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.

Essay

Comment

Community

Nationalism

17 September 2025

7 min read

I was angry and you called me Gammon: Gary from Blackpool, Charlie Kirk, and all these flags

A triptych of three faces of wrath poorly heard and poorly expressed

John Clifton

John is a Salvation Army officer and theologian,

Marchers carry British, English and Israeli flags

Unite the Kingdom marchers.

Met Police.

William Blake once warned:

I was angry with my friend;
I told my wrath, my wrath did end.
I was angry with my foe:
I told it not, my wrath did grow.

Blake understood that unspoken—and, more precisely, unheard—wrath does not wither. Left untended, it grows. Its bitter roots tentacle around grievance; neglect waters it, and violence ripens as its fruit. Much like Blake’s tree, the wrath spreading through towns in this nation, and beyond, springs from seeds of anger. It is not irrational. It is cultivated in betrayal, frustration, and systemic disregard.

This essay is a triptych. Three panels, three faces of wrath poorly heard and poorly expressed. In England, it riots in the streets and hangs from lamp posts. In America, it narrows into bullets. These are not isolated curiosities but variations on the same Western fracture — anger left unheard, curdling until it explodes.

Wrath, of course, is not the same as anger. Anger is a natural passion, a flare of the soul in the face of injury or injustice. It can be righteous when governed by love, as even Christ was angry at hardened hearts. Wrath, by contrast, is anger left to harden — anger unspoken, unheard, or indulged until it festers into a vice. Scripture names it as both the fire of God’s judgement and, in humanity, a deadly sin. Wrath is anger that has ceased to heal and has become scar tissue.

Panel I: Gary from Blackpool

Enter “Gary from Blackpool”.

He was a London commentator’s caricature of provincial ignorance—“1 GCSE, two brain cells, and three teeth.”

The tweet was deleted, but not before the sneer had spread. Gary was a meme. He doesn’t exist, and yet he does; there are loads of “Garys” in Blackpool.

And Gary is angry.

His wrath first erupted in St John’s Square in the summer of 2024. When he raised a St George’s flag on a roundabout, it was not swaggering nationalism but a pathetic attempt to claim a place in a nation that no longer cares about people like him.

Blackpool’s collapse has been much-storied: once thriving, now one of the most deprived. Reports and documentaries measure poverty, chart prospects, and speculate on futures. The town is endlessly narrated.

Gary is not.

Yet his story mirrors that oft-told collapse. Poverty has scarred him visibly: the teeth, failing health. Gary’s life expectancy: 69, more than a decade shorter than elsewhere. He’s scarred invisibly too, in narrowed hopes and disillusion. These are not individual failings but markers of systemic neglect: underfunded schools, crumbling services, an NHS that doesn’t reach him. Dentist appointments in Blackpool are rarer than hens’ teeth, which are in better condition than Gary’s.

The England Gary remembers is gone. In its place stands a society he no longer recognises: multicultural, politically sensitive, shifting away from its past. A Daily Mail headline once told him, “Garys are heading for extinction” while Muhammad, in all its spelling variants, had become the most common baby name.

And then the boats. Images looping on his screen: more change he cannot control. His Brexit vote promised to take back control; his refusal to vote ever again, a gesture of resignation.

Because they don’t care about him. They hadn’t even cared for the girls. Now he saw the same system ushering them into clinics to become boys.

Gary and those like him, through their anger, reveal a politics that has abandoned them, economics that offer no hope, and a culture that makes them strangers in their own country. Rioting is no cure; it tears open wounds without healing. But the response is illuminating: in 2011, they prompted soul-searching; in 2024 and 2025, they brought only ridicule. The tweet exposed a national reflex: to mock rather than listen. That sharpened the bitterness.

Wrath here does not whisper or wait. It riots.

Panel II: Charlie Kirk

Gary may never have heard of Charlie Kirk, but Kirk’s rhetoric channelled the very anxieties that defined Gary’s world—about loss, displacement, and neglect. This resonance helps explain how his voice travelled so widely.

I didn’t watch Charlie Kirk either. His reels surfaced on Instagram or YouTube now and then, but it wasn’t my algorithm that latched onto him. It was my four nephews’—aged sixteen to twenty-two, two in Kent, two in New Zealand—imagination he captured, even if not always their agreement. Young men across the globe, caught in the fast cadence of an American voice.

When I saw the news, my reaction surprised me. It was strangely visceral for someone who had never featured in my life in the way he had theirs. I felt sick. Because he was dead. Because he wasn’t a politician behind glass or a general behind medals. He was public, certainly, but also strangely normal. And he had children, both younger than my youngest, and a wife.

And he had the guts to speak to people. Theo Von said he “tweeted with his feet.” How many of us can say we say what we believe as vociferously face to face as we might be brave enough to do on social media? He was visible. Accessible. Flesh and blood with people, not just pixels. I think this is partly why he appealed to my nephews. I’ve seen Facebook friends of their generation posting tributes, then engaging courteously and constructively with those who insisted on quoting Kirk out of context. For them, defending him has not been rage but dialogue.

And then the gun.

Charlie’s killer pulled a trigger. Wrath had narrowed into single, precise bullets with slogans on them. But this was not justice, not even protest. It was wrath corrupted into murder; an execution.

Wrath here does not riot. It narrows into bullets. It turns cannibal.

What will this spilt blood birth in those who listened, watched, believed?

Panel III: Flags in Hartlepool and Horden

And here, in England, it is the flags.

In America, flags are furniture. They’re on every porch, every school, every stadium. But in Hartlepool and Horden, when flags multiply on streetlights, and red crosses are painted onto white roundabouts, they do not feel ordinary. They are a display of patriotism that feels out of character here. They feel ominous.

They do not shout; they whisper. Every day. A slow, stubborn signal of belonging and defiance. Not the riot of Gary. Not the bullet for Charlie. But something quieter, somehow more enduring. Wrath sewn into fabric, taking root in silence as surely as Blake’s tree, its persistence echoing Gary’s resentment, its quiet endurance unsettling in a way different from the bullets that struck Charlie. When they thicken in certain places, when they layer and cluster, they become atmosphere.

Union Flags made it onto some streetlights I walk past with my daughter in Newcastle, on the way to the swimming pool. “What do they mean?” she asked. For some, pride. For others, threat. For most, perhaps nothing at all. And then they were torn down, leaving a frayed seam, a dangling strip of tattered cloth still tied to the upright metal. That felt even more ominous. Not simply a sign of division, but of reaction. And do you notice, where they are hung only as high as a ladder will reach, they look almost like flags at half-mast? As if beneath the defiance there lingers a subconscious grief.

And so the question lingers: what will come of it all? What future is being staked out? Are these new buds on Blake’s poisonous tree?

Some flags are celebrated, raised over civic buildings as sacraments of a new national creed.

Other flags are torn down, left to fray on lamp-posts, almost threatening in their persistence.

Wrath here does not riot or narrow. It takes root.

This is England, isn’t it?

A benediction: I was angry

And how might anger, left unheard before it hardens into wrath, speak with the voice of Christ?

I was angry, and you called me gammon.
I was angry, and you called me woke.
I was angry, and you heard only your politics,
not my pain.

I was angry, and you argued about tribes and sides.
I was angry, and you measured me as vote, as threat, as cause.
I was angry, and you did not really listen to me.

Truly I tell you:
when you saw the angry and called them only left or right,
you understood nothing.
You did not know me.

And these will go away still unheard,
their wrath growing strong in the shadows, waiting to erupt.

But those who bore the anger of the poorly heard,
who listened without contempt or fear,
This too is England. I am found there.

This article was first published on John Clifton’s SubStack. It is reproduced by kind permission of the author.

Visit his SubStack

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