How children’s books challenge us to hope harder

Reading an award-winning children’s book challenges Elizabeth Wainwright much more than expected - to imagine and hope.

Elizabeth Wainwright

Elizabeth Wainwright is a writer, coach and walking guide. She's a former district councillor and has a background in international development.

A close up of face, showing an eye, mostly obscured by a closely-held open book.

This year, the Waterstones book of the year prize was awarded to Impossible Creatures, a fantasy book for children by Katherine Rundell. This was not the children’s book of the year; this was overall book of the year – it beat novels and non-fiction books for adults. I felt momentarily but deeply joyful when I heard the news and was curious why.

During the pandemic, I found myself unable to read the non-fiction books I usually turn too. Even adult fiction felt heavy. It was children’s books and authors I turned to. Philip Pullman, Dodie Smith, Alan Garner, Ursula K Le Guin. Others new to me. On reflection, I wasn’t reading these books because they were in any way easier, because they weren’t – they asked me to think and hope and imagine much harder than a lot of adult books, despite everything the news would have me believe. And it is for that very reason that I sought these books out. The Waterstones prize made me think a bit more about this – and why it might matter now especially.

Imagination helps us to confront and solve problems – it is not an indulgence, it is essential for the becoming world, and for being the people we are called to be.

First, I thought about my time as a District Councillor in local government. Here, I quickly learned all sorts of things about planning, environment, community, working across opposition and more. I needed to call on my perseverance, patience, strategic thinking. But the things that I found myself calling on again and again were imagination and relationship-building. Building relationships – especially with people who weren’t like me – was the only way to get things done. And imagination because it’s the thing that recreates, that sees things as they could be not as they are. Albert Einstein said, “we cannot solve our problems with the same thinking we used when we created them”, and I’ve seen how that’s true. It did not feel enough, for example, to try to fix problems of dwindling budgets with more cuts and more inefficient meetings. Instead, imagination asked me to think about what this budget-setting process might look like at its best, and how the wider community might help us decide priorities, and how we might restructure our work so that the District doesn’t just scrape by, but thrives. It asked me to step out of business-as-usual, and imagine business-as-it-could-be.

Jesus too shows us the importance of imagination – he so often called out who he saw people to be, not who they were. And he points us now towards what is yet to come. He calls us to wait, and to trust in his arrival – however distant it might feel. Children’s books often do this too: Frodo trusting that the ring would be destroyed, imagining life outside of the grip of the darkness of Mordor, despite all evidence to the contrary. Bastian’s imagination helping to save Fantasia in the Neverending Story. Jo March showing the possibility of another kind of life in Little Women. Imagination helps us to confront and solve problems – it is not an indulgence, it is essential for the becoming world, and for being the people we are called to be.

I think the best children’s books do the same thing – they ask us to look up, to look out, to feel the whisper of the voice behind us urging us on to something more beautiful.

Second, the children’s books I read during lockdown gave me hope in a way that books for adults didn’t at the time. Hope is, I think, innately tied to imagination. It asks us to look ahead, even when things aren’t clear, and walk forward. Rebecca Solnit explores hope, optimism, and activism in her short book Hope In the Dark. She says,

“Hope just means another world might be possible, not promised, not guaranteed. Hope calls for action; action is impossible without hope.”

I think the best children’s literature shows us how to hope, and shows us what right action can look like when we invoke that hope. In Rundell’s Impossible Creatures, Mal and Christopher must save the ‘Archipelago’ – where mythical creatures still live – and the world beyond them from a growing darkness. Hope shines bright, reminding the reader that it is not naïve but necessary and world-changing, if we let it be. Hope changes things. In the New Testament, Paul tells that along with faith and love, hope will remain. When it feels like the world – fictional, or real – is falling away, hope will remain. Coupled with imagination, bound with faith and love, made active with hands and hearts, it might just pull us through to things we cannot yet see.

When she won the National Book Award, Ursula K Le Guin underlined the necessity of imagination and hope right now:

“Hard times are coming, when we’ll be wanting the voices of writers who can see alternatives to how we live now, can see through our fear-stricken society and its obsessive technologies to other ways of being, and even imagine real grounds for hope. We’ll need writers who can remember freedom – poets, visionaries – realists of a larger reality.”

Jesus was the ultimate realist of a larger reality. He asks us to love in the face of hate, to believe that food and wine can come from faith, to believe so hard in love – not as a pink heart-shaped commodity, but as a world-shaking force – that we might literally see resurrection. Jesus lived in a particular place, at a particular time, grounded in people and soil and society, but always pointing to the bigger truth he knew, and to a world that did not yet exist. I think the best children’s books do the same thing – they ask us to look up, to look out, to feel the whisper of the voice behind us urging us on to something more beautiful. Importantly, this is not a rejection of the world as it is – we are called to love our neighbours here and now, to build the kingdom on earth as it is in heaven. But in what is, there is the seed of what could be, there is a light that shines in places that are still dark. I think the gospel, and the best children’s books, help us to see that light and see what it might illuminate. Jesus knew that children’s minds were perhaps better at seeing this light – he even says, “Truly I tell you, unless you change and become like little children, you will never enter the kingdom of heaven.” Allowing ourselves to imagine, to hope, is perhaps the only way we’ll take the kingdom of heaven seriously here on earth.

Katherine Rundell herself has pointed out that children’s books don’t just make good readers, they make good people. I think that with imagination, hope, courage, and more, they help call forth the people we are becoming, and the world that could become. That is why I turned to them during lockdowns, that is why I turn to them now as parts of our world seem dark, and that is why I turn again and again to Jesus – the ultimate realist of a larger reality.

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.