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.

Interview

Culture

Nationalism

Politics

S&U interviews

22 September 2025

14 min read

Tim Farron: our politics is fragmenting, not polarising

Responding to Christian nationalism and the politicisation of religion

Graham Tomlin

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

Tim Farron stands on a conference stage with arms wide

Farron addresses the opening rally of the Liberal Democrat Conference.

This is a transcript of a recent conversation between Tim Farron MP, former leader of the Liberal Democrat party in the UK and Graham Tomlin, Editor-in-Chief of Seen & Unseen

Graham Tomlin: I read a book recently by Bijan Omrani called God is an Englishman. It makes the case for Christian faith as having hugely shaped English life - our legal system, our literature, our poetry, music, language, landscape and everything. The point he makes is that the probably the biggest social change in the last 50-60 years is the decline of Christianity as a publicly recognised set of assumptions. Do you think that's true? And does it matter?

Tim Farron: I think there's certainly some truth in it. I do subscribe to the Tom Holland thesis, which is that Western liberal democracy owes its existence, and therefore the West in terms of values, to the gospel. What do I mean by that? I mean a sense that all human beings are awesomely made in the image of God, and therefore are of enormous value - every single one of them. that justice matters, that no one should be above the law. Likewise, a kind of more negative view of humanity, which is we're all sinners, and therefore we shouldn't be concentrating the power in the hands of too few of us. And so, I think Western liberal democracy definitely owes itself to Christianity. I'm speaking to you from the Houses of Parliament where there are chapels everywhere, and there are relics, shall we say, of the Christian faith all around. Indeed, the day in Parliament, including this day, begin with prayer. And good prayers for that matter. So, I I certainly do take his point.

Is it significant that over the last 50-60 years that has been a declining influence in our politics? Yes, of course it's significant. I think again to quote other people, Oz Guinness's line that we live in a ‘cut-flower society’ is one I really think is true. The reality is that so many of the values that we hold to in Western societies, in the UK in particular, are grounded in faith in Christ, in what the gospel teaches us. And if we've now two or three generations into Christianity formerly being the established religion, but in reality not, then after a while, you lose. Cut flowers look nice and pretty for a while, but eventually they die because they're not attached to the roots.

The image I've heard recently that is that that of a dying tree. A cut flower doesn't take long to die off. But a dying tree, where the roots have shrivelled up takes quite a long time. It can still look like a very flourishing tree, but over decades, it begins to wither above the surface as well as below.

Bede, in the eighth century, was probably the first to really identify the English nation as a as a united entity linked into kingship and Christianity. We had the Coronation recently, which was a deeply Christian event. We have bishops, the succession of the monarchy is Protestant. The King is the Supreme Governor of the of the Church of England. But does all that make Britain a Christian nation? Would you call it a Christian nation?

TF: I'm always quite wary about referring to anything as a Christian nation. Nations aren't saved. Individuals are. I don't think we are ever encouraged in the Bible to think that people or nations are saved by conquest. I'm not just talking about invasions and crusades. I'm talking about elections. We know that all human beings are sinners, that politics is not ultimate. I think there's plenty of guidance for us in the Bible to tell us that politics matters, that we're meant to seek the welfare of the city in which we've been placed, that we're meant to care for those around us, to love our neighbour in practical ways, not only in spiritual ways, but in physical ways as well. I think we're to engage in politics. But politics is not ultimate, and we should be careful about seeing the advance of the Kingdom as something you do either with the rifle or the ballot box.

We’ve just had the Unite the Kingdom march through London with Tommy Robinson and friends. At that event, there were people holding crosses, hymns were sung, there was a chant of “Christ is king”. What do you make of all that does it? Does it worry you?

Yes, it does worry me if I'm honest with you. I can see some silver linings, but the appropriation of Christianity by one political movement troubles me. Well, let's put boldly - it is heretical. Christ should shape our politics. Our politics should not be shaping our faith.

I think there are two forms of Christian nationalism. I'll pick one of them – it is the idea that we should be a kind of clerical state. All the laws should be Christian, and we should act like a Christian nation, almost like a Christian version of some of some Islamic countries.

On the other hand, you've got the marches run by Tommy Robinson - a kind of Christian nationalism where Christianity is seen as a symbol of Englishness and of Britishness, to be appropriated to wear as a badge. It's Land of Hope and Glory, ‘green and pleasant land’, St George, myths of our past flags and all the rest of it. And it's all kind of like a pot-pourri, a minestrone of things that make us British. I don't want to poo-poo that, but that's not Christianity and so my worry is that whenever a political party seeks to appropriate Christianity, then by definition, the other half of the culture war will have their fingers in their ears when it comes to the gospel, and that's a really bad thing. And also, the way in which it is spoken of, it's not spoken of lovingly, gently. It's not spoken of in a way of where we're seeking to bring people into relationship with Christ, but as a kind of a as a badge or as an emblem.

Jesus will not endorse your politics. If you have grabbed hold of the cross and Christianity as motifs of your patriotism, your nationalism, it's not Christianity. Jesus will not endorse you. He won’t endorse people on the other end of the spectrum either. He will disturb you. He will contradict you. And if you want to come into a living relationship with Jesus Christ, be prepared to put all of that in the bin because he will ask you to.

Theologians and sociologists often use a distinction between thick and thin religion. Thin religion is an identity marker which can be used as a bit of a stick to beat people with, but thick religion is where you really take seriously the teachings of the faith. You go deeply into it, develop a life of prayer, attending church, really taking this seriously.

There were genuine Christians on the Tommy Robinson march and I'd love to speak to some and understand where they were coming from on all of this. On my podcast through the whole party conference season, I'll be interviewing Reform people, Lib Dems, Conservatives, Labour - and so I don't condemn anybody for their political views. I do think there’s something about the whole kind of Tommy Robinson cabal, which is just especially ungodly, but that doesn't mean that he's not tapping into concerns that are legit.

What’s the silver lining?

In Christian nationalism, you've got a bunch of people who think they like Christianity. They may never have heard it properly, but they think they like it. And so, there's a good chance they might come into the door, and if they come into the door and the right person is behind pulpit, they might hear the gospel as well.

I'm doing various talks at the Lib Dem conference. Two of them are specifically Christian and in the first instance I'll have to do battle with “isn't Christianity bad? Isn't it all made-up and not true anyway?” And those are two hurdles before I can then even begin with the gospel. When somebody thinks Christianity is part of being English and we should reclaim it, then at least I'm over those first two hurdles! And I can then get into the gospel, which will be equally shocking to them. Equally shocking. It is a very big hurdle. Jesus Christ is the cornerstone that you will trip over because he will tell you that you've got to love your enemy. He will tell you to love the unborn, and he'll also tell you to love the refugee. He will tell you to abide by, traditional sexual ethics, and he will also tell you that racism is an outrageous sin. He will tell you that the package of beliefs that you signed up to - tear them up.

I always like to remind myself of something David Steel said a few weeks after I joined the Liberals when I was 16 at the first conference of my membership. He said any liberal that doesn't disagree with at least ten per cent of Liberal policies isn't really a liberal. And I like that. But I think that with Christians, it should be even more so. You know, you're joining a band of sinners. You know that because you're one of them. And so you're going to join imperfect group of people who are seeking.

Political parties being that is something we maybe accept, but the culture war seems to flush us into trenches which are far more neatly cut, where there is so much more hostility. And I would argue that Christians need to stay out of the court. You can join a party. Don't get in a culture war trench.

What about the rise of Reform? It does seem to tap into a kind of deep unease that is around middle Britain. You will hear people in that movement talking about the increasing prominence of Islam or ‘woke’ ideology. And they see that as a sort of threat to the Christian character of the nation. Are they right to feel threatened by that?

One thing we should say first and foremost: Christ is on the throne. The battle is won. Don't panic. With regard to Middle England or Middle Britain, I want to be really respectful about Muslims and accept their rights to think different things. And I think Islam is just another world view. That's not Christianity, so is atheism, so is agnosticism, so is nominal Christianity. And so, I don't feel especially threatened. I mean, as a Christian I don't feel threatened at all because the victory is Christ’s. It's won and God does not need our help.

Do I think Islam is true? Carefully, I would respectfully think it isn't. I think atheism is untrue. I think agnosticism is untrue. I think modified versions of Christianity where we've added or taken stuff away from it is untrue. Yet I will die in a trench to defend people's rights, to think all of those things.

And I think Christianity is true and Jesus is who he says he is. And so what I do think is that we should have the right to respectfully disagree. And that's the thing that I've think we may have lost in the last 20 or so years, and some people will put that down to woke ideology. But nobody who is ‘woke’ ever uses the phrase ‘woke’! If you use the word ‘woke’, you've turned lots of people off. If you think you're anti-woke entirely, then you're anti-Christian. If you're entirely woke, then you probably are as well. As I said earlier on, if you are following Christ, you should be concerned for the rights and the life of the unborn child, and should be equally concerned for the right to the refugee. And so what are you, woke or not woke? You are above all that. That's what you are. If you're complaining about wokery, you've got a problem. If you're massively woke, you've got a problem, in a very gentle and gracious way. You should be above all.

It seems to me that both kind of conservative and progressive elements or instincts have their roots in Christianity because, you know, the progressive element knows very deeply that the world is fallen. It's broken, it needs justice. Things need changing. We can't just assume everything is fine. But the conservative approach gets that not everything is up for grabs, that there are some things that is given to us. We just simply have to accept the nature of reality that God has given to us. And so, you've got to be a little bit of both if you're if you're being authentic to Jesus?

I think that's right. And I think that's one of the reasons why it's completely legitimate for Christians to belong to different political parties.

I want to ask you about the Conservative MP Danny Kruger joining Reform.
Some would say that our politics is getting more polarised and there's not much space left in the middle.

It is polarised. I think there's an awful lot of anger. You hear some of the language of the Tommy Robinson characters and some others talking about civil war as if they want it, a language you just wouldn't have heard, at least not from the right. You might have heard it from the revolutionary Communists and the Socialist Workers back in the day when I was a student. But then again, let's be careful not to have rose-tinted spectacles about on about the past. The political and ideological difference between Margaret Thatcher and Michael Foot was colossal including, of course, that Margaret Thatcher thought it was stupid to not be in the European Union and Michael Foot wanted to leave! So too over nuclear defence, who we're allied to, who should own the means of production - massive, difficult decisions and divisions between the two parties back then. Today no-one's really arguing about who controls the means of production, or what level of taxation there should be or any of that stuff. These days it’s all about identity. Somebody once said that the lower the stakes, the more ferociously over which they are fought. And it seems now that we're arguing about stuff that - oh, forgive me - doesn't matter.

As for Danny Kruger, he's intellectually credible. That's something Reform haven't got a lot of. And now they have with Danny. And the Labour Party just feels hated. And so, the parties that are not Labour and the Tories are doing well. Reform appear not to be held back by the need to present ideas that are based on evidence, and therefore they can say anything, and therefore they're on 30 per cent of the poll and we're on a mere 17 per cent and the Greens are on nine or 10 per cent.

But I think where we're at is that there's a real detachment of people from the parties they've always supported. And that's been going on for some time. You could say it sort of started the 60s and the 70s, but it's absolutely got turbocharged since Brexit. That certainly seems to be where we are on the timeline and so people who had always voted Labour are now not doing so, those who always voted Tory, not doing, it's incredibly fluid.

I guess what you're pointing to is not so much the polarisation of political discourse, but the fragmentation of it. After all. 400 years ago we were on the brink of a civil war. That's polarisation! If we're living in a very fragmented world, what is the role of the church in such times? And – can we call Britain a Christian nation in any sense?

I think the role of the church is to model Christ. We should love Jesus internally and we should be pointing to him and making him known externally. And that's our job really. I'm not convinced we do that enough.

I think we should be modelling Christ in his servant-heartedness in loving our communities in a practical way. And that means doing things like supporting refugees, supporting people in living in poverty, making sure that we make best use of whatever property the church might have to meet social need, but always, always put in the gospel at the centre of it.

The story of the account of Jonah really resonates with me because of how he is towards Nineveh. Jonah ends up in the belly of the fish because he's legged it, he's gone literally in the opposite direction to where God was wanting to send him. He was going to go to Nineveh, to speak to these terrible people that he really did not like at all. Jonah was meant to tell them that they need to repent and believe. And Jonah knew God is a good and almighty powerful God, and unless he preached the word of God, they never would repent. He hated Nineveh. So he legs it to Spain and ends up in the belly of a fish. But the point is this. We've all got a Nineveh.

Who is it for you? Is it Tommy Robinson? Is it Jeremy Corbyn? Who's your Nineveh? And whoever they are, you pray for them and reach out to them and love them. You do not need to agree with them. You should not agree with them. This models the utterly radical nature of the gospel and holding out the possibility of salvation, a relationship with the living God to absolutely everybody, including the people you do not like. To love your enemy. It's the most radical thing that you can do, it's the heart of what he did because he did that all the way through to the cross.

Tim, thank you so much. It's always good to talk with you. It's always very illuminating, inspiring, encouraging.

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