He mentions he tried but was unable to understand the arguments of a prominent opposing (non-Christian) bioethicist, which bodes ill for his ability to pass an ideological Turing test.
They could be guilty of other things: of misdiagnosing the disease, of recklessly pursuing a treatment that is likely to do more harm than good, of showing up to the operating room drunk, etc. Following the analogy, perhaps you think similar errors of judgment map onto the lockdown debate. But while those would be bad things they are categorically different things than deliberate killing.
Albert Camus, “Return to Tipasa,” 1953. From Lyrical and Critical Essays.
Apropos the 18th century skeptics, I've been digging these lectures on Malthus: https://youtu.be/8kkjQDqNs9U