It's our mistakes that make us human

What we learn distinguishes us from tech.

Silvianne Aspray

Silvianne Aspray is a theologian and postdoctoral fellow at the University of Cambridge.

A man staring at a laptop grimmaces and holds his hands to his head.

Francisco De Legarreta C. on Unsplash.

The distinction between technology and human beings has become blurry: AI seems to be able to listen, answer our questions, even respond to our feelings. It becomes increasingly easy to confuse machines with humans. In this situation, it is increasingly important to ask: What makes us human, in distinction from machines? There are many answers to this question, but for now I would like to focus on just one aspect of what I think is distinctively human: As human beings, we live and learn in time.

To be human means to be intrinsically temporal. We live in time and are oriented towards a future good. We are learning animals, and our learning is bound up with the taking of time. When we learn to know or to do something, we necessarily make mistakes, and we take practice. But keeping in view something we desire – a future good – we keep going.

Let’s take the example of language. We acquire language in community over time. Toddlers make all sorts of hilarious mistakes when they first try to talk, and it takes them a long time even to get single words right, let alone to try and form sentences. But they keep trying, and they eventually learn. The same goes with love: Knowing how to love our family or our neighbours near and far is not something we are good at instantly. It is not the sort of learning where you absorb a piece of information and then you ‘get’ it. No, we learn it over time, we imitate others, we practice and even when we have learned, in the abstract, what it is to be loving, we keep getting it wrong.

This, too, is part of what it means to be human: to make mistakes. Not the sort of mistakes machines make, when they classify some information wrongly, for instance, but the very human mistake of falling short of your own ideal. Of striving towards something you desire – happiness, in the broadest of terms – and yet falling short, in your actions, of that very goal. But there’s another very human thing right here: Human beings can also change. They – we – can have a change of heart, be transformed, and at some point in time, actually start to do the right thing – even against all the odds. Statistics of past behaviours, do not always correctly predict future outcomes. Part of being human means that we can be transformed.

Transformation sometimes comes suddenly, when an overwhelming, awe-inspiring experience changes somebody’s life as by a bolt of lightning. Much more commonly, though, such transformation takes time. Through taking up small practices, we can form new habits, gradually acquire virtue, and do the right thing more often than not. This is so human: We are anything but perfect. As Christians would say: We have a tendency to entangle ourselves in the mess of sin and guilt. But we also bear the image of the Holy One who made us, and by the grace and favour of that One, we are not forever stuck in the mess. We are redeemed: are given the strength to keep trying, despite the mistakes we make, and given the grace to acquire virtue and become better people over time. All of this to say that being human means to live in time, and to learn in time.

So, this is a real difference between human beings and machines: Human beings can, and do strive toward a future good.

Now compare this to the most complex of machines. We say that AI is able to “learn”. But what does it mean to learn, for AI? Machine learning is usually categorized into supervised learning, unsupervised and self-supervised learning. Supervised learning means that a model is trained for a specific task based on correctly labelled data. For instance, if a model is to predict whether a mammogram image contains a cancerous tumour, it is given many example images which are correctly classed as ‘contains cancer’ or ‘does not contain cancer’. That way, it is “taught” to recognise cancer in unlabelled mammograms. Unsupervised learning is different. Here, the system looks for patterns in the dataset it is given. It clusters and groups data without relying on predefined labels. Self-supervised learning uses both methods: Here, the system uses parts of the data itself as a kind of label – such as, for instance, predicting the upper half of an image from its lower half, or the next word in a given text. This is the predominant paradigm for how contemporary large-scale AI models “learn”.

In each case, AI’s learning is necessarily based on data sets. Learning happens with reference to pre-given data, and in that sense with reference to the past. It may look like such models can consider the future, and have future goals, but only insofar as they have picked up patterns in past data, which they use to predict future patterns – as if the future was nothing but a repetition of the past.

So this is a real difference between human beings and machines: Human beings can, and do strive toward a future good. Machines, by contrast, are always oriented towards the past of the data that was fed to them. Human beings are intrinsically temporal beings, whereas machines are defined by temporality only in a very limited sense: it takes time to upload data, and for the data to be processed, for instance. Time, for machines, is nothing but an extension of the past, whereas for human beings, it is an invitation to and the possibility for being transformed for the sake of a future good. We, human beings, are intrinsically temporal, living in time towards a future good – which machines do not.

In the face of new technologies we need a sharpened sense for the strange and awe-inspiring species that is the human race, and cultivate a new sense of wonder about humanity itself.

Article

Assisted dying

Comment

Politics

25 November 2024

7 min read

Assisted dying hasn’t resolved Swiss end of life debates

Despite attempts to normalise it, new challenges still arise.

Markus Zimmerman

Markus is Professor of Moral Theology and Ethics at the University of Fribourg, Switzerland.

A single bed, wiith an unmade colourful duvet stands in the corner of a room. A hoist reaches over it from the corner.

The dying room, Dignitas Clinic, Zurich.

Dignitas.

While countries such as Germany, France or the UK are currently struggling to find a suitable regulation for assisted suicide, their peers in the Netherlands, Canada and Switzerland have years of experience with the controversial medical practice. Even if each state must explore its own ways of dealing with these ethically controversial issues, it is obvious that international experience should not be ignored as they try to find a way forward.

In Switzerland the discussions and challenges surrounding assisted suicide are increasing rather than decreasing. Contrary to the idea that a liberalisation of assisted suicide would lead to fewer debate, tensions and difficulties are increasing. My observation, and thesis, indicates that practices such as assisted suicide cannot be “normalised”, even in the medium and long term.

Developments

In recent years, one to two per cent of all deaths in Switzerland were due to assisted suicide. From an overall perspective, this practice is therefore still a marginal phenomenon. However, a look at the total number of assisted suicides per year gives a different impression, as this has increased more than fivefold in the years between 2008 and 2020, from an initial 253 to 1,251 deaths per year, a rising trend. The cause of death statistics for Switzerland only include those cases of assisted suicide in which persons resident in Switzerland were involved and the death was reported to the authorities. According to the Swiss Federal Statistical Office, in 2020, it was mainly people over the age of 64 who made use of assisted suicide. Detailed information on the underlying illnesses of the people affected in 2018 shows that about 40 per cent were affected by cancer, just under 12 per cent by diseases of the nervous system, a further 12 per cent by cardiovascular diseases and just over a third by other illnesses, including dementia and depression. There are currently seven right-to-die organisations in Switzerland which play a leading role in a typical assisted suicide procedure. They work closely with doctors who are prepared to prescribe a lethal drug, generally Pentobarbital. The data reflects an ambivalent picture: on the one hand, the proportion of assisted suicide cases is relatively low in relation to all deaths and, for example, in comparison to the large number of people who die in Switzerland in a state of deep sedation until death; on the other hand, the number of assisted suicides in Switzerland has risen sharply in recent years.

Perceptions and assessments

Since the 1990s, the public perception and assessment of assisted suicide in Swiss society has changed from an initially cautious and sceptical attitude towards broad acceptance. While the debates in other countries are characterised by relatively sharp controversies between those in favour and those against, public discourse in Switzerland has been less polarised. There are indications of a certain normalisation of the situation, the strongest sign is that Switzerland has so far refrained from regulating assisted suicide in a separate law. The results of a recently-published study on the opinions of Swiss people over the age of 55 regarding assisted suicide confirm these impressions.: The survey showed that over four-fifths of respondents support legal assisted suicide, almost two-thirds can imagine asking for assisted suicide themselves at some point, and that almost one-third are considering becoming members of an right-to-die organisation in the near future, with one-twentieth of respondents already being members at the time of the survey in 2015. Among people with a higher level of education and older people aged between 65 and 74, approval of assisted suicide and corresponding practices was higher than among less educated, younger and very old people; approval was also significantly lower among religious practitioners.

Sensitive topics

The fact that assisted suicide enjoys broad support in Swiss society as a whole does not mean that there are not difficult and controversial aspects relating to its practice. Relevant topics include, in particular, places of death, authorisation criteria and procedures.

Places of death: Assisted suicide is permitted also for mentally ill persons in psychiatric clinics, but the federal court recommends great caution here and requires two psychiatric expert opinions to ensure that the person willing to die is capable of judgement with regard to the desire to commit suicide. Although assisted suicide for children and adolescents has hardly been an issue in Switzerland to date, the corresponding debates are currently being held in Canada and elsewhere. The question of whether people in prison also have a right to make use of assisted suicide, has been the subject of intense debate in Switzerland for years, with a generally positive response. The question of whether right-to-die organisations should be given access to acute hospitals and nursing homes is still the subject of controversial debate, with regulations varying from hospital to hospital, nursing home to nursing home

Authorisation criteria: With regard to the admission criteria for persons willing to die, the capacity for judgement is at the centre of attention: while the importance of the criterion is undisputed in itself, there is a struggle for reliable standards and procedures to reliably test this criterion. Since the publication of the SAMS ethical guidelines Management of Dying and Death in 2018, the criterion for end of life and, depending on this, that of unbearable suffering have received new attention due to an objection by the Swiss Medical AssociationFMH. While the guidelines are based on the criterion of unbearable suffering, the FMH wants to stick to the near end of life. It is certainly difficult to diagnose the existence of unbearable suffering, as the international debate on the significance and assessment of existential (neither physical nor psychological) suffering shows. This difficulty is illustrated by the debate that has been going on for several years in Switzerland about so-called old-age suicide and the inherent criterion of tiredness of life. At the centre of the dispute is the legally difficult question of whether a doctor is also allowed to prescribe a lethal drug to a healthy person.

Procedures: Here the role of the medical profession and right to die organisations is by far the most important issue. In contrast to the physician-centred models in Belgium, Canada and the Netherlands, the Swiss model of assisted suicide is based on the idea that every person has the right to end their life and may call on the help of any other person to do so. Although the medical profession is usually involved in the process, the management of the procedure is normally the responsibility of a right-to-die organisation. This division of responsibilities is always up for debate when legal regulations are being considered, in which doctors should tend to take the lead in the process due to their professional background. There is also a debate about how and by whom compliance with the authorisation criteria should or could be monitored, whereby it remains to be decided whether this should be carried out before or after the death. At present, a certain amount of monitoring takes place following a suicide, insofar as the authorities investigate the cases afterwards. There is also debate as to whether Pentobarbital is a suitable means of suicide, especially if this barbiturate is not administered intravenously but taken orally; there is no knowledge of how many cases are currently administered intravenously and by whom an infusion is then set up. Last but not least, consideration has already been given to the use of lethal drugs, such as helium gas, which can be obtained over the counter.

Attempts at regulation

Political efforts to regulate assisted suicide in Switzerland in a more nuanced way than today have been made since the 1990s but have remain largely without consequences to date. In relevant judgements by the Federal Supreme Court or in statements by the Federal Department of Justice and Police, reference is regularly made to the ethical guidelines of the SAMS. These are classified as soft law and are therefore not legally binding, even though their content has become the subject of dispute. The National Advisory Commission on Biomedical Ethics (NCE) had already recommended more far-reaching legal regulation in 2005 as part of a detailed opinion on the subject; in the opinion of the NCE at the time, the review of authorisation criteria, a justifiable regulation of assisted suicide for the mentally ill, children and adolescents and state supervision of right-to-die organisations, should be ensured by law. The question is what form a legal regulation can take that grants the medical profession far-reaching powers but at the same time prevents medical paternalism (in favour of or against assisted suicide). From the perspective of Swiss experience, this is “a square circle”: either the doctors retain the final decision on who receives the barbiturate, or official access rules are established, the review of which does not generally require medical expertise.

The outlook

In the short and medium term, it can be assumed that the number of assisted suicides in Switzerland will continue to rise. The coronavirus pandemic and the particular difficulties faced by nursing homes during this time are likely to exacerbate this increase. In view of these expectations and the legislative processes in other European countries, pressure is likely to increase in Switzerland to create a legal regulation. Overall, I think politically it will be important to create a legal regulation, in order to ensure legal equality and legal certainty on the one hand and prevention of abuse and expansion on the other. At the centre of social-ethical reflection is the challenge of learning to deal with the pluralism of different ideas of a good death and to develop and establish alternative models to medically assisted dying. The thesis I mentioned at the beginning is confirmed today: assisted suicide in Switzerland can hardly be normalised; new problems, challenges and demands are constantly arising. Suicide, whether with or without the help of another person, always means an existential transgression that defies normalisation.