On liberty’s limits: why Mill was wrong about freedom

This month, it’s 150 years since philosopher JS Mill died. His definition of freedom remains hugely influential. But is it still the right one for healthy relationships and contentment amid the isolation of modern life?

Graham Tomlin

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

A copy of the Statue of Liberty, holding a stick of bread, stands outside a shop window displaying an 'Open 24 Hours' signs.

Photo by KC Welch on Unsplash.

You can tell what a society values by what it goes to war over. In the 17th century we fought our wars over religion. In the 19th it was empire. In the 20th and 21st, we fought our wars over freedom, either defending our own or trying to export our version of it to other parts of the world. We tend, of course, to assume we know what freedom is: the liberty to do what we like, as long as don’t harm other people. But we rarely know how time-conditioned and recent such a view of freedom is.

John Stuart Mill, child prodigy, colonial administrator, Member of Parliament and philosopher, who died 150 years ago this year, is one of the primary architects of our contemporary ideas of freedom. In his own words, his book On Liberty, published in 1859, was an exploration of the ‘nature and limits of the power that can legitimately be exercised by society over the individual’. Mill famously argues that the only valid reason for interfering with another person’s liberty of action is to protect them from physical harm. It is never justifiable to interfere with another person’s freedom to ensure their happiness, wisdom or well-being, because that is to determine what that person’s well-being is. Freedom is defined as liberty of conscience, thought, feeling and opinion, as ‘liberty of tastes and pursuits … doing as we like … without impediment from our fellow creatures, so long as what we do does not harm them’.

For Mill... individual liberty is vital, not just for the sake of the individual, but for the sake of human progress.

Mill is one of the great champions of nonconformity in thought and action. Even if just one person held a particular opinion while everyone else in the world held the opposite, there would be no justification in silencing that one voice. For Mill, one of the main ingredients of social progress is freedom from the traditions and customs imposed by others, both the past constraints of tradition, and the present ones of custom, which restrict the cultivation of individuality, which in turn ‘is one of the leading essentials of well-being’. Individual liberty is vital, not just for the sake of the individual, but for the sake of human progress. Without it there will be no originality or genius, no new discoveries or innovation. Civilisation cannot advance without individual freedom which encourages spontaneous expression, the development of new thoughts and ideas unconstrained by the patterns of the past.

It is a powerful argument. On Liberty is full of the fear of Victorian conformity – the individualist’s reaction to a stifling society with a high degree of social control. It is very much a book of its time, assuming the cultural superiority of the modern age. It also breathes an elitism that looks down on the mediocrity of what it calls ‘average men’.

But more than that, there is, I think, a deeper flaw in this way of thinking about freedom. If freedom is essentially my liberty to say or do what I like, as long as I don’t tread on the toes of my neighbour, then what does that do to my relationship with my neighbour? He or she becomes at best a limitation, or at worst a threat to my freedom. There may be all kinds of things I want to do – play music loud on a summer’s night, or drive my car at 100 mph on a quiet suburban road – but I can’t because I might disturb my neighbour’s peace or risk crashing into an oncoming bus. Or even worse, my neighbour might want to play her music too loud for me, or drive her car too fast in my direction, thus invading my personal space. This approach keeps the peace between us, but at the cost of making us see each other either as irritating limitations to our desires which of course define our self-chosen goals in life, or threats to our own precious autonomy.

The German sociologist Hartmut Rosa argues that

“the ethical imperative that guides modern subjects is not a particular or substantive definition of the good life, but the aspiration to acquire the resources necessary or helpful for leading one.”

In other words, in the individualised world imagined by Mill, we are all left to dream our own dreams, choose our own ambitions, and are all caught up in the fight to get hold of the money, rights, friends, looks, health, and knowledge that will enable us to get to our self-chosen destination. It therefore makes us competitors with each other, not only seeing each other as rivals in this race for resources, but also as potential threats who might stand in the way of our freedom to pursue our dreams.

There is however another, older view of freedom, rooted more in character and virtue than in individualised personal goals. This version, found in classical literature, sees liberty not as freedom from the limitations and social expectations that stop us following our self-chosen desires, but freedom from the passions. The Greeks viewed the soul as like a ship which should sail serenely towards the harbour of such virtues as prudence, courage and temperance. It was guided on this journey by paideia, or education in virtue, yet was at the same time buffeted by the winds of irrational and destructive impulses such as envy, anger or lust that threaten to blow it off course. For them, our passionate inner desires are not the sacrosanct moral guide to our true selves but are a distraction from the true path of virtue.

True liberty is freedom from anything that would stop us becoming the person we were created to be.

This version was developed further by Christian thinkers such as St Paul, St Augustine and Thomas Aquinas. For them, true liberty is freedom from anything that would stop us becoming the person we were created to be: someone capable of love for what is not ourselves – for God and our neighbour. True liberty is freedom from internal urges such as the greed, laziness or pride that turn us in upon ourselves rather than outwards towards God and each other. It is also freedom from external forces such as the grinding poverty that dangles the temptation to steal in order to survive, or an economy that constantly tells us that if you don’t acquire as much stuff as your neighbour you are a failure. It is not so much freedom for ourselves, but freedom from ourselves: freedom from self-centred desires, or the crippling self-absorption that makes us think only of our own interests. It is freedom to create the kind of society where we are more concerned with our neighbours’ wellbeing than our own.

In this view of freedom, my neighbour becomes not a limitation or a threat, but a gift – someone without whom I cannot become someone capable of the primary virtue of love. Putting it bluntly, if I am to become someone capable of other-centred love, I need someone to practice on.

This Christian understanding of freedom offers a vision of society where you might begin to trust other people to look after your own needs, because they are looking out for yours. It is also a vision of freedom that delivers personal happiness better than the libertarian view. Becoming the kind of person who has learnt, as St Paul once put it, to ‘look not to your own interests, but to the interests of others’ is in fact a recipe for healthy relationships and contentment rather than the increasing isolation of much modern life.

Mill may have had a point in the stifling conservatism of Victorian Britain, but in an age of increasing loneliness, isolation and anxiety, his view of freedom doesn’t help build good neighbourhoods, families or communities. We need a better version - one that brings us together, rather than drives us apart.

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.