Article

Art

Culture

28 February 2024

6 min read

St Kilda: sketching sanctuary and struggle

A remote Scottish island’s many meanings catch an artist’s eye.

Alastair Gordon

Alastair Gordon is co-founder of Morphē Arts, a painter and art tutor at Leith School of Art. He works from his studio in London and exhibits across the UK, Europe and the US.

An artist holds a sketchbook while standing overlooking a deserted village by a bay, sided by jagged cliffs.

Sketching on St Kilda.

Nestled amidst the tempestuous waters of the North Atlantic Ocean, the islands of St Kilda stand as a testament to isolation unparalleled in the British Isles. Located miles out from the Scottish mainland, the islands form an archipelago that rises defiantly, resembling a fortress of solitude amidst the tumultuous waves.

In 1930, the islanders made a heartfelt plea to be evacuated from their beloved home, as the challenges of survival had become insurmountable. This marked the poignant conclusion of a remarkable two thousand years of human existence on the islands and no permanent community has been established since. Presently, St Kilda stands as a wild and desolate terrain, teeming with a diverse array of wildlife. Amongst the rugged slopes, one can witness the unexpected presence of wild sheep, descendants of the original livestock once cared for by the community. Following the evacuation, the sheep were left to roam freely, adapting to their newfound freedom. Isolated from the outside world for countless centuries, the islands have even given rise to their own unique subspecies of mouse and wren, a testament to the extraordinary resilience of life in this remote haven.

It took me three arduous attempts, spread across consecutive years, to finally set foot on the elusive Hirta, the main island in a cluster of islets and sea stacks known collectively as St Kilda. Access to this remote wilderness is only granted during the warmer months, and my previous endeavours had been thwarted by relentless bouts of stormy weather. However, these failed attempts only served to intensify my determination, turning the eventual arrival into a pilgrimage of sorts, where the sweet taste of success was amplified by the challenges overcome.

Standing at the water's edge, I found myself contemplating the concept of an island as a unique form of solitude, a refuge or retreat, perhaps even a hermitage or prison.

As St Kilda emerged on the horizon, it appeared like a jagged tooth or a mystical axis mundi, a place where the earthly and spiritual realms intersect. Despite its wild and untamed nature, the island is paradoxically dominated by the imposing presence of the Ministry of Defence. Strange listening devices and radars loom over the cliff tops, as if engaged in a silent conversation with the world beyond. Stories of St Kilda often carry an air of romanticism, but the reality of island life was harsh and unforgiving.

As our boat ventured into the circular embrace of St Kilda, a sudden stillness descended upon the waters, transforming the surroundings into an idyllic oasis of tranquillity. The island, formed from the remnants of a volcanic eruption, boasts a natural harbour in the shape of a perfect circle, its walls rising like a majestic amphitheatre to a towering height of 426 metres, equivalent to the Empire State Building, before plunging abruptly into a sheer drop.

The village, consisting of a single street lined with stone cottages known as Black Houses, was the epicentre of island life. Daily existence revolved around the rhythms of fishing, agriculture, and church. Each morning, the island parliament convened to allocate the day's tasks, which often involved harvesting birds, tending to livestock, and repairing nets. Every year, the men of the island would scale the treacherous cliffs with nothing more than homemade ropes to gather the young birds from their precarious nests, while their protective parents swooped and dived in an attempt to thwart such pillaging. Winters were harsh, and the traditions of the church were strict. Missionaries were sent to the island to minister to the faithful, imposing a rigid routine of spiritual disciplines that seemed to serve as both law and religion.

Upon reaching the shore, we were greeted by the island steward, one of only two current inhabitants of the island and resident only in the warmer months. Unless, of course, one counts the Ministry of Defence, whose enigmatic presence permeates every corner of the island. Their satellite dishes and listening posts loom ominously, as if engaged in some clandestine communication with an unseen realm, shattering the illusion of complete wilderness.

Standing at the water's edge, I found myself contemplating the concept of an island as a unique form of solitude, a refuge or retreat, perhaps even a hermitage or prison. It brought to mind the image of Superman in his fortress of solitude or Edmond Dantès, a victim of misfortune, imprisoned and abandoned until the idea of the Count allowed for a rebirth.

But deep down, I knew that this fantasy was far from the brutal reality faced by those who eked out a living on the edge of the world

As a child, I often sought solace on islands during family holidays. There was something about the encircling presence of land surrounded by water that evoked a sense of tranquillity, a sanctuary away from the worries of the world. A sacred space where a weary soul could commune with the divine.

As I ascended the steep walls of Hirta, my camera in hand and sketchbook tucked under my arm, I couldn't help but feel a sense of purpose. I felt like one of those Romantic painters of the previous century who attempted to bring a taste of the natural sublime to the city dwellers, trapped in their concrete jungles and smog-filled air. In that moment, I released mine is not the task of modern-day Romantic painter, venturing into the wilderness to capture moments of awe-inspiring beauty but to chronicle the mundane moments of domestic sublime as witnessed by this landscape through centuries of human inhabitation. The images I captured and the sketches I made now form the basis of new paintings to feature in an upcoming exhibition at An Lanntair gallery in Stornoway.

But as I continued my climb, I couldn't help but question the romantic notions that had fuelled my journey. The landscape itself remained indifferent to my perception of it. It cared not for the grand narratives I projected onto its rugged terrain. It simply existed, unyielding and unapologetic.

And what of St Kilda? Was it truly an idyllic haven, shielded from the political and ecological pollutants of the outside world? Or was it a fortress of solitude, where harsh regimes and a cruel climate ruled? Perhaps it was an oxymoron, embodying both extremes simultaneously.

As our boat sailed away from the island, I found myself pondering the reality of life on St Kilda. What was it truly like to inhabit such a remote place? At times, I allowed my imagination to wander, envisioning a utopia where crime was unheard of, where the absence of policing was a testament to the inherent goodness of humanity. But deep down, I knew that this fantasy was far from the brutal reality faced by those who eked out a living on the edge of the world. Life on St Kilda must have been a constant struggle, a battle against the elements, made bearable only by the flickering hope of a better future.

As I packed away my camera and sketchbook, I couldn't help but feel a sense of gratitude for the opportunity to glimpse into the past, to touch the remnants of a forgotten world. The exhibition I will present in Stornoway will be more than just a collection of art; it will be a tribute to the resilience of the islanders, not just in St Kilda but across the Outer Hebrides in times of hardship, to their ability to find beauty and hope in the harshest of circumstances. And as I prepare to share their story again through painting, I hope that it will serve as a reminder of the fragility and strength of the human spirit, even in the face of isolation and adversity.

Alastair Gordon is an artist based in Edinburgh and London. His new exhibition of paintings opens at An Lanntair in Stornoway, Isle of Lewis, 31 May 2024. The exhibition coincides with a parallel two-person exhibition with Elaine Woo MacGregor opening the same night at Cynthia Corbett Gallery, London.

Sketching St Kilda and the Outer Hebrides

A sketchbook line and watercolour image.

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.