Column

Attention

Comment

Community

13 July 2023

7 min read

The art of being inconvenienced

In our fast-paced attention-deficient society, Elizabeth Wainwright reflects on the value of inconvenience as a safeguard against the commodification of life.

Elizabeth Wainwright

Elizabeth Wainwright is a writer, coach and walking guide. She's a former district councillor and has a background in international development.

a newly laid hedge merges into an older one, next to a road

Photo by Annie Spratt on Unsplash.

It’s May as I write this, and I’m noticing Iris flowers everywhere. They don’t flower for long, but they are glorious when they do. There is another kind of Iris too - our newborn daughter Iris, born in May under a full moon; appropriately named the ‘flower moon’ in some cultures. And it really was a time of flowers - in her name, and in the Devon hedgerows outside which were bursting into life and nurturing a rainbow of wildflowers - pink campion, creamy hawthorn, yellow celandine, bluebell, violet, endless green. These hedgerows are ancient. ‘Hooper’s formula’ can give an estimate of just how ancient - counting the number of woody shrubs and trees in a 30m section and multiplying by 100 gives a rough estimate (one species for every 100 years). This makes the hedges and sunken earth-banked lanes around us well over 1000 years old, thousands of years in places. They feel essential to the structure of this place.

The layers of land in this part of Devon are overlain and interwoven, sometimes reinforcing what was there before, sometimes obliterating it. Today the threat of obliteration looms larger than ever - development, forestry and rapidly changing agricultural practices all squeeze rural communities and landscapes to the edge. But these old hedgerows and earth banks seem to resist the march of development and ‘progress’ – continuing a line of resistance that stretches back to the local Celtic people resisting Anglo-Saxons, who in turn resisted the Normans. The hedges represent old ways, they hold their ground and ask us to slow down and prioritise other things than convenience and blind progress.

Because for local farmers, it is not convenient to farm these small wonky fields with their thick-hedged edges. In other parts of the country, fields got bigger and bigger as hedges were ripped out, especially during the Second World War when food production was a priority. And the size of fields kept pace with the growing machinery used to farm them. Farmed fields in some parts of the country are now vast. But not here. Outside the window huge tractors thunder past, but they look out of place in these narrow lanes and small fields - old spaces that are less and less able to resist the damage of modern machines.

I think inconvenience is good for love and for neighbourliness. Loving and knowing our neighbours are beautiful intentions, but they can quickly become easy words and abstract concepts.

But whilst these ancient hedgerows are inconvenient for modern farming, they are convenient for life, because things can exist here that wouldn’t if the hedges were removed - biodiversity, soil structure, shelter and food for countless species through the year; species that are under threat from intensive agriculture elsewhere. It is the inconvenience of the hedges and fields here that leaves room for life.

I think about how this is true of other things; how inconvenience might bring life, how it might even be essential for our relationship with things that matter. Two specific things come to mind.

First, I think inconvenience is good for love and for neighbourliness. Loving and knowing our neighbours are beautiful intentions, but they can quickly become easy words and abstract concepts. Putting the idea of neighbourliness into practice will be inconvenient - it will have an impact on me and my life, it will take time and might be awkward at first - but it is where the love and I think the hope is. The future has lately been sounding bleak - heatwaves and wildfires and temperatures higher than climate modelling has predicted; economies in turmoil; never ending conflicts. Loving our neighbour isn’t about niceness, or just for when it’s convenient – it’s for right now as the world burns, it’s for helping us know the world through the lives of others, it’s for rebuilding affection and life on earth.

Second, I have found that inconvenience is good for knowing the Bible. When I first began reading it — curiously but non-committaly as a young adult — the thing that kept me coming back was its beauty. Much of its meaning was lost to me, but its sound and rhythm wasn’t. The Bible is inefficient, inconvenient. It is often impenetrable, mysterious, poetic. And poetry is often inconvenient - it asks us to slow down, to pay attention, to engage imagination and heart and feeling, to re-read something that might not at first be clear. And when its meaning or imagery sticks then it remains, I do not forget it. If the Bible’s authors wanted readers to understand something, to believe something, there are shorter and clearer ways to do so which might even guarantee particular outcomes like belief. But the Bible turns towards poetry and beauty and depth - not transfer of information, not efficiency, not convenience. It asks the reader to slow down and listen, to reach beyond the immediacy of information to another way of being and knowing.

Another Iris speaks - not flower, not daughter, but a singer through our kitchen speakers - Iris Dement is singing a song called Working on a World I May Never See. It makes me think about the importance of investing in hedgerows and neighbours, a declaration of belief that their possibility offers more than the efficiency and productivity they sacrifice. Because we are not made for efficiency, or blind progress, or productivity. I think we are made to love, and to work on a world we may never see; an ask that I increasingly see requires not just ‘development’ and technology and financial investment, but investment in love and neighbours and place. But as the world hurtles on, love seems diminished, its power underestimated or increasingly it seems, unknown. I notice talk of love sometimes met with cynicism, as if it’s a warm fuzzy idea but not something to take seriously, as if it might be world-shaking. But I think it is — or it could be if we let it.

And so I welcome inconvenience, I welcome the courage and patience it teaches me.

The hedgerows and my neighbours and parts of the Bible remind me to take love seriously. They slow me down with their long-way-roundedness, their use of 100 words or species where one would be more efficient, their conjuring of feeling and images where information might be quicker. They ask me to pay attention, they offer beauty, they bring my gaze to things they matter.

In Eric Fromm’s 1956 book The Art of Loving he examines various kinds of love, and then explores the disintegration of love in the modern western world, which is in part he says because:

“Modern man has transformed himself into a commodity; he experiences his life energy as an investment with which he should make the highest profit, considering his position and the situation on the personality market. He is alienated from himself, from his fellow men and from nature. His main aim is profitable exchange of his skills, knowledge, and of himself, his "personality package" with others who are equally intent on a fair and profitable exchange. Life has no goal except the one to move, no principle except the one of fair exchange, no satisfaction except the one to consume.”

(All this written before the arrival of the ‘personality market’ of social media, and before Amazon’s all-consuming invitation to consume).

In examining this commodification of life, and in a line that touches on our fondness for convenience, Fromm says:

“Modern man thinks he loses something—time—when he does not do things quickly. Yet he does not know what to do with the time he gains—except kill it.”

He goes on to argue that love is not a sentiment but a practice; one that involves discipline, concentration, and patience. These aren’t things that a fast-paced attention-deficient society leaves much room for. He says too that

“Love is not primarily a relationship to a specific person; it is an attitude, an orientation of character which determines the relatedness of a person to the world as a whole…”

The hedgerows outside and the poetry of Bible teach me patience and concentration, and they shift my centre of relatedness outwards, from my own need for convenience, from focus on my life and just the people in it, to the wider world - worlds seen and unseen.

Fromm says

“To be loved, and to love, need courage, the courage to judge certain values as of ultimate concern—and to take the jump and to stake everything on these values.”

And so I welcome inconvenience, I welcome the courage and patience it teaches me. The life-giving ‘inconvenience’ of the ever-changing hedgerows, and neighbourliness, and the Bible, and many other things help me to slow down and pay attention, they help me to know and to love, they help me to work on a world I may never see.

Article

Assisted dying

Comment

Politics

25 November 2024

7 min read

Assisted dying hasn’t resolved Swiss end of life debates

Despite attempts to normalise it, new challenges still arise.

Markus Zimmerman

Markus is Professor of Moral Theology and Ethics at the University of Fribourg, Switzerland.

A single bed, wiith an unmade colourful duvet stands in the corner of a room. A hoist reaches over it from the corner.

The dying room, Dignitas Clinic, Zurich.

Dignitas.

While countries such as Germany, France or the UK are currently struggling to find a suitable regulation for assisted suicide, their peers in the Netherlands, Canada and Switzerland have years of experience with the controversial medical practice. Even if each state must explore its own ways of dealing with these ethically controversial issues, it is obvious that international experience should not be ignored as they try to find a way forward.

In Switzerland the discussions and challenges surrounding assisted suicide are increasing rather than decreasing. Contrary to the idea that a liberalisation of assisted suicide would lead to fewer debate, tensions and difficulties are increasing. My observation, and thesis, indicates that practices such as assisted suicide cannot be “normalised”, even in the medium and long term.

Developments

In recent years, one to two per cent of all deaths in Switzerland were due to assisted suicide. From an overall perspective, this practice is therefore still a marginal phenomenon. However, a look at the total number of assisted suicides per year gives a different impression, as this has increased more than fivefold in the years between 2008 and 2020, from an initial 253 to 1,251 deaths per year, a rising trend. The cause of death statistics for Switzerland only include those cases of assisted suicide in which persons resident in Switzerland were involved and the death was reported to the authorities. According to the Swiss Federal Statistical Office, in 2020, it was mainly people over the age of 64 who made use of assisted suicide. Detailed information on the underlying illnesses of the people affected in 2018 shows that about 40 per cent were affected by cancer, just under 12 per cent by diseases of the nervous system, a further 12 per cent by cardiovascular diseases and just over a third by other illnesses, including dementia and depression. There are currently seven right-to-die organisations in Switzerland which play a leading role in a typical assisted suicide procedure. They work closely with doctors who are prepared to prescribe a lethal drug, generally Pentobarbital. The data reflects an ambivalent picture: on the one hand, the proportion of assisted suicide cases is relatively low in relation to all deaths and, for example, in comparison to the large number of people who die in Switzerland in a state of deep sedation until death; on the other hand, the number of assisted suicides in Switzerland has risen sharply in recent years.

Perceptions and assessments

Since the 1990s, the public perception and assessment of assisted suicide in Swiss society has changed from an initially cautious and sceptical attitude towards broad acceptance. While the debates in other countries are characterised by relatively sharp controversies between those in favour and those against, public discourse in Switzerland has been less polarised. There are indications of a certain normalisation of the situation, the strongest sign is that Switzerland has so far refrained from regulating assisted suicide in a separate law. The results of a recently-published study on the opinions of Swiss people over the age of 55 regarding assisted suicide confirm these impressions.: The survey showed that over four-fifths of respondents support legal assisted suicide, almost two-thirds can imagine asking for assisted suicide themselves at some point, and that almost one-third are considering becoming members of an right-to-die organisation in the near future, with one-twentieth of respondents already being members at the time of the survey in 2015. Among people with a higher level of education and older people aged between 65 and 74, approval of assisted suicide and corresponding practices was higher than among less educated, younger and very old people; approval was also significantly lower among religious practitioners.

Sensitive topics

The fact that assisted suicide enjoys broad support in Swiss society as a whole does not mean that there are not difficult and controversial aspects relating to its practice. Relevant topics include, in particular, places of death, authorisation criteria and procedures.

Places of death: Assisted suicide is permitted also for mentally ill persons in psychiatric clinics, but the federal court recommends great caution here and requires two psychiatric expert opinions to ensure that the person willing to die is capable of judgement with regard to the desire to commit suicide. Although assisted suicide for children and adolescents has hardly been an issue in Switzerland to date, the corresponding debates are currently being held in Canada and elsewhere. The question of whether people in prison also have a right to make use of assisted suicide, has been the subject of intense debate in Switzerland for years, with a generally positive response. The question of whether right-to-die organisations should be given access to acute hospitals and nursing homes is still the subject of controversial debate, with regulations varying from hospital to hospital, nursing home to nursing home

Authorisation criteria: With regard to the admission criteria for persons willing to die, the capacity for judgement is at the centre of attention: while the importance of the criterion is undisputed in itself, there is a struggle for reliable standards and procedures to reliably test this criterion. Since the publication of the SAMS ethical guidelines Management of Dying and Death in 2018, the criterion for end of life and, depending on this, that of unbearable suffering have received new attention due to an objection by the Swiss Medical AssociationFMH. While the guidelines are based on the criterion of unbearable suffering, the FMH wants to stick to the near end of life. It is certainly difficult to diagnose the existence of unbearable suffering, as the international debate on the significance and assessment of existential (neither physical nor psychological) suffering shows. This difficulty is illustrated by the debate that has been going on for several years in Switzerland about so-called old-age suicide and the inherent criterion of tiredness of life. At the centre of the dispute is the legally difficult question of whether a doctor is also allowed to prescribe a lethal drug to a healthy person.

Procedures: Here the role of the medical profession and right to die organisations is by far the most important issue. In contrast to the physician-centred models in Belgium, Canada and the Netherlands, the Swiss model of assisted suicide is based on the idea that every person has the right to end their life and may call on the help of any other person to do so. Although the medical profession is usually involved in the process, the management of the procedure is normally the responsibility of a right-to-die organisation. This division of responsibilities is always up for debate when legal regulations are being considered, in which doctors should tend to take the lead in the process due to their professional background. There is also a debate about how and by whom compliance with the authorisation criteria should or could be monitored, whereby it remains to be decided whether this should be carried out before or after the death. At present, a certain amount of monitoring takes place following a suicide, insofar as the authorities investigate the cases afterwards. There is also debate as to whether Pentobarbital is a suitable means of suicide, especially if this barbiturate is not administered intravenously but taken orally; there is no knowledge of how many cases are currently administered intravenously and by whom an infusion is then set up. Last but not least, consideration has already been given to the use of lethal drugs, such as helium gas, which can be obtained over the counter.

Attempts at regulation

Political efforts to regulate assisted suicide in Switzerland in a more nuanced way than today have been made since the 1990s but have remain largely without consequences to date. In relevant judgements by the Federal Supreme Court or in statements by the Federal Department of Justice and Police, reference is regularly made to the ethical guidelines of the SAMS. These are classified as soft law and are therefore not legally binding, even though their content has become the subject of dispute. The National Advisory Commission on Biomedical Ethics (NCE) had already recommended more far-reaching legal regulation in 2005 as part of a detailed opinion on the subject; in the opinion of the NCE at the time, the review of authorisation criteria, a justifiable regulation of assisted suicide for the mentally ill, children and adolescents and state supervision of right-to-die organisations, should be ensured by law. The question is what form a legal regulation can take that grants the medical profession far-reaching powers but at the same time prevents medical paternalism (in favour of or against assisted suicide). From the perspective of Swiss experience, this is “a square circle”: either the doctors retain the final decision on who receives the barbiturate, or official access rules are established, the review of which does not generally require medical expertise.

The outlook

In the short and medium term, it can be assumed that the number of assisted suicides in Switzerland will continue to rise. The coronavirus pandemic and the particular difficulties faced by nursing homes during this time are likely to exacerbate this increase. In view of these expectations and the legislative processes in other European countries, pressure is likely to increase in Switzerland to create a legal regulation. Overall, I think politically it will be important to create a legal regulation, in order to ensure legal equality and legal certainty on the one hand and prevention of abuse and expansion on the other. At the centre of social-ethical reflection is the challenge of learning to deal with the pluralism of different ideas of a good death and to develop and establish alternative models to medically assisted dying. The thesis I mentioned at the beginning is confirmed today: assisted suicide in Switzerland can hardly be normalised; new problems, challenges and demands are constantly arising. Suicide, whether with or without the help of another person, always means an existential transgression that defies normalisation.