Article
Assisted dying
Care
Comment
Ethics
6 min read

It's a dreadful thing when we regard the disabled, the dependent, and the different as disposable

A MND sufferer reflects on the historic vote to legalise assisted dying
A crowded House of Commons awaits a vote.
MPs await the result.
Parliament TV.

I can’t say I’m surprised, but I am disappointed. The euthanasia juggernaut has been gathering momentum throughout the western world. In this country it appeared as the Voluntary Euthanasia Society, to be later rebranded as the richly endowed Dignity in Dying. It’s been beavering away for decades, with well publicised personal stories and legal cases which have been very effective in persuading general opinion that dying is frequently nasty and that we should have the right to choose when and how to die. That organisation resisted using the term ‘suicide’, which is what they advocate, realising that it opens up the accusation of devaluing life. So, I’m not surprised that MPs have, after an impassioned debate, by a narrow majority, eventually given way to the pressure.

A fortnight ago, I had my annual check-up at the motor neurone disorder clinic and subsequently received the GP letter.

“Date seen 02/06/2025…  Diagnosis (this visit) Primary Lateral Sclerosis…  Symptom onset 2000”.

I well remember the year 2000, my voice deteriorating, my balance starting to fail me, resulting finally a year later in the consultant’s verdict, “You have a motor neurone disorder.”

I knew what that meant as at the time Diane Pretty, backed and publicised by the Voluntary Euthanasia Society, was fighting through the courts as far as the European Court of Human Rights for the right for her husband to take her to commit suicide in Switzerland in the Dignitas “clinic”. It was a frightening time to receive an MND diagnosis, and it still is today. The normal progression is both swift and relentless. However, the Motor Neurone Disease Association does say “in the majority of cases, death with MND is peaceful and dignified”.

At that time I could have been depressed; I could have known how much care I would need, how much it might eat into our savings; I could have feared the physical and emotional toll it would take on my wife; I could have been desperate about the future. Certainly I was vulnerable. Fortunately, I was of an optimistic nature and had plenty of reasons for living.

But it could easily have been otherwise. I might well have panicked and opted for a doctor to help me die, if the law debated in the Commons today was in effect. Then I wouldn’t have seen two sons getting married nor grandchildren being born and growing up. I would have missed out on twenty years of an increasingly restricted but paradoxically fulfilled life.

Of course you might argue that I’m ‘lucky’ to have, as became clear over the years, my exceptionally rare and slow form of MND, but I wasn’t to know that, as indeed none of us do despite our doctors’ best predictions. Indeed I am lucky to be alive.

However it was my experience that brought me face to face with the fact of my own mortality and the issue of assisted dying. There seemed to me to be four main drivers. First, the desire for autonomy; second, the insistence of independence; third, a sort of compassion, and fourth, finance. There were two further factors: fear of death and fear of being “a burden”.

Autonomy

It’s a modern western concept that humans are by nature autonomous beings, meaning that choice is an inalienable right. I once co-wrote a book with the title, I Choose Everything, based on a quote of Therèse of Lisieux. It was from a childhood incident, but it did not mean she reserved the right for total autonomy, but rather the opposite. As she later wrote, “I fear only one thing: to keep my own will; so take it, for ‘I choose all!’ that you (God) will!”

Absolute choice is not a virtue. Choosing where to drive your car is not a virtue as it can endanger other road users. There are many limitations on freedom or taboos that protect others in a society. Taking someone’s life directly or indirectly is a universal one. Individuals submitting to a higher authority holds a community and a nation together.  

Independence

Another related modern heresy is the ideal of independence. How utterly fatuous this is! None of us is born independent. We’re born relational. All of our lives we are interdependent. Being cared for is not to be lacking in dignity. Being 100% dependent does not deprive someone of their human dignity. Even the most disabled person is a human being made in the image of God. It is a dreadful thing when a society regards the disabled, the dependent, the different, the mentally deficient and the declining as inferior and potentially disposable. Of course the advocates of the Bill would vehemently deny that they or it implied any such thing. Yet the history of the twentieth century bears witness to how subtly a society can be seduced by the pernicious philosophy of eugenics.

Compassion

It is a modern paradox that medical advances have contributed to the illusion that death is to be feared. Yes, death has always been the last enemy and, yes, we hope it will be peaceful. But we shall all die. Contrary to received wisdom, the compassionate response to that fact of life is not to “put someone out of their misery”; compassion (literally suffering with) means to be with them in their suffering. This is what good palliative care provides, making the end of life dignified, worth living and even pain free.

As former Prime Minister Gordon Brown pertinently asked, “When only a small fraction of the population are expected to choose assisted dying, would it not be better to focus all our energies on improving all-round hospice care to reach everyone in need of end-of-life support?”

Finance

Of course palliative care costs more than facilitating patients to take their own lives. According to the Daily Mail “Legalising assisted dying would save the taxpayer £10million in NHS costs in its first year, rising to £60million after a decade, according to grim new estimates published by the government.” The estimates are indeed grim, but also attractive to politicians straining to balance the national budget. Yet they raise the fundamental question: do we want to live in a society which values money over life?

Which is the most fundamental of all the issues: the sanctity of life has been a core principle central to all the Abrahamic faiths, which undergird our culture and way of life. In the words of Job on hearing of the death of all his children, “The Lord gave and the Lord has taken away.” The start and end of life are not ours to determine. We lack the wisdom of God.

Apparently the majority of our parliamentarians have decided to place that prerogative into the hands of suggestible and distinctly fallible humans beings. We or our children shall, I fear, reap the whirlwind.

As an afterthought I have a number of friends who disagree with me, often after personal experience of watching a loved one die. I sympathise and I suppose that I must be glad for them that the MPs have represented their wishes. And I would never condemn them if they decided to choose the route of assisted dying for themselves. I hope they won’t have to.

Meanwhile I trust that, when the Bill comes to the upper house, their Lordships will fulfil their function of revising it wisely and effectively. They certainly have relevant expertise, for example in the field of palliative care - which is in danger of being squeezed following this bill.

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Article
Comment
Leading
Psychology
Theatre
6 min read

Are you a narcissist?

We all have a little bit of narcissism in us – the question is whether we’re a Moses or an Iago
An Elizabethan man holds a dagger up while grinning.
Kenneth Brannagh's Iago in the 1995 film of Othello.
Sony Pictures.

Is everyone a narcissist these days? It sometimes feels so. Google Trends data shows an eleven-fold increase in searches for “narcissism” between 2010 and 2023, and the term has become a social media buzzword. Online quizzes asking, “Am I a narcissist?” are everywhere, offering dubious self-diagnosis at the click of a button. Genuine Narcissistic Personality Disorder, however, is complex and painful – especially for those in close relationships with someone who cannot acknowledge the harm that they are able to cause or feel any sense of remorse. Narcissus, in Greek mythology, was a handsome young man who was cursed to fall in love with his own reflection, but it was not until the early 20th century that the term “narcissism” was then picked up by the emerging field of psychoanalysis. Initially, Sigmund Freud adopted it in a non-pejorative way to describe the stage in child development when an infant is aware only of their own need for love and attention. Eventually, as that infant grows into a child it begins to experiment with showing others love and attention, and if surrounded by the right relationships, the child learns that love can be reciprocal – a back-and-forth pattern of give and take. Freud wrote:  

“Loving, then, contributes to the lowering of self‑regard. Having one’s love returned, however, restores one’s self‑regard and replenishes one’s narcissism.”  

In its healthiest form, narcissism reflects a positive sense of self – a recognition of one’s own needs and a reasonable desire for them to be met, whilst also knowing that we must give of ourselves, again within reason, to meet the needs of others. In this sense, yes, we are all a little bit of a narcissist. It is only occasionally, most commonly when the early bond between a child and their caregivers is inconsistent or unstable, that this self-focus can become problematically distorted, sometimes leading to a personality disorder. For such a person, a constant hunger for attention and affirmation, often combined with a lack of empathy or a tendency to use empathy as a means to manipulate others, leads to a life of take-take-take; one which can cause significant harm to others and ultimately to themselves.  

Estimates for Narcissistic Personality Disorder are that it affects about one to two per cent of the population, a number which is intriguingly high. The unfortunate news is that true Narcissistic Personality Disorder is notoriously difficult to treat, precisely because key tenets of the condition include a lack of self-awareness and an overinflated sense of self belief. The classic response of the one with Narcissistic Personality Disorder is, of course, “How dare my therapist say that I am a narcissist? They must be the problem!” 

However, much more prevalent are what might be called “sub-clinical narcissists” – people who act selfishly, arrogantly, or manipulatively, influencing others to conform to their desires. We all know one or more of those – sometimes we meet one when we look in the mirror. Whilst this may make us feel pretty rotten, whether we are the giver or the receiver of such treatment, it does not always warrant a clinical intervention. Even so, it can still be extremely difficult to process how and why human narcissistic tendencies are able to cause others so much pain. If, as Freud proposes, a certain degree of narcissism is hardwired into human nature, what can we do about its tendency to evil?  

In Shakespeare’s tragedy Othello, the character of Iago is a master manipulator who displays all the cold-hearted indifference of a true narcissist. Early in Act 1 he expresses his indignation that he has been passed over for promotion. Firmly convinced of his own superiority, he slyly boasts that he will play a false self to Othello, feigning loyalty for his own ends and stating: “I am not what I am.”  

These words are a clever and rather chilling inversion of a famous phrase from the Bible. In the story of the Exodus, God meets with Moses in the form of a burning bush, and when Moses asks for the name of God a voice replies: “I am what I am.” As Moses stands before God, barefoot and awestruck, he hears that enigmatic statement and is forced to confront the question of who he truly is – an ashamed murderer, a fugitive, a short-tempered man of slow speech but hasty acts. Moses acknowledges all these awkward truths about himself and declares himself wholly unfit to be called by God as a leader. Yet God uses Moses anyway, and at the end of his life, Moses dies a celebrated hero – a deliverer who is mourned by all his people.  

Not so Iago. As the tale of Othello draws to its tragic close, Iago is wounded, arrested and escorted from the stage. The audience knows that he has been condemned to execution, but unlike pretty much every other character in that fateful final scene, Iago’s death does not take place onstage. He is simply removed, dismissed from everybody’s notice – a narcissist’s worst nightmare.  

One can see the crucial difference between Moses and Iago – whilst Moses is concerned that his own flawed nature makes him unfit to be become a great leader, Iago is driven to grasp at leadership by a belief in his own grandiosity and acts vengefully when passed over. Right to the end, Iago expresses not one word of self-doubt or regret for his actions. Indeed, he refuses to account for himself at all. “Demand me nothing,” he says at the close; “What you know, you know.” 

Seemingly, the problem of narcissism’s tendency towards evil lies not in actions, but in methods of self-evaluation. While we all make regrettable mistakes, and sometimes it can be hard to judge the difference between unreasonable selfishness and reasonable self-preservation, the true narcissist is afraid to explain themselves, unwilling to bear the judgement of outside scrutiny. The narcissist will look only in the mirror.  

But whereas a mirror only reflects light, a burning bush produces it. In the end, the resources of the Christian tradition do not simply diagnose our narcissism, they offer us a way through it. They offer an outside perspective from which we can truly evaluate our own actions – a light that shines through the mirror.  

If you have ever clicked the link for the online quiz, or been tempted to, then that is an encouraging sign of willingness to be open to outside scrutiny. But of all things, would we really want to trust only human voices, especially the unknown and unknowable voices of the internet, as an authoritative arbiter? If narcissism is so inherent to human nature, it logically takes something higher and brighter than our fellow human beings to really bring it into the light. But in any case, you can save yourself the time of completing that dubious online diagnostic quiz since the whole enterprise can be summed up in just one question:  

Have you ever wondered if you have Narcissistic Personality Disorder? If the answer is yes, you probably do not. So demand yourself nothing, what you know you know.  

Support Seen & Unseen

Since Spring 2023, our readers have enjoyed over 1,500 articles. All for free. 
This is made possible through the generosity of our amazing community of supporters.

If you enjoy Seen & Unseen, would you consider making a gift towards our work?
 
Do so by joining Behind The Seen. Alongside other benefits, you’ll receive an extra fortnightly email from me sharing my reading and reflections on the ideas that are shaping our times.

Graham Tomlin
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