Review

Addiction

Culture

Film & TV

11 April 2023

6 min read

Who’s by your side?

It’s tough to watch A Good Person. Its laser focus and tenderness prompts Lauren Windle to recall her experience of addiction and recovery.

Lauren Windle

Lauren Windle is an author, journalist, presenter and public speaker.

An old man accompanies a young woman into a wood-panelled hall, both look aprehensive.

Morgan Freeman and Florence Pugh in A Good Person

Metro-Goldwyn-Mayer.

I don’t watch films about addiction. When I first got clean and sober almost nine years ago, I soaked in any piece of content I could find on drugs, drug use and recovery. At the time it was just YouTube clips of Russell Brand and the occasional memoir of a starlet who turned to cocaine before discovering yoga. After going to a 10:30am showing of Amy Winehouse documentary film Amy and bawling through the entire film, I decided to call it quits. I don’t need to see horrific stories of desperation – I’ve lived one. I am not a casual observer of addiction narratives; I’ve got skin in the game.

In 2018 I went to see A Star Is Born thinking I was watching a rags-to-riches tale of an unlikely popstar. I quickly realised we weren’t there to witness the female protagonist’s ascent, so much as the male protagonist’s decent. I got back in my car and had to wait a quarter of an hour for the fit of hysterical tears to pass before I drove home. I had the same realisation watching A Good Person.

Going in I knew that I had signed up to a film with Morgan Freeman and Florence Pugh. I knew that Pugh’s character Allison “had it all” before a “dramatic accident changed everything”. The ground here sounded so well-trodden that I thought I may need my wellies to navigate it. I knew that there was some element of addiction, but I envisaged a reasonably light touch depiction of a few too many nights on the sauce.

I knew I was wrong when, about half an hour in, Allison lay on the cold bathroom floor to soothe her withdrawal from prescription opioids. She was sweating, shaking and breathless and from then on, it all felt distressingly familiar. The trajectory of her decline was too quick, too obvious, too accurate. As Allison bargained, manipulated and begged for drugs, I saw myself. As Allison looked directly into the mirror and said: ‘I hate you’ to her own glazed reflection, I saw myself. As Allison was dragged out of a stranger’s house party unable to stand up straight, I saw myself.

The hopelessness, the false starts, empty promises and rare moments of lucidity rang so true, that I would find it hard to believe writer Zach Braff hadn’t experienced his own similar hardship. Either that or the recovering addicts they hired to consult on the project deserve a bonus of investment banker proportions.

When Allison eventually reached out for help and asked a woman to sponsor her, the loving directness that came back was reminiscent of those I was given by my first sponsor. It was virtually word for word what I remember being told when I, nine days sober, made the same terrifying request. The experienced mentor told her: “Some beat it, some die.” And she’s right.

Any of my friends who went to an in-patient treatment centre were told to look around because in five years a decent number of their cohort would be dead. And they were always right. Some people give up and let the tide of addiction pull them under. They feel exactly as Allison did when she told Daniel (played by Morgan Freeman): “I’m not sure I have the will.” And when she confessed in a Narcotics Anonymous meeting that: “Without [the pills] I want to die.”

In the 2015 film Amy, the one that convinced me to stick to rom-coms, there’s a scene that stuck with me. Amy had been invited to perform at the Grammy’s but was denied a visa because of her well-documented drug use. It was arranged for her to live perform in London and it would be broadcast on big screens at the event. When the date came around she was in a stint of sobriety. She performed beautifully and won five Grammys. One of her friends burst into her dressing room to celebrate the momentous achievement but all Amy said was that it wasn’t as good without the drugs.

You learn to love the cage you built around yourself and stop dreaming of more, because you are blind to anything beyond the walls you’ve created.

Getting into addiction means silencing that feeling in your Spirit that says that something isn’t right and you should go home. It’s consistently pushing through when you get a pit of your stomach urge to cut and run. Because you want the drugs, so you know you’ll have to take the chaos they’re packaged in. At some point you stop remembering that you ever felt uncomfortable, and you start to think you enjoy where you are, what you’re doing and the people you’re doing it with. You get Stockholm syndrome and life before your captor is a distant memory. You learn to love the cage you built around yourself and stop dreaming of more, because you are blind to anything beyond the walls you’ve created. You’re not happy, but what other options do you have? You could trade the misery of addiction for the misery of abstinence, but either way you’ll be miserable so you might as well do it with the drugs.

Except, that’s not true. When we’re living our lives right, we’re living them in complete freedom. Slaves to no substance or behaviour with the freedom to say yes to what we want and, crucially, the freedom to say no. It’s the present Jesus gave us in the resurrection but so many of us, myself included, hand it back like it came with a gift receipt.

I wish I’d known the dreams that would be realised, the friendships forged and the profound moments I would experience on the other side of those first, excruciating months of sobriety.

What I wish I could have told Amy at the Grammy’s, Allison in that NA meeting and myself when I first said the words: “I think I’m addicted”, is that there’s so much more than what you can currently see. I wish I’d known the dreams that would be realised, the friendships forged and the profound moments I would experience on the other side of those first, excruciating months of sobriety. I would have wanted to know that in time my grip would loosen, my knuckles would go from white back to their fleshy hue and I would be able to breathe again. It wouldn’t feel like a compromise or half a life or as though something was missing, but I would feel more fulfilled and alive than any drug would ever allow me.

A Good Person demonstrates the chronic and repetitive condition of addiction with a laser sharp accuracy that, for someone with lived experience, could burn. But it’s also a tender reminder of the power of unlikely friendships forged from a mutual understanding of adversity. It made me think of the woman who scooped me up as I backed away from my first ever support group meeting and said: “You can sit next to me.” It made me grateful for the woman who mouthed “it’s going to be OK,” at me across the table as I sat there listening with tears rolling down my face. It reminded me of the awe I felt the first time I heard someone speak about the insomnia, shame and self-hatred of drug addiction, and I realised I wasn’t the only one. The film showed the transformative effect of consistent community in a way that I hope encourages people to turn up to one of those meetings like Allison and I did. I pray that it is the turning point in many people’s lives.

Should you go and watch it? Absolutely. Just don’t ask me to go with you.

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.