In his recent book Losing Our Dignity, Charles Camosy, a Catholic, examines certain disturbing trends in medicine and bioethics regarding children born with severe congenital illnesses, adults suffering from brain damage, and other difficult cases and attributes them to what he terms “the secularization of medicine.” Devorah Goldman writes in her review:

Camosy makes a forceful case that an “irreligious understanding of medicine” has contributed to a distorted view of what makes life worth living. Medical systems often operate on the belief that life can be measured along material lines, dismissing the idea that human life is inherently sacred. In such cases, people who are chronically ill, disabled, or elderly are not given the same consideration as those with the potential to contribute materially to society.

Respecting life at different stages, though, is not the same thing as arriving at a common understanding of death. This is one wrinkle in the book: as technologies for sustaining human organs and basic functions (including breathing) have improved, it has become more challenging to identify death, particularly in cases of catastrophic brain injury. This is less a question of equal care than of life itself, and of our capacity to know when it is over.

Camosy rightfully skewers the [British National Health Service’s] “quality-adjusted life year system,” . . . which is used to determine “whether a treatment or intervention’s cost can be justified.” The NHS employs a tortured calculation based in part on how long a person might be expected to live after receiving treatment, as well as (in the NHS’s language) his “ability to carry out the activities of daily life, and freedom from pain and mental disturbance.” This arbitrary and materialist approach to healthcare places elderly and disabled people at risk of being rejected wholesale by the UK’s medical system.

But in placing all the blame for such grotesqueries on a single trend in a single discipline—bioethics—Camosy misses the broader picture. Specifically, he does not adequately acknowledge how this academic attitude is driven by, or at least interacts with, the political and technological realities of modern medicine.

In September, Cypriot police narrowly foiled a plot by an Iranian agent to murder five Jewish businessman. This was but one of roughly a dozen similar operations that Tehran has conducted in Europe since 2015—on both Israeli or Jewish and American targets—which have left three dead. Matthew Karnitschnig traces the use of assassination as a strategic tool to the very beginning of the Islamic Republic, and explains its appeal:

In the West, assassination remains a last resort (think Osama bin Laden); in authoritarian states, it’s the first (who can forget the 2017 assassination by nerve agent of Kim Jong-nam, the playboy half-brother of North Korean dictator Kim Jong-un, upon his arrival in Kuala Lumpur?). For rogue states, even if the murder plots are thwarted, the regimes still win by instilling fear in their enemies’ hearts and minds. That helps explain the recent frequency. Over the course of a few months last year, Iran undertook a flurry of attacks from Latin America to Africa.

Whether such operations succeed or not, the countries behind them can be sure of one thing: they won’t be made to pay for trying. Over the years, the Russian and Iranian regimes have eliminated countless dissidents, traitors, and assorted other enemies (real and perceived) on the streets of Paris, Berlin, and even Washington, often in broad daylight. Others have been quietly abducted and sent home, where they faced sham trials and were then hanged for treason.

While there’s no shortage of criticism in the West in the wake of these crimes, there are rarely real consequences. That’s especially true in Europe, where leaders have looked the other way in the face of a variety of abuses in the hopes of reviving a deal to rein in Tehran’s nuclear-weapons program and renewing business ties.