Article
Assisted dying
Death & life
4 min read

Behind the data: the social messages physician assisted suicide sends to the autistic

If intense suffering caused by society drives autistic people to seek assisted death, then society has failed.
A hand rest gently on another outstretched hand.
Alexander Grey on Unsplash.

Statistically speaking, autistic people are far more likely to die by suicide than non-autistic people. They are also, statistically speaking, far more likely to die by physician assisted suicide than non-autistic people, in countries where this is allowed.  

For example, in a study of 927 people who sought physician assisted suicide in the Netherlands (where this is legal) 39 of them were autistic. That’s about four per cent, but the prevalence of diagnosed autism in the Netherlands is only one to two per cent. The researchers go on to note that 21 per cent of these 39 people cite autism or intellectual disability as the “sole cause of suffering” that had prompted them to request assistance to die.  

I don’t like speaking statistically. For a start, 21 per cent of 39 people is 8.19 people, which raises obvious questions. A little digging reveals that what the researchers mean really is eight people. Eight people with eight unique stories that include an account of autistic suffering so intense that they asked for help to end their lives.  

But we do not have those stories, not really. Included in the report are carefully anonymised excerpts from the physicians’ notes, and this is the nearest that we can get.  

‘The patient suffered from his inability to participate in society [ … ] [He] was not able to live among people, because he was easily overstimulated. This made him isolated’ (2019 (22), male, 70s, ASD) 

‘The patient had felt unhappy since childhood and was persistently bullied because he was just a bit different from others [ … ] [He] longed for social contacts but was unable to connect with others. This reinforced his sense of loneliness. The consequences of his autism were unbearable for him [ … ] The prospect of having to live on in this way for years was an abomination to him and he could not bear it’ (2021 (26), male, 20s, ASD) 

The debate about legalising physician assisted suicide in the UK is ongoing, and the British Medical Association have provided a helpful guidance document which sets out the main arguments, both for and against, without making a recommendation either way. In the document, they observe that the reasons people ask for assisted suicide are predominantly personal and social, not clinical, and also that “laws send social messages.” I agree that laws do that, and I also think that those seeking assisted suicide send social messages too.  

For example, even just from these two tiny excerpts, I hear that a life worth living is one where people can participate in society and have social contacts, even if they are a “just a bit different from others.” It would be good to hear more. It would be good to sit down over a cup of coffee with each of these two men and ask them all my questions about their lived wisdom when it comes to autism.  

I could ask “2019 (22), male, 70s, ASD”: 

What causes the overstimulation - are there places where you don’t feel that?  

Can we create more such places for autistic people to socialise?  

And I could ask “2021 (26), male, 20s, ASD”:  

What makes you feel different?  

What kind of social contacts and connections do you think that you are looking for?  

But of course, I can’t do that, because these two men have been assisted to die.   

The word ‘welcome’ is striking to me here. What does it mean to welcome someone, not to merely include or tolerate, but to really welcome someone. 

When approached for comment, autistic theologian Claire Williams said:  

‘There is something of a personal and social tragedy reflected in these cases. If we understand that much of the difficulty that autistic people suffer is caused by society – as per the neurodiversity paradigm – then it is the case that these two nameless men were failed by society. They felt that their lives could not find a place in an unwelcoming world. It is, of course, their choice to end their lives but I do also think that God chose to start their lives and finds them to be infinitely valuable. They were both made in God’s image and reflect something of it. That they felt there isn’t a place for them that is suitable is a tragedy because society should do better to welcome them.’ 

The word ‘welcome’ is striking to me here. What does it mean to welcome someone, not to merely include or tolerate, but to really welcome someone, even if they seem ‘a little bit different from others’? Dr Léon van Ommen, another theologian who writes about autism, suggests that it is a matter of making oneself and one’s resources fully available to that person, to the point where they feel that you belong to them. This is not to promote relationships with unhealthy power dynamics, but to highlight that when a person feels truly welcomed by another, they feel the opposite of owing a debt or being a burden – they feel they are of value, that you would be lacking something without them.  

I feel we are lacking something without you, “2019 (22), male, 70s, ASD”. And I feel we are lacking something without you, “2021 (26), male, 20s, ASD”. Not to forget the 37 others who are a little like you. We can pause to reflect on the social messages that you have sent, what you are teaching all of us about what it means to live a “good” life. But I am sorry that you have all died now and we cannot hear more.   

Whether people in the UK should be able to choose physician assisted suicide, I, personally, am not yet sure. Like the BMA, I see and respect the very good arguments both for and against. But eight people have chosen physician assisted suicide due to autism or intellectual disability, and when it comes to the social messages that sends, I feel compelled to sit down and listen.  

Article
Culture
Digital
Economics
Psychology
6 min read

Do you believe in a coin called hope?

From fiat to faith: the rise of crypto evangelism
 An image show a braclet that has a bitcoin symbol beside a cross, a crescent and a Star of David.

“The bridge from chaos to hope.” This was the rather grandiose language used on social media platform X last summer by one prolific tweeter boasting 4.4 million followers. What they were describing, however, was not a religion or philosophy, nor a social movement or political party, nor a breakthrough in medical technology or a self-help technique. Rather, financier Michael Saylor was talking about the world's biggest cryptocurrency, bitcoin. 

Saylor’s profile on X declares that “#Bitcoin is hope.com”. That website contains, among other things, video clips of Saylor talking about how “bitcoin is the manifest destiny for the United States of America”, “bitcoin is economic immortality”, “bitcoin is forever money” and so forth. 

Saylor is in fact just one - albeit a particularly successful one (his net wealth stands at around $10 billion, according to Forbes) - of a number of vocal crypto advocates, trying to explain the huge, transformational impact on society that the cryptocurrency will supposedly have. Their precise arguments can vary, but are often along the following lines: the fiat money system is broken due to manipulation by governments and central banks - for instance through money printing - leaving control of the money supply in the hands of a small group of the rich, while the purchasing power of the general public is eroded; in contrast, bitcoin is incorruptible, not controlled by the government, available to everyone and finite in supply. 

A common thread running through some of the writings and talks of a number of these bitcoin enthusiasts is a quasi-religious language, used to convey bitcoin’s importance. 

Hope.com, for instance, includes a research paper on “The bitcoin reformation”. Its author writes: “It wasn’t until I studied the era around the Protestant Reformation that I felt I’d found a potential blueprint of sufficient scope” to describe what is happening with bitcoin. 

Particularly vocal crypto proponents are known as bitcoin evangelists, while some crypto investors will talk of fellow “bitcoin believers”. They can even drink their coffee from a ‘bitcoin salvation’ mug) (which depicts two winged cherubs holding the cryptocurrency). Non-believing sceptics are termed “no-coiners”. 

Early bitcoin adopter Roger Ver - who has been indicted on fraud and tax charges, which he says are false - is known by the nickname “bitcoin Jesus”. One non-profit decentralised community is named Bitcoin God. 

The precise mix of irony and sincerity being used in such examples is of course debatable and will vary. Nevertheless, among the most fervent crypto investors there appears to be an earnest belief in the transforming power of bitcoin. 

But there may be additional reasons why some of the most fervent proponents instinctively reach for such language. 

“There’s a link with forms of transhumanism - the idea that we’re in the middle of an upgrade of humanity.” 

Dr Roger Bretherton, a clinical psychologist and Seen & Unseen contributor, argues there are elements of tribalism and “the psychology of identity” in some of the most cultic aspects of the crypto world. He sees some similarities there with “old 60s cults of people believing UFOs were going to land in their backyard”, talking about crypto as a cult rather than crypto as a currency.

“People overlap their identity [with a particular movement]. They're saying ‘that's me, that's who I am,’” he said. 

“In periods of uncertainty we seek to find certainty in our groups. We're in an individualistic society.” 

Use of religious language also points to a belief that bitcoin/crypto/blockchain will bring about some form of a radical global change less on the scale of an incremental technological development, and more akin to a transformational religious experience. 

“There's an element of faith and an eschatology attached to crypto: 'this is the new thing that will change the world,'” said Bretherton. 

“There’s a link with forms of transhumanism - the idea that we’re in the middle of an upgrade of humanity - the kingdom of tech is coming. It feels like crypto becomes part of the same narrative. The key question is whether our future lies in technology and power, or in love.” 

For such fervent bitcoin proponents, attempts to rubbish their beliefs are often futile. Indeed, trying to do so may only serve to strengthen the believer’s resolve that they are right. 

“There's a cognitive dissonance,” said Bretherton. “The more ridicule you've had to go through, the more you've given up, the more social difficulty you've gone through - particularly if you've given up a career to pursue crypto - then the stronger your belief. It's the sunk cost fallacy.” 

So far, bitcoin believers have proved the doubters wrong. The price of the coin has gone from less than $20,000 in the wake of the collapse of crypto exchange FTX in late 2022 to around $118,000 at the time of writing. Saylor has turned MicroStrategy (now known as Strategy) - the company of which he was CEO in 2020 when he decided to use it to buy and hoard bitcoin - into a $110bn market cap firm that has spawned many copycats.  

But what importance bitcoin eventually assumes in society is still very much an open question. It has not yet become a form of payment for our morning coffee or for buying a house, and maybe it never will. Whether it can really function as “digital gold”, a hedge against inflation or “a bank in cyberspace” (as Saylor calls it) is debatable. But it has already made huge strides, soaring to a market price well above what most people would ever have imagined. In July, US Congress passed a landmark bill regulating stablecoins - a type of cryptocurrency pegged typically to the dollar - in what is being seen as a huge step forward for the industry. 

Nevertheless, it seems likely that some of the wilder claims made about bitcoin may not come to pass. What happens if true believers are left disappointed? 

Bretherton says such belief systems have to subtly change their “metanarrative” as and when they do not deliver on initial promises. 

“It can't make predictions that can be shown to be false,” he said. “If crypto doesn't deliver its promises in the future, it has to find another way that's softer but which lasts. So it either collapses or it finds a way to become more nuanced."  

Whatever importance bitcoin eventually assumes in society, our desire to put our faith in it - or in anything else - reveals something deeper about our human nature. 

In the Bible, the book of Ecclesiastes explores humankind’s attempts to find meaning in human lives without God. The main character tries career, pleasure and wealth. But ultimately, they find that these things are just “meaningless”, “vapour” or “chasing after the wind”. 

That search for meaning, for the eternal, is inbuilt in our character. As the book’s author puts it: God has “set eternity in the human heart”.  

We are not designed merely to be born, to live and then to die. Instead, each one of us has been created with an inherent desire to know if there is something eternal out there, and to find out whether we can be part of that story. Crypto cannot offer us that salvation. The only thing or person who can, the author of Ecclesiastes would argue, is the One who put that desire in us in the first place.  

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