Review

Books

Culture

2 February 2023

7 min read

Cormac McCarthy's harrowed inheritance

Written before the death of Cormac McCarthy, Austin Stevenson reviews the acclaimed author's last sibling novels, exploring the frugal conversations within them and how dialogues shape virtue.

Austin Stevenson

Austin is a philosophical theologian who works at the intersection of philosophy, religion, and culture.

A diver swims above a crashed plane lying on the sea bed.

A diver investigates a crashed plane on the seabed.

Mael Balland via Unsplash.

This review was first published in March 2023, before Cormac McCarthy's death in June 2023.

When reading The Passenger, the first novel Cormac McCarthy has published since his Pulitzer Prize winning book The Road came out in 2006, I was reminded of a comment E. M. Forster jotted in his notebook about Henry James. ‘However hard you shake his sentences no banality falls out.’ McCarthy has drawn forth prodigious lyricism and acuity by some syntactical alchemy. Rarely in contemporary fiction have I drawn so much delight from just the words on the page. Much of his prose is poetry shrouded in paragraphs.

He scanned the landscape.

Here’s a dream.

This man was a forger of antiquities.

He travelled in documentation.

In the instruments for their preparation.

An old world figure. A dark suit, somewhat travelled in.

A down at the heels formality

to which yet clung the odor of the exotic.

A spectre of saccharine sincerity haunts modern fiction, and the fear of it has all but eviscerated mainstream novels of the polyphonic ornamentation of classical literature. What McCarthy has accomplished here is to recover the elegance, musicality, and intricacy of such great works, but in the context of a spare and denuded grammatical landscape. Sentimentality could not survive for a moment in these two novels, and yet they are genuine and raw to the core.

The Passenger follows Bobby Western, a deep-sea salvage diver who is inspecting a private jet that crashed off the Gulf Coast. He observes that, among the bodies strapped to the seats in this sunken tomb, one passenger from the manifest is missing. This kicks off the plot of the novel, wherein shadowy figures interrogate and surveil Bobby to ascertain what he knows about the missing passenger, seizing his assets and pushing him to an itinerant existence on the road. And yet, to explain the plot of The Passenger is largely to conceal what it is about, for it is primarily a book about ideas: physics, metaphysics, mathematics, and language.

The Passenger’s sibling novel, Stella Maris, is set eight years earlier, in 1972, and follows Bobby’s younger sister, Alicia. It is named for the midwestern psychiatric institution Alicia checks herself into and consists of conversations between Alicia and her psychiatrist. Bobby and Alicia are the children of a physicist who worked on the Manhattan Project with Oppenheimer. “His father. Who had created out of the absolute dust of the earth an evil sun by whose light men saw like some hideous adumbration of their own ends through cloth and flesh the bones in one another’s bodies.” Both initially followed his footsteps into academia, but Bobby dropped out of Caltech to race cars in Europe. Alicia quit after having exhausted the intellectual grist internal to mathematics and failed to resolve the foundational questions haunting the discipline (and reality) itself. “She knew that in the end you really cant know. You cant get hold of the world. You can only draw a picture.”

Bobby is lying in a coma in Europe for the entirety of Stella Maris after crashing in a Formula 2 race. By the time he wakes, Alicia has died by suicide. She is ever-present in The Passenger but only as a memory, and the novel is punctuated by chapters that recount her conversations with the Kid, a hallucinatory figure that has followed her since puberty. “The Thalidomide Kid and the old lady with the roadkill stole and Bathless Grogan and the dwarves and the Minstrel Show. All of them gathered at the foot of her bed.” Alicia may or may not be schizophrenic. And autistic. She is also a world-class violinist.

The philosopher Alasdair MacIntyre has argued that it is from those who came before us that we receive the depth or poverty of our language and, to some degree, our conversational habits, and it is through the right kinds of conversations that we learn the relationship between the various goods to which we order our lives and become educated in the virtues. The poverty of conversational idioms that many of us have received does much to cut us off from participation in and pursuit of the goods that contribute to our flourishing. I wonder if literature is a possible antidote to this. Specifically, literature with rich dialogue. And this is one of McCarthy’s great strengths.

'McCarthy is intent on exploring the nature of reality in this novel.'

In dialogue, his characters often start with the end in mind, and then find their way together. Or don’t. Their conversations are frugal, consisting primarily of three- or four-word sentences, and yet they almost always stumble onto to questions of deep significance. There are a lot of rough characters in these novels, but they share a surprising vulnerability. As always, McCarthy doesn’t use quotation marks or tell us who is speaking. When he wants us to, it is easy to follow the flow of dialogue, but occasionally he throws us off the scent. Particularly when Alicia is conversing with her hallucinations, their voices often meld together. The effect amplifies the ethereal quality of their exchanges.

Bobby is in the habit of asking people if they believe in God—a practise he seems to have picked up from his Granellen (his grandmother).

Do you believe in God, Bobby?

I don’t know, Granellen. You asked me that before. I told you. I dont know anything. The best I can say is that I think he and I have pretty much the same opinions. On my better days anyway.

No one has confident answers to this question, but it often serves to push the conversation along an interesting direction. “I dont know who God is or what he is. But I dont believe all this stuff got here by itself.” McCarthy is intent on exploring the nature of reality in this novel, and for him, the question of God is clearly part of that exploration, wherever it may lead. Fortunately, he is well aware that the question of God is not the same question under debate between fundamentalists and atheists.

Do you think of yourself as an atheist?

God no. Those were the good old days.

In their own ways, these characters exhibit an immanence that is haunted by transcendence. This search for some kind of meaning in the everyday stuff of existence might stand behind McCarthy’s frequent use of sacramental imagery drawn from the Catholicism of his youth. Evil cannot be depicted adequately without a conception of the good of which it is a privation. One might read McCarthy as reverse-engineering this process—ascertaining goodness by staring down its absence.

There is a tension in these novels between words and numbers. Which is more real? These questions are closely bound up with the characters’ struggles with mental illness and grief. For Alicia, “intelligence is numbers. It’s not words. Words are things we’ve made up. Mathematics is not.” She insists on the transcendent nature of mathematics and many of her conversations with her therapist centre on precisely these questions about what is real, true, stable, with frequent mention of Platonism. This brought to mind Viktor Frankl’s insistence that treating mental illness requires that we acknowledge its existential dimension. ’Man’s search for meaning is the primary motivation in his life.’ Alicia’s mental illness is bound up with her own search for meaning, and vice versa, as well as with the dark cloud that hangs over her family’s legacy. “For a long time I’ve suspected that we might be simply incapable of imagining the epochal evils of which we stand rightly accused and I thought it at least a possibility that the structure of reality itself harbors something like the forms of which our sordid history is only a pale reflection.” History falls short of the forms of the age.

Transcendence isn’t the only spectre that haunts these pages, and there is a kind of paranoia running through the narrative that seems fitting in an era rife with conspiracy thinking. Given his father’s exploits, Bobby is not particularly surprised to discover documents missing from Granellen’s home, or his own apartment rifled through while he’s gone. As Joseph Heller wrote, 'Just because you’re paranoid doesn’t mean they’re not after you.' It’s clear that someone is after Bobby, and the entire family may or may not be subject to clandestine observation. But there is also a broader sense of powers beyond our control watching, hounding, manipulating.

You think somebody’s after you?

I don’t know. I just wonder if maybe lots of people dont feel that way.

For no reason.

Yeah.

They have inherited a troubled legacy, but each, in their own way, has learned to talk about it, and that’s no small thing. This may be McCarthy’s most ambitious work, and you don’t need to understand it to find it extremely enjoyable.

Article

Assisted dying

Care

Culture

Death & life

13 November 2024

8 min read

The deceptive appeal of assisted dying changes medical practice

In Canada the moral ethos of medicine has shifted dramatically.

Ewan Goligher

Ewan is a physician practising in Toronto, Canada.

A tired-looking doctor sits at a desk dealing with paperwork.

Francisco Venâncio on Unsplash.

Once again, the UK parliament is set to debate the question of legalizing euthanasia (a traditional term for physician-assisted death). Political conditions appear to be conducive to the legalization of this technological approach to managing death. The case for assisted death appears deceptively simple—it’s about compassion, respect, empowerment, freedom from suffering. Who can oppose such positive goals? Yet, writing from Canada, I can only warn of the ways in which the embrace of physician-assisted death will fundamentally change the practice of medicine. Reflecting on the last 10 years of our experience, two themes stick out to me—pressure, and self-deception.

I still remember quite distinctly the day that it dawned on me that the moral ethos of medicine in Canada was shifting dramatically. Traditionally, respect for the sacredness of the patient’s life and a corresponding absolute prohibition on deliberately causing the death of a patient were widely seen as essential hallmarks of a virtuous physician. Suddenly, in a 180 degree ethical turn, a willingness to intentionally cause the death of a patient was now seen as the hallmark of patient-centered doctor. A willingness to cause the patient’s death was a sign of compassion and even purported self-sacrifice in that one would put the patient’s desires and values ahead of their own. Those of us who continued to insist on the wrongness of deliberately causing death would now be seen as moral outliers, barriers to the well-being and dignity of our patients. We were tolerated to some extent, and mainly out of a sense of collegiality. But we were also a source of slight embarrassment. Nobody really wanted to debate the question with us; the question was settled without debate.

Yet there was no denying the way that pressure was brought to bear, in ways subtle and overt, to participate in the new assisted death regime. We humans are unavoidably moral creatures, and when we come to believe that something is good, we see ourselves and others as having an obligation to support it. We have a hard time accepting those who refuse to join us. Such was the case with assisted death. With the loudest and most strident voices in the Canadian medical profession embracing assisted death as a high and unquestioned moral good, refusal to participate in assisted death could not be fully tolerated.

We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

Regulators in Ontario and Nova Scotia (two Canadian provinces) stipulated that physicians who were unwilling to perform the death procedure must make an effective referral to a willing “provider”. Although the Supreme Court decision made it clear in their decision to strike down the criminal prohibition against physician-assisted death that no particular physician was under any obligation to provide the procedure, the regulators chose to enforce participation by way of this effective referral requirement. After all, this was the only way to normalize this new practice. Doctors don't ordinarily refuse to refer their patients for medically necessary procedures; if assisted death was understood to be a medically necessary good, then an unwillingness to make such referral could not be tolerated.

And this form of pressure brings us to the pattern of deception. First, it is deceptive to suggest that an effective referral to a willing provider confers no moral culpability on the referring physician for the death of the patient. Those of us who objected to referring the patient were told that like Pilate, we could wash our hands of the patient’s death by passing them along to someone else who had the courage to do the deed. Yet the same regulators clearly prohibited referral for female genital mutilation. They therefore seemed to understand the moral responsibility attached to an effective referral. Such glaring inconsistencies about the moral significance of a referral suggests that when they claimed that a referral avoided culpability for death by euthanasia, they were deceiving themselves and us.

The very need for a referral system signifies another self-deception. Doctors normally make referrals only when an assessment or procedure lies outside their technical expertise. In the case of assisted death, every physician has the requisite technical expertise to cause death. There is nothing at all complicated or difficult or specialized about assessing euthanasia eligibility criteria or the sequential administration of toxic doses of midazolam, propofol, rocuronium, and lidocaine. The fact that the vast majority of physicians are unwilling to perform this procedure entails that moral objection to participation in assisted death remains widespread in the medical profession. The referral mechanism is for physicians who are “uncomfortable” in performing the procedure; they can send the patient to someone else more comfortable. But to be comfortable in this case is to be “morally comfortable”, not “technically comfortable”. We deceive ourselves if we think that doctors have fully accepted that euthanasia is ethical when only very few are actually willing to administer it.

We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

There is also self-deception with respect to the cause of death. In Canada, when a patient dies by doctor-assisted death, the person completing the death certificate is required to record the cause of death as the reason that the patient requested euthanasia, not the act of euthanasia per se. This must lead to all sorts of moments of absurdity for physicians completing death certificates—do patients really die from advanced osteoarthritis? (one of the many reasons patients have sought and obtained euthanasia). I suspect that this practice is intended to shield those who perform euthanasia from any long-term legal liability should the law be reversed. But if medicine, medical progress, and medical safety are predicated on an honest acknowledgment about causes of death, then this form of self-deception should not be countenanced. We need to be honest with ourselves about why our patients die.

There has also been self-deception about whether physician-assisted death is a form of suicide. Some proponents of assisted death contend that assisted death is not an act of deliberate self-killing, but rather merely a choice over the manner and timing of one's death. It's not clear why one would try to distort language this way and deny that “physician-assisted suicide” is suicide, except perhaps to assuage conscience and minimize stigma. Perhaps we all know that suicide is never really a form of self-respect. To sustain our moral and social affirmation of physician-assisted death, we have to deny what this practice actually represents.

There has been self-deception about the possibility of putting limits around the practice of assisted death. Early on, advocates insisted that euthanasia would be available only to those for whom death was reasonably foreseeable (to use the Canadian legal parlance). But once death comes to be viewed as a therapeutic option, the therapeutic possibilities become nearly limitless. Death was soon viewed as a therapy for severe disability or for health-related consequences of poverty and loneliness (though often poverty and loneliness are the consequence of the health issues). Soon we were talking about death as a therapy for mental illness. If beauty is in the eye of the beholder, then so is grievous and irremediable suffering. Death inevitably becomes therapeutic option for any form of suffering. Efforts to limit the practice to certain populations (e.g. those with disabilities) are inevitably seen as paternalistic and discriminatory.

There has been self-deception about the reasons justifying legalization of assisted death. Before legalization, advocates decry the uncontrolled physical suffering associated with the dying process and claim that prohibiting assisted death dehumanizes patients and leaves them in agony. Once legalized, it rapidly becomes clear that this therapy is not for physical suffering but rather for existential suffering: the loss of autonomy, the sense of being a burden, the despair of seeing any point in going on with life. The desire for death reflects a crisis of meaning. We deceived ourselves into thinking that assisted death is a medical therapy for a medical problem, when in fact it is an existential therapy for a spiritual problem.

We have also deceived ourselves by claiming to know whether some patients are better off dead, when in fact we have no idea what it's like to be dead. The utilitarian calculus underpinning the logic of assisted death relies on the presumption that we know what it is like before we die in comparison to what it is like after we die. In general, the unstated assumption is that there is nothing after death. This is perhaps why the practice is generally promoted by atheists and opposed by theists. But in my experience, it is very rare for people to address this question explicitly. They prefer to let the question of existence beyond death lie dormant, untouched. To think that physicians qua physicians have any expertise on or authority on the question of what it’s like to be dead, or that such medicine can at all comport with a scientific evidence-based approach to medical decision-making, is a profound self-deception.

Finally, we deceive ourselves when we pretend that ending people’s lives at their voluntary request is all about respecting personal autonomy. People seek death when they can see no other way forward with life—they are subject to the constraints of their circumstances, finances, support networks, and even internal spiritual resources. We are not nearly so autonomous as we wish to think. And in the end, the patient does not choose whether to die; the doctor chooses whether the patient should die. The patient requests, the doctor decides. Recent new stories have made clear the challenges for practitioners of euthanasia to pick and choose who should die among their patients. In Canada, you can have death, but only if your doctor agrees that your life is not worth living. However much these doctors might purport to act from compassion, one cannot help see a connection to Nazi physicians labelling the unwanted as “Lebensunwortes leben”—life unworthy of life. In adopting assisted death, we cannot avoid dehumanizing ourselves. Death with dignity is a deception.

These many acts of self-deception in relation to physician-assisted death should not surprise us, for the practice is intrinsically self-deceptive. It claims to be motivated by the value of the patient; it claims to promote the dignity of the patient; it claims to respect the autonomy of the patient. In fact, it directly contravenes all three of those goods.

It degrades the value of the patient by accepting that it doesn't matter whether or not the patient exists.

It denies the dignity of the patient by treating the patient as a mere means to an end—the sufferer is ended in order to end the suffering.

It destroys the autonomy of the patient because it takes away autonomy. The patient might autonomously express a desire for death, but the act of rendering someone dead does not enhance their autonomy; it obliterates it.

Yet the need for self-deception represents the fatal weakness of this practice. In time, truth will win over falsehood, light over darkness, wisdom over folly. So let us ever cling to the truth, and faithfully continue to speak the truth in love to the dying and the living. Truth overcomes pressure. The truth will set us free.