00:01:22.360I was particularly involved in brain injury and finding new treatments for preventing brain injury in newborn babies.
00:01:30.500And then from my work, I got more and more interested in some of the fascinating and challenging ethical debates that are going on to do with medicine and the advances in technology.
00:01:41.340And so I've now retired from the clinical front line, but I'm still very much involved and engaged in medical ethics and in technology issues related to technology, including artificial intelligence and the new challenges which are coming up down the road.
00:02:23.520It's something that we don't talk about.
00:02:25.260It's something that is an absolute taboo subject in the West.
00:02:29.360And it seems to me that over the past 18 months, as a pandemic has encroached in all our lives, we've suddenly become a little bit more aware of our own mortality.
00:02:40.100And I think we've had a little bit of a moral crisis.
00:02:43.760Well, I think there's something in that.
00:02:44.680I think the interesting thing is that particularly what psychoanalysts and psychologists say is that all of us suffer fundamentally from death anxiety, from this outrageous discovery that our lives are going to end.
00:02:59.420And then we develop psychological mechanisms to try and live with that reality.
00:03:04.700And the commonest psychological mechanism is defense.
00:03:15.680And what's happened in the pandemic is that all of a sudden that those defense mechanisms have turned out to be not very good because we've just been bombarded with these horrific images, haven't we, of mass graves and intensive care units and weeping relatives and watching those statistics.
00:03:33.300And we've realized, actually, it does affect us.
00:03:36.620And so I think there is a sort of epidemic of death anxiety, particularly in those early days of the lockdown.
00:03:42.100And, you know, you talk about death anxiety.
00:03:45.180What are the symptoms of death anxiety?
00:03:49.320Well, I think everybody is incredibly different, isn't it?
00:03:52.820I mean, how do people cope with this sense of a lot of it is just fear?
00:03:59.640I mean, a sense of heart racing, you know, the symptoms of fear, anxiety.
00:04:07.140You know, one of the things we all got used to is you're walking along the street and someone's coming the other way and you suddenly, you almost bump into them.
00:04:15.780And I remember people cowering back and with great sort of terror on their faces that, you know, you were going to be the angel of death to them.
00:04:29.500I think sleeplessness, inability to sleep.
00:04:33.580You know, there's been an epidemic of mental health.
00:04:35.860It comes out in many, many different ways.
00:04:38.200And tragically also, I think broken relationships, abuse, you know, a whole litany of things.
00:04:44.600One of the things as pediatricians, we're aware of it.
00:04:47.680The fact there's actually been an increase in child abuse going on during the lockdown, but often not recognized because the normal mechanisms by which these things became apparent were not there.
00:04:58.660Do you think we've reacted rationally to this, the fear?
00:05:03.540Because I think you're right when we look around and see how people react.
00:05:07.480When I see some polling numbers, for example, you know, 20% of the British public want a permanent curfew after 10 p.m.
00:05:14.840You're going, I'm not sure you really, you know, you're reacting rationally to this.
00:05:19.620Do you think that as a society, as Francis, I think I was alluding to earlier, we've kind of wet the bed on this one a little bit?
00:05:26.840Probably a great deal of bedwetting going on.
00:05:35.280As human beings, we find it incredibly hard to assess risk.
00:05:39.520You know, so in my previous work as a pediatrician, one of the things I often had to do was to discuss with parents whether they were going to have their children vaccinated.
00:05:48.680And particularly early on in my career, it was about the whooping cough vaccine.
00:05:52.280There were statistics that one in 300,000 children suffered permanent brain damage because of a whooping cough vaccination.
00:06:01.000And I've spent endless hours of my life talking to parents who've been agonizing about, you know, should I have my child vaccinated?
00:06:10.220And the problem is, of course, if you say if your risk is one in 100,000 or one in 85 or what does that mean?
00:06:16.720You know, if I've got a one in 85 risk of dying, is that something I should worry about?
00:06:21.260Is that something I should change my life over?
00:06:23.720You know, if it's one in two in 50, is that better than one in 85?
00:06:27.440You know, I think psychologically we just can't access those mathematical risks.
00:06:34.640And we don't know how to translate it into living.
00:06:37.560And this is, I think, part of the problem in the pandemic is how psychologically we learn to live with risk.
00:06:44.640And I think that a lot of people got the risk completely out of kilter so that they felt that by going to the local shop, you know, they were putting their life at mortal risk.
00:06:57.520And therefore, and interestingly, you know, I mean, politically, you can see that Boris and the government in those early days of the lockdown, their intention was to stoke fear.
00:07:09.960I mean, it was in order to get people to obey the lockdown.
00:07:13.260They deliberately stoked these images about, you know, save lives, protect the NHS.
00:07:20.400It was and the hidden message, if you don't follow the lockdown, you might die.
00:07:25.300So and kill someone else or kill someone else.
00:07:27.280And so there was this deliberate stoking, wasn't there, of fears.
00:07:31.220And now when we say, hang on, it's not quite as bad as that, and we should now get it in proportion.
00:07:37.580I think what's interesting is there's a whole population of people who once these fears are turned on, particularly older people, they're just not at all sure they ever want to come out of their houses ever again.
00:07:48.160It's interesting because I think some people who watch our show regularly might at this point be thinking, well, they've got this guy on who agrees with their scepticism about lockdown.
00:07:56.060But you actually have a very mixed view about the measures the government have taken.
00:08:00.060For example, one of the things I know you talked about is the fact that the NHS being overwhelmed would be just a catastrophic thing to happen, given the number of people with chronic conditions.
00:08:11.760So can you give us some input on that from kind of inside the medical profession's point of view?
00:08:17.500Yeah, I have to say I was very frustrated about some of the conversation that was going on early on where people were saying, well, why do we need to protect the NHS?
00:08:25.040I mean, it's just, you know, as though it's a bit like protecting shipbuilding or protecting the on-the-send.
00:08:31.460Just to be clear, John, Francis and I were both very much in favour of the first lockdown and complied with it completely.
00:08:36.580It was more the later steps that we were more sceptical about.
00:08:40.640I think what a lot of people who are not in the business don't really understand is how utterly central healthcare has become to the functioning of a modern society.
00:08:51.900In that sense, it's utterly different, I think, from virtually any other of the activities of a modern society.
00:08:59.540And that's because so many of us have got chronic conditions, which for our normal everyday functioning, we depend on the continual existence and input of health services.
00:09:14.240It's not simply the case that health services are there in case people are critically ill and going to die.
00:09:19.100It's the fact that normal living depends.
00:09:22.560You know, there are so many people with diabetes, with kidney problems, with hypertension, blood pressure, with cardiac problems, with respiratory problems, with asthma and so on.
00:09:34.020And many, many of these people would have either died or be chronic cripples and severely disabled in the past.
00:09:41.780But now, and I'm one of them, we're all of us getting on with our lives with chronic conditions, thanks to the fact that we've got continuous healthcare input.
00:09:51.960And if we become particularly sick and we know that there are people there who are going to look after us and bail us through some acute episode and so on.
00:09:59.800So the prospect of happening was that if the NHS became genuinely overwhelmed, that literally all those activities stopped happening simply because it was the NHS was overwhelmed with COVID patients, then the knock-on effects on the whole functioning of society was far greater, I think, than people recognised.
00:10:24.140It would have absolutely catastrophic consequences and also for the economy because, of course, you know, so many of those people with chronic health conditions are also productive members of the economy.
00:10:36.120And therefore, if once the health system goes down, the economy goes down as well.
00:10:40.660I think that awareness, I think that was something that was appreciated in the Department of Health and in the Cabinet, but it was something that was often not appreciated in the kind of debates that were going on.
00:10:55.180You know, it's very naive and simplistic to say we either back the economy or we back health, the NHS, you know, which should we back?
00:11:02.880In a modern society, that simply is a meaningless kind of comparison, I think, dichotomy.
00:11:12.460Having said that, I think, of course, we're now in a very different stage.
00:11:16.100So my own feeling as a medic, and I think the vast majority of people with experience of frontline medicine, that we really didn't have any alternative but to try to protect the NHS at that, at the time, at the peak.
00:11:32.880I think now, of course, we're in a very different situation and these very difficult questions of lockdowns versus economic and growth and freedom and liberty and so on and that trade-off.
00:11:47.180And I think we're going to be living with those kind of trade-offs for the foreseeable future.
00:11:51.200I mean, you say we're going to be living with the trade-offs for the foreseeable future and talking about death.
00:11:58.840The excess deaths caused by the lockdown and the shutting down of the NHS, I mean, those are very, very difficult subjects and topics to address.
00:12:07.900They are. And, you know, this is one of the bizarre things that struck me in the height of the pandemic.
00:12:14.920And that is, in many ways, the kind of what was happening in London was a kind of, it felt like an existential risk.
00:12:22.500You know, it felt as though, you know, the analogy with warfare was not ridiculous, you know.
00:12:28.140But the difference was, you know, and I was thinking back to what it would have been like, you know, in these very streets in the Second World War or in the Blitz and, you know, when the whole nation is at war.
00:12:38.420The bizarre thing that was going on in the pandemic is that a small number of people, many of whom are my friends and who I was closely related to, health professionals working in ITUs and A&E departments, it was a war zone.
00:12:52.340I mean, what they were going through, watching the bodies, seeing people struggling for life, working through the night, it was a war zone.
00:13:00.760But it was for a tiny minority of people.
00:13:03.540And the vast majority of the population was sitting on their backsides, warm, well-fed, safe, and watching Netflix.
00:13:12.300And there's this sort of strange disconnect that I know that just down the street, there is absolute carnage going on in the ITU.
00:13:20.600And yet the vast majority of people, it has no impact at all.
00:14:25.240Do you think that we talk enough about the effects that COVID had on the medical professionals themselves?
00:14:31.060I mean, I've received some messages from doctors who said that the front line was carnage, that a lot of doctors have got PTSD as a result.
00:14:41.180And there was one, and I don't know if it's true, saying that one of them actually committed suicide as a result of what they'd seen on the front line.
00:14:49.720I mean, there have been a whole number and people who are permanently traumatized.
00:14:54.640I mean, particularly, actually, it's the junior doctors who I feel most for, because I know, you know, as a junior, you get catapulted into horrific situations where you feel completely out of your depth.
00:15:07.520You know, at least when you're an experienced consultant, you've been here before and you've got some way of understanding what's going on and how to cope.
00:15:14.600But I think, you know, what happened is there were some final year medical students who were just sort of announced, you know, you thought you were going to do your finals next year.
00:15:23.580You are now a qualified doctor and you report for duty tomorrow.
00:15:27.380And they were suddenly, you know, and watching people die and feeling utterly overwhelmed.
00:15:33.760So I think there are a lot of stories that need to come out.
00:15:38.880And it is interesting that, and I think a lot of health professionals feel that the rest of the country has just done very well, thank you.
00:15:47.920And, you know, and yes, it was nice when everybody got around and clapped hands.
00:15:52.760But frankly, that was, you know, that was a bit trivial in terms of, you know, in wartime, the instinct was we've got to celebrate the war heroes.
00:16:04.440We've got to, you know, you think of everything that goes on into the lost soldiers and Poppy Day and celebrating the people who gave their lives for this country.
00:16:13.440There are far more people who have given their lives and suffered damage because of COVID than in some of the military conflicts, certainly since the Second World War.
00:16:26.200So, and yet, are we going to have the same kind of recognition, celebration, naming?
00:16:32.740One of the fascinating things, of course, is that many of the health professionals who died came from ethnic minorities and were not, you know, they are at the absolute bedrock of the NHS.
00:16:46.180And yet, again, I think there's been this sense that they haven't been recognised or celebrated in the way that our heroes would be from the armed forces.
00:16:56.360Do you think this whole thing is, relates very much to what you were talking about earlier, which is, there's kind of this meme going around on the internet, like, what kind of pandemic is this that you wouldn't know it, it's happening unless you watch the news.
00:17:10.520And that is kind of speaks to the disconnect between the fact that the medical professionals were on the front line facing it, everybody else.
00:17:18.540I mean, you literally could have not noticed it if you didn't turn the TV on.
00:17:23.720It is very weird, isn't it? Because if you think any other existential crisis which hits an entire nation, everybody notices.
00:17:34.360It's something which is affecting my life.
00:17:36.840And yet, extraordinarily, people could have a really nice time and just let a few health professionals get on with it.
00:17:44.440Do you think that the reason for this is partly because the people who died from this are primarily very old people?
00:17:51.320And so, it's kind of, I mean, this sounds very crass, but since we've got you on to talk about this very difficult subject, I'm just going to say it like it is, right?
00:18:25.700And, you know, this is something that's really weird about COVID because there have been lots of lethal pandemics before.
00:18:33.040And, in fact, I was, you know, 10 years ago, I was part of an ethics group that was discussing how the NHS would cope with a lethal pandemic.
00:18:40.640But we were basing it on previous lethal pandemics.
00:18:43.820The interesting thing about previous lethal pandemics is they actually target young people, and it's young, fit people who particularly – so that was true of the Spanish flu.
00:18:58.500I mean, it's often – it's young, fit, healthy people are the ones who are particularly – who get it most severely and who die like flies.
00:19:05.780And that's what we were expecting, and that's part of the horror we were, you know, imagining all these people, 18-year-olds, 21-year-olds, 25-year-olds, fit, young, healthy people, dying in ITU.
00:19:16.920How is society going to cope with that?
00:19:19.420The fascinating thing about COVID, and there are – there's a scientific reason as to why this is – it's almost completely unique.
00:19:25.460It has this very precise age relationship.
00:19:28.680It goes – the risk goes up linearly with every 10 years of age.
00:19:32.480And that's just because of something very strange about the biology and how it actually gets into the cells.
00:19:39.000And so that meant this very unusual age profile, that it was almost entirely older people, and particularly once you got into your 70s and 80s, you were at very high risk, whereas the people in their 20s, as you said, felt immune.
00:19:54.620And it's certainly – when the next lethal pandemic comes, there's no reason to think it will be like that.
00:20:00.180But I do think the psychological response, the way that people responded, would have been very different if all your mates – if you knew that all these young, fit, healthy people were going down and dying.
00:20:14.420And you – much more like the AIDS – you know, when I was around, when the AIDS epidemic first hit, and what was so awful was it was young, healthy, fit people who were dying like flies.
00:20:28.240And, of course, that made a huge, huge psychological impact in a way that actually this – because this has been this – it's largely been going on in old people's homes and elderly people and so on, has not had the same psychological –
00:20:42.980And do you think that reaction is wrong, or do you think it's a rational reaction?
00:20:49.400And, again, a difficult question, I know, but this is something that I wrestle with, right?
00:20:54.920Should I, as a young, relatively healthy man, really be that worried about COVID?
00:21:02.020And I think, clearly, because now knowing what we know, you are in a very different category from me in terms of the risks if we got infected.
00:21:12.360I mean, that's just – that's the biology.
00:21:47.100We must have them headlined BearFest in Russia.
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00:22:09.480As you know, there's a lot we don't know about COVID.
00:22:13.860And I think, again, what the medics are aware of is they're seeing a whole lot of really weird stuff.
00:22:19.540People with strokes, people with heart failure, people with weird things.
00:22:24.940Almost every bodily system can be affected by COVID.
00:23:07.000Is it possible that it's actually going to have an impact, which comes apparent 10, 20 years now?
00:23:12.660There are other examples of infections, of virus infections, which only showed neurological symptoms 20 years later, 30, 40 years later.
00:23:21.960Is it possible we're going to have an epidemic of some weird neurological conditions, even dementia or motor neuron disease or multiple sclerosis,
00:23:30.660which was actually triggered by minor infections, which people didn't even notice?
00:24:54.520And this comes back to, well, thinking about death, doesn't it?
00:24:56.740Because, you know, when you're 25 and your life's ahead of you and, you know, what, you know, I mean, death, I just don't need to think about it.
00:25:04.640And health, well, I don't need to worry about health.
00:25:08.900You know, and so it is possible for people to have this sort of completely unrealistic understanding of what's going on and what life is like and of the reality of death and disease.
00:25:26.060So I think, again, coming back to death, the thing was, until the 50s, 60s, everybody saw death.
00:25:49.280And somewhere in the 50s and 60s, with a dramatic fall in mortality because of improvements in health care and other things, and death is now medicalized and it just happens behind curtains.
00:26:00.300It happens and I can tell myself death doesn't happen.
00:26:17.440We've seen it in the news, the media, death tolls, the amount of people dying.
00:26:21.380All of a sudden, it doesn't seem as abstract as it used to.
00:26:26.140I would like to believe that it will change people's attitudes to death.
00:26:32.780I have a nasty feeling that the defense mechanisms are so incredibly powerful and that as life goes back to normal and we just say, well, you know, well, that wasn't that weird.
00:26:43.980You know, let's get back to normal living.
00:26:46.400I think people's attitudes to death need to change, but I'm not convinced the pandemic has actually, is going to cause that kind of sea change.
00:26:56.780And what, sorry, do you want to crack on?
00:26:58.180Well, I was just going to say, it makes perfect sense to me.
00:27:00.120I once got stuck in a Bulgarian airport for 24 hours.
00:27:05.320And the moment it was over, I'm just, I was just like, I'm never thinking about this again.
00:27:09.900And I have a feeling that that will be very similar with COVID, to be honest with you.
00:27:14.200But, you know, I was going to ask you as a sort of counter argument, because I hear absolutely the importance of not over-trivializing it.
00:27:22.800But on the other hand, you talk about our failure to assess risk.
00:27:26.520And one of the big concerns for me has been that while we threw the kitchen, everything but the kitchen sink at COVID, we do seem to have forgotten that there's other things that cause death as well.
00:27:39.000Cancer, heart attacks, suicides, mental health, depression, drug addiction, all of the child abuse, which you mentioned earlier.
00:27:47.140And all of these things have obviously exploded in the last 18 months.
00:27:51.660Do you think that we have got the right balance between addressing those causes of mortality?
00:27:58.040Well, I mean, you know, I have a lot of sympathy with the politicians.
00:28:14.980You know, it's that famous thing, you know, events, dear boy, events.
00:28:18.280You know, what, what, everybody, but everybody was blindsided by this.
00:28:23.240And I think in a way, that's one of the main things to take away.
00:28:28.120And that is, you have no idea what is coming down the line.
00:28:32.160And therefore, the ability to improvise, the ability to understand, prioritize, and work out what's most important is incredibly important.
00:28:43.920I think in a sense, this is a wake-up call.
00:28:46.720Well, arguably, despite the terrible things that have happened in the pandemic, you could say we dodged a bullet.
00:28:55.320It could have been catastrophically worse.
00:28:58.540And because of this weird virus, it was very much less bad than it could have been.
00:29:07.080And we've also seen a spectacular way in which the medics and the scientists came together in order to develop the vaccine.
00:29:16.940I mean, I think that, again, is a story which, if you're not actually in the business, you don't realize quite how utterly extraordinary that was.
00:29:24.880And actually, very, very impressive, very encouraging that when the chips are down and when we're facing this kind of existential crisis and wondering whether the human race can survive, you know, or whether UK PLC is going to go bust, that all of a sudden, all the traditional rivalries, all the me first and the petty concerns go on the back burner.
00:29:48.980Everybody is on the same team, supporting one another.
00:29:53.140You know, vicious competitors are working together to try and crack this problem and collaborating and sharing information and clearing the deck, you know, so that the normal bureaucracy and all the frustrations, all of a sudden, it's gone.
00:30:10.840You know, whatever you want, you can have it.
00:34:18.860And we need to be talking about how we would like to die.
00:34:21.480You know, it's interesting that when you ask people how they want to die, the commonest reaction you get is, I just want to go out like a light.
00:34:32.180I want, you know, I want to go to bed one day, perfectly healthy, and just die in the bed just like that.
00:34:50.340Everybody agreed that sudden, unexpected death was the absolute catastrophe.
00:34:55.800And, in fact, there's a prayer in the Church of England.
00:34:59.580One of the main prayers is to pray against sudden death because, you know, because the idea of just being snuffed out with no warning, no possibility of saying goodbye, no possibility of preparing your next generation, no possibility of asking forgiveness for all the people you've hurt and wounded,
00:35:16.480no possibility of asking for all the people you've hurt and wounded, no possibility of preparing to meet your maker or reincarnation or whatever you believe in, but just bang, just go.
00:35:27.760Whereas, interestingly, now it's seen as an ideal way to go.
00:35:31.460But I think a lot of that is about our narcissism.
00:35:33.680We're not actually thinking about other people.
00:35:35.260We're not actually thinking about our loved ones who are going to discover us cold in the bed.
00:35:39.840You know, our children are, you know, all we're thinking about is our precious own little experiences that we shouldn't have anything at all nasty or threatening or anxiety making.
00:35:49.440So, you know, it's that kind of self-preoccupation again, which is part of the problem.
00:35:54.860But if I can push back on you just so slightly, but let's be honest, dying is fucking horrible, isn't it?
00:36:00.140Well, it isn't fun, but it is also, it's an immense opportunity.
00:36:07.440I mean, I have seen people die and I have seen people how it turns out that dying has been an opportunity for restoring relationships, for fulfilling dreams, for having the most amazing conversations they've never had before, but all kinds of positive things that can happen when people are dying.
00:36:27.160I mean, one of the interesting things is that if you're dying, you get a kind of relational authority.
00:36:32.760So, when you're dying, you can say, I haven't spoken to my mate, we had this terrible argument 10 years ago, and I haven't spoken to them since, but actually, can you tell them that I'm dying and I'd really like to talk to them?
00:36:48.100And because you're dying, you have some kind of leverage, authority.
00:36:53.600And, you know, I haven't spoke to my dad for 30 years, but, you know, could you get a message that I'm in the ITU and I'd really like to speak to him before I die?
00:37:01.700So, dying actually is an opportunity for healing, for exploring new things, for dreaming dreams.
00:37:10.060So, that was the whole vision behind palliative care, was this idea that instead of just being snuffed out, couldn't there be something precious about those last few hours and days?
00:37:23.640And so, the motto came from the palliative care movement was, not only are we going to help you to die well, we're going to help you to live before you die.
00:37:32.360And that was the idea, that to live before you die, that actually those final hours, days, weeks, months can turn into something incredibly precious, incredibly wonderful.
00:37:43.200So, it doesn't have to be effing awful.
00:37:46.980I mean, it's effing awful if there's nobody there, if you're abandoned, if there's no care, there's nobody love you.
00:37:53.360But actually, time and time again, I've seen it turn into something that's effing wonderful.
00:37:59.480And do you think that the reason you talk about making it a communal experience, the reason that often we don't do that is that we've become these pleasure-optimizing machines almost, where the thing that we most want is to have pleasure, and the thing that we most want to avoid is discomfort.
00:38:20.240And you see it in the culture everywhere, whether it's, you know, we as comedians talk about people being easily offended or whatever.
00:38:27.540Like, we think that the highest value is not to experience discomfort of any kind, whereas we really know that discomfort is often the prelude to the biggest transformations, the biggest growth opportunities, the most positive events in our lives have often been preceded by experiencing something deeply uncomfortable.
00:38:49.460Now, this is very close to home for me, because, I mean, what you're describing is the philosophy of utilitarianism, and that was invented by Jeremy Bentham, who was actually seated on a chair at the entrance to University College London, my university, because he was an out-and-out atheist, and he insisted, he didn't believe in any of this eternal life rubbish, but he wanted his body to be preserved so that he should continue to play a role in the university.
00:39:19.060In fact, it's laid down in the university that his body, his embalmed body should be present at every meetings of the university council, and it still is, although...
00:39:29.060Now it makes sense where Lennon got his idea from.
00:39:32.700Although, 19th century embalming techniques were not very good, and after a while the body became so disgusting, they now use a sort of plastic replica.
00:39:41.060It's a replica, but it is still there.
00:39:44.120So, the essence of utilitarianism is the idea that the ultimate good is pleasure, and the ultimate evil is pain.
00:39:52.500And therefore, as you say, pain, all aspects of pain and discomfort are deeply immoral, evil, and to be avoided at all costs.
00:40:02.260And you're right that modern culture has completely imbibed that, all except, to my fascination, there's one area which it doesn't, and that's the gym.
00:40:10.840Because we all know, no pain, no gain, you know.
00:40:14.740So, on the sports field and in the gym, we all get the idea that actually there is a benefit to agony, that real sweat and pain and struggle can actually be beneficial.
00:40:31.640But in the rest of our lives, utilitarianism is God.
00:40:42.340But I think people are waking up to this, John, because I don't know how familiar you are with Jordan Peterson, and we've had him on the show a couple of times.
00:40:49.460And I think he became a huge star precisely by giving people this message, actually, that if you want to have a meaningful life, if you don't, if this existential dread that you experience on a daily basis by pursuing momentary pleasures and, you know, the newest coffees and then this and then that,
00:41:08.360actually, by binding yourself to other people, by standing up in the face of adversity, by dealing with the discomforts that come with the fact that you are responsible for things.
00:41:21.260And that message has actually seemed to have really resonated with a lot of people, because I think we've just gone so far down this utilitarian path that a lot of people are starting to realize it doesn't lead anywhere.
00:41:33.340Yeah, that's absolutely right. And dying, as you said, is the prime example of that.
00:41:40.160Here is this really frightening, unpleasant, terrible reality, which we're all of us in different ways called to face.
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00:43:03.940I mean, to be honest, physical pain is the easy stuff.
00:43:07.000I mean, we are, these days, as medics, amazingly good at controlling physical pain.
00:43:13.060The problem is there are other kinds of pain, which dying people have, particularly relational pain, psychological pain, existential pain, spiritual pain.
00:43:40.740They are fantastic opportunities for growth.
00:43:43.780And that's why I'm not looking forward to dying, but actually, I recognize that going through that experience myself could be even a strange kind of adventure.
00:43:54.800You know, I've got more things to learn, more things to experience, more things to say to other people, more things for them to say to me.
00:44:03.300What have you learned from watching people die, John?
00:44:05.460You can't summarize it in a, you know, what have I learned from life?
00:45:30.300You know, the mechanism of denial that just says it doesn't exist, I'm not going to think about it, change the subject, actually is very limiting.
00:45:39.960I mean, it keeps you at this kind of very childish level.
00:45:47.120And there's a sense in which, you know, it's often said you don't grow up until you've watched your parents die.
00:45:51.860And I think there's something in that, too.
00:45:53.360You know, there's something about being exposed to that and seeing the next generation and seeing them die.
00:46:02.560And so there is an opportunity to grow.
00:46:05.160And I think, you know, there is a huge amount of infantilism in our modern society, particularly, if I might say it, you know, with a sort of millennial generation who...
00:46:32.640Well, I think there's just a sort of self-preoccupation and a narcissism.
00:46:36.600You know, again, the strange thing is, as you get older, you hear your dad saying things.
00:46:44.440You think, actually, you know, I thought my dad was completely out to lunch and mistaken.
00:46:49.700And now I've kind of realised, actually, he was not completely in my...
00:46:52.180My dad used to talk about the impact of the war and the experience of being in the army.
00:46:58.440He was in the army during the Second World War and how it had changed him and how his life would have been different if he hadn't gone through that experience.
00:47:08.980And, of course, you know, up until the 60s, every generation had experienced war.
00:47:15.780In Europe, there's been continuous war for centuries.
00:47:18.860I mean, the idea that you could go without there being major armed conflict and that it wouldn't touch you is simply inconceivable.
00:47:27.380But now we have had peace and prosperity for, what, 70, 80 years?
00:47:34.260And, therefore, we've grown up generations for whom war is simply inconceivable.
00:47:40.300It simply doesn't figure in their setting.
00:47:44.560And, actually, that's the abnormality, I think.
00:47:48.680I think no other generation has been so free from war.
00:47:53.760And I think it's not a bizarre reality that the absence of war in some...
00:48:02.760Because I suspect war, similar to dying, it's because it makes you think about reality.
00:48:10.220It makes you think about what really matters, about what the ultimate meaning of existence is.
00:48:14.360And it's possible, in this period of peace and prosperity, to be sitting on your backside, playing computer games, watching the world go by, in a kind of infantilized existence.
00:48:29.440I just want to tell the viewers I do none of those things.
00:49:07.120Well, I understand why people think this is the obvious solution.
00:49:17.800And to that extent, I sympathize with it because, you know, unfortunately, one of the terrible paradoxes is that although actually Britain leads the world in terms of palliative care,
00:49:29.600and in terms of all the resources we commit to it, and in terms of the expertise we have, the terrible reality is an awful lot of people in this country die very badly.
00:49:39.020They die without decent care, without expert support, without the right resources.
00:50:11.420We don't think we should make it a priority.
00:50:13.400A lot of the NHS doesn't even pay for it.
00:50:17.180A lot of it is paid out of people jingling boxes and saying, support your local hospice, which is, you know, that we don't even provide proper care for the dying.
00:50:29.000So we will spend billions and billions and billions to give someone an extra half a year of life at the age of 80.
00:50:36.960But we won't spend money to give them a death and dignity.
00:50:42.100Correct. And we don't think it's important.
00:50:44.480And the great British public doesn't think it's because basically politicians respond to what the public think.
00:50:52.780They put a huge amount of pressure on when it comes to cancer and heart disease and so on.
00:50:56.020They do very little about death and dying.
00:50:58.980So therefore, the sad reality is even in some of our major teaching hospitals, people die very badly.
00:51:06.540They die because doctors are poorly trained, because they're not having the resources, there's not the emphasis on it and all the rest.
00:51:12.980And so it's understandable that people say, well, I've heard these horror stories.
00:51:17.020Surely the best thing to do is to have a lethal injection or take a lethal medicine and so on.
00:51:23.960And so I understand the motivation, but I personally think it's wrong.
00:51:28.180Because I think it short circuits that there are all kinds of problems with making killing part of what doctors do.
00:51:38.560But from a personal point of view, it goes back to this utilitarianism, doesn't it?
00:51:44.340I mean, euthanasia is great because I just don't have to have any of that unpleasantness.
00:51:49.940I mean, you know, as soon as I start those first twinges, I sit down, take the medicine and it's gone.
00:51:56.280So all those opportunities for growth, for discovery, for healing, are all short circuitous.
00:52:07.340Do you not think there are some cases, though, where someone can't talk, can't eat, you know, they're in pain that cannot be treated medically, etc.,
00:52:15.880where they're not really living and those opportunities aren't there, where it's the humane thing to do to give them that option?
00:52:23.980I have to say that with really expert palliative care, and I've seen, you know, the very best experts doing it in the very best places,
00:52:34.020those situations are vanishingly rare, interestingly.
00:52:36.560I mean, there are certainly rare situations where it seems that people are in such distress that nothing can be done for them apart from just putting them to sleep.
00:52:47.520But it is actually very rare, and it's often a question of digging down to discover what is causing the suffering.
00:52:56.100And it's very rarely physical things that are causing the suffering.
00:52:59.100People are often in agony because of broken relationships, because of loneliness, because of lack of meaning in their lives.
00:53:05.700And therefore, is the right thing to do is just to bump them off?
00:53:10.140Or could there be a better way of helping people to rediscover meaning?
00:53:16.160So I personally think that if you legalize it, you know, there are 500,000 people a year in the UK who die every year.
00:53:29.040Do you know how many go to Dignitas every year?
00:53:32.980So it's a tiny, tiny, tiny proportion.
00:53:37.980The question is, do we change the entire law of the country and therefore mean that every dying person has to consider, do I want to be?
00:53:46.060Because once you legalize it, you have to give people the option.
00:53:48.740I need to tell you, you've got cancer, you know, we can support you, we can prevent you suffering, we can give you da-da-da-da-da-da, but there is always the option, we could kill you.
00:54:02.920Once you make that option, you've really changed the ballpark, isn't it?
00:54:09.180And so the question is, for the sake of a small number of people, do we take 500,000 people and offer them the prospect of killing themselves?
00:54:22.420I was thinking, and look, there's one thing that obviously we haven't talked about that underpins a lot of this.
00:54:27.600I was half expecting you to whip a Bible out halfway through this.
00:54:31.880Because there is a spiritual element to all of this, I think.
00:54:35.400And, you know, Francis and I are not believers.
00:54:38.720But do you think, as we've become a more secular society, some of the downstream consequences that you've talked about are a product of that?
00:54:49.300Well, it's a very complex mix, isn't it?
00:54:51.540Certainly, I think that inevitably your beliefs about is there anything beyond the grave, you know, makes a difference.
00:55:02.220And it makes a difference to how we respond.
00:55:04.260Well, I, as you implied, I'm a Christian.
00:55:10.280I'm basically a sort of mainstream Anglican Church of England Christian.
00:55:15.880But I worked with a colleague, a pediatrician, who was a card-carrying atheist.
00:55:21.640And he said to me once, we talked about caring for dying babies.
00:55:25.440And he said, you know, it is different for you and me, John, because, you know, when you're caring for a dying baby, you're sending them to heaven.
00:55:32.600And when I'm caring for a dying baby, I'm sending them to the compost heap.
00:55:37.360And, you know, it was meant as a joke, but we both knew it was true.
00:55:43.240And therefore, if you do genuinely believe that all there is is the compost heap and that human beings are some bizarre, you know, existential freak of the universe, which somehow got its knickers in a twist.
00:55:59.560And instead of doing the normal thing, it somehow went very much very wrong and we evolved and it's all utterly meaningless and, you know, and we just fizzle out.
00:56:09.020Well, that does change your attitude to these issues.
00:56:14.520Interestingly, before Christianity was a thing in the ancient world, suicide was regarded as the most logical, rational, noble way to die in many cultures.
00:56:30.220And it was really only Christianity which opposed suicide because of its view that life was precious and that all life was precious.
00:56:43.180And therefore, you know, for 20 centuries, there's been a sort of idea that suicide is not a good way to end your life.
00:56:53.300And in fact, you know, we still in a very secular NHS put enormous amount of work into suicide prevention, you know, and the Samaritans and a huge amount of emphasis saying killing yourself is not a good way to die.
00:57:06.480But arguably, if you follow the logic and you say it's all, there isn't any ultimate significance to life, there isn't anything beyond the grave, then perhaps suicide becomes rehabilitated as a rational way to die.
00:57:29.160And so I suspect that's going to be one of the big arguments as we look into the future.
00:57:34.120You know, what does it mean to die well?
00:57:37.160Does it mean this traditional view that dying is part of life and that there are things to learn and that it's an opportunity for growth and so on and for care and support?
00:57:50.420Or in the end, is it best to top yourself?
00:57:53.020If I've decided my life is coming to an end, why not?
00:57:58.120Good, good enough to end the interview on.
00:57:59.880To be honest with you, I haven't talked this much about dying since I was a comedian.