Review
Ageing
Assisted dying
Culture
5 min read

For love there is no charge

Out of mind old people are at the centre of Allelujah! Sian Brookes reviews the film adaptation of Alan Bennett’s play.

Sian Brookes is studying for a Doctorate at Aberdeen University. Her research focuses on developing a theological understanding of old age. She studied English and Theology at Cambridge University.

In a hall decorated for a celebration a person stands in front of a seated group, all have their arms raised in celebration.
Jazz hands at the hospital.
BBC Films.

Spoiler alert – this film review reveals significant elements of the plot. 

Allelujah! is not a film that shies away from the big issues. In fact, you would be hard pressed to find a big issue this comedy/political commentary/drama/part-thriller doesn’t at least make reference to (and yes, it spreads itself across all of these genres too). With such an eclectic approach it is difficult at times to keep up with the narrative, and the deeper meaning of the film. Based on the Alan Bennett play, the plot centres around The Bethlehem, a small northern hospital for geriatric patients, which is facing closure due to the Tory government’s efficiency drive. It focuses on two members of staff, Alma Gilpin, a stoic and matter-of-fact but seemingly excellent nurse who has served the hospital her entire career, and a younger Dr Valentine. Other protagonists include an ex-miner patient and his son, a management consultant who has “made it” to London and is currently advising the Health Secretary to close hospitals such as the one in question for the sake of government finances. 

Whether it’s politics or the personal, this film has it all. It deals with levelling up, the cultural and economic gap between the north and south, the challenges of budget cuts in the NHS, the problems of a national health service claiming to 'care' but with managers more preoccupied by Westminster’s economic priorities. It depicts families waiting for older relatives to die in order to grab their inheritance, the broken relationship between an ageing man and his son, and those all-important stories of the older patients’ lives well-lived. And yet as the story line develops, a plot twist emerges which comes to overshadow the entire film, and in the process speaks to what is perhaps the most poignant of the many discussions it raises. Nurse Gilpin, who, until now has appeared consistently caring and committed to her patients, has been quietly administering fatal beakers of milk and morphine to those who she deems to be on “her list” of those who most need relief from their situation. When confronted by the doctor she justifies her actions with a multifaceted answer based on the requirement to provide more beds to a broken healthcare system, but also insisting “I had ended someone’s suffering”.  

When Dr Valentine remarks, “I like old people” a visitor responds “not even old people like old people”.

The manner in which Nurse Gilpin goes about what is effectively enforced euthanasia, is deeply chilling. And yet her reasoning is not entirely foreign to us – to end suffering could be deemed a noble cause. In fact, the need to simply delete the reality of suffering, particularly the suffering of the old is one that perhaps is not so uncommon. Throughout Allelujah!,we are reminded of our tendency to run from, to detest, to reject the suffering of the elderly in our society. When Dr Valentine remarks, “I like old people” a visitor responds “not even old people like old people”. A teenage intern declares to a patient “I hope I never live to be your age”. At the same time, characters look back on the days “when the elderly weren’t farmed out”, and questions are asked of families “if they love them, why do they put them away?”. A very good question. Of course, care needs are often too great for families to endure, yet it is still important to ask why the suffering of the old has become a professionalised service, which most of us avoid at all costs. Perhaps the answer to this is that we don’t like to watch the old suffer, we don’t like to watch them die, because their suffering and their death remind us of our future selves, our future suffering, our future death. In our sanitised, anything-is-possible-with-medicine-and-science society, death and the suffering that comes with it, is something from which we flee at all costs. Instead of acknowledging and working with it, we would rather pretend it wasn’t there at all.  

And yet, even as we try to avoid it, suffering and death are both certain parts of all our futures. 100% of us will die. For Nurse Gilpin, the solution to this is to bring on death prematurely, to erase the pain, overcome the misery by offering a false hope – that it doesn’t need to exist at all. In direct contrast to this, in a film which is littered with Christian references (Allelujah, The Bethlehem), there is a different approach taken by a messiah-type figure who seems to get everything right. Dr Valentine is compassionate and understanding. He not only challenges the political systems which undermine those most at the margins of society, but also has the kind of bedside manner we would all hope for in a doctor. In a closing monologue Dr Valentine utters the words of the doctors in the NHS, “We will be here when you are old, and we would die for you, we are love itself and for love there is no charge”.  

It is this suffering with which is so compelling, this suffering with which is truly sacrificial.

Nurse Gilpin and Dr Valentine offer two fundamentally different approaches to end of life care. One hastens the end quickly, deletes the suffering as efficiently as possible in order to make way for those in less pain. The other sits with those who suffer, holds their hand, gently cares for the human person that is in front of them. Even more, and perhaps most significantly Dr Valentine does not only watch from afar, but is willing to suffer himself for the sake of those in pain - working tirelessly, giving himself over day after day, fighting on with little sleep for limited pay just to make things a little less painful. It is this suffering with which is so compelling, this suffering with which is truly sacrificial, this suffering with which speaks of something much greater than politics, efficiency or inheritance, this suffering with which is indeed “love itself”, completely free of charge.  This is the logic that Christians see in the ancient notion of the incarnation, celebrated every Christmas, of God with us. This is what our older people need, this is what we will all need when we grow old. Let us only hope that when we get there, we find the one who is willing to offer it.

Article
AI
Culture
Generosity
Psychology
Virtues
5 min read

AI will never codify the unruly instructions that make us human

The many exceptions to the rules are what make us human.
A desperate man wearing 18th century clothes holds candlesticks
Jean Valjean and the candlesticks, in Les Misérables.

On average, students with surnames beginning in the letters A-E get higher grades than those who come later in the alphabet. Good looking people get more favourable divorce settlements through the courts, and higher payouts for damages. Tall people are more likely to get promoted than their shorter colleagues, and judges give out harsher sentences just before lunch. It is clear that human judgement is problematically biased – sometimes with significant consequences. 

But imagine you were on the receiving end of such treatment, and wanted to appeal your overly harsh sentence, your unfair court settlement or your punitive essay grade: is Artificial Intelligence the answer? Is AI intelligent enough to review the evidence, consider the rules, ignore human vagaries, and issue an impartial, more sophisticated outcome?  

In many cases, the short answer is yes. Conveniently, AI can review 50 CVs, conduct 50 “chatbot” style interviews, and identify which candidates best fit the criteria for promotion. But is the short and convenient answer always what we want? In their recent publication, As If Human: Ethics and Artificial Intelligence, Nigel Shadbolt and Roger Hampson discuss research which shows that, if wrongly condemned to be shot by a military court but given one last appeal, most people would prefer to appeal in person to a human judge than have the facts of their case reviewed by an AI computer. Likewise, terminally ill patients indicate a preference for doctor’s opinions over computer calculations on when to withdraw life sustaining treatment, even though a computer has a higher predictive power to judge when someone’s life might be coming to an end. This preference may seem counterintuitive, but apparently the cold impartiality—and at times, the impenetrability—of machine logic might work for promotions, but fails to satisfy the desire for human dignity when it comes to matters of life and death.  

In addition, Shadbolt and Hampson make the point that AI is actually much less intelligent than many of us tend to think. An AI machine can be instructed to apply certain rules to decision making and can apply those rules even in quite complex situations, but the determination of those rules can only happen in one of two ways: either the rules must be invented or predetermined by whoever programmes the machine, or the rules must be observable to a “Large Language Model” AI when it scrapes the internet to observe common and typical aspects of human behaviour.  

The former option, deciding the rules in advance, is by no means straightforward. Humans abide by a complex web of intersecting ethical codes, often slipping seamlessly between utilitarianism (what achieves the most amount of good for the most amount of people?) virtue ethics (what makes me a good person?) and theological or deontological ideas (what does God or wider society expect me to do?) This complexity, as Shadbolt and Hampson observe, means that: 

“Contemporary intellectual discourse has not even the beginnings of an agreed universal basis for notions of good and evil, or right and wrong.”  

The solution might be option two – to ask AI to do a data scrape of human behaviour and use its superior processing power to determine if there actually is some sort of universal basis to our ethical codes, perhaps one that humanity hasn’t noticed yet. For example, you might instruct a large language model AI to find 1,000,000 instances of a particular pro-social act, such as generous giving, and from that to determine a universal set of rules for what counts as generosity. This is an experiment that has not yet been done, probably because it is unlikely to yield satisfactory results. After all, what is real generosity? Isn’t the truly generous person one who makes a generous gesture even when it is not socially appropriate to do so? The rule of real generosity is that it breaks the rules.  

Generosity is not the only human virtue which defies being codified – mercy falls at exactly the same hurdle. AI can never learn to be merciful, because showing mercy involves breaking a rule without having a different rule or sufficient cause to tell it to do so. Stealing is wrong, this is a rule we almost all learn from childhood. But in the famous opening to Les Misérables, Jean Valjean, a destitute convict, steals some silverware from Bishop Myriel who has provided him with hospitality. Valjean is soon caught by the police and faces a lifetime of imprisonment and forced labour for his crime. Yet the Bishop shows him mercy, falsely informing the police that the silverware was a gift and even adding two further candlesticks to the swag. Stealing is, objectively, still wrong, but the rule is temporarily suspended, or superseded, by the bishop’s wholly unruly act of mercy.   

Teaching his followers one day, Jesus stunned the crowd with a catalogue of unruly instructions. He said, “Give to everyone who asks of you,” and “Love your enemies” and “Do good to those who hate you.” The Gospel writers record that the crowd were amazed, astonished, even panicked! These were rules that challenged many assumptions about the “right” way to live – many of the social and religious “rules” of the day. And Jesus modelled this unruly way of life too – actively healing people on the designated day of rest, dining with social outcasts and having contact with those who had “unclean” illnesses such as leprosy. Overall, the message of Jesus was loud and clear, people matter more than rules.  

AI will never understand this, because to an AI people don’t actually exist, only rules exist. Rules can be programmed in manually or extracted from a data scrape, and one rule can be superseded by another rule, but beyond that a rule can never just be illogically or irrationally broken by a machine. Put more simply, AI can show us in a simplistic way what fairness ought to look like and can protect a judge from being punitive just because they are a bit hungry. There are many positive applications to the use of AI in overcoming humanity’s unconscious and illogical biases. But at the end of the day, only a human can look Jean Valjean in the eye and say, “Here, take these candlesticks too.”   

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