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.

Article

Comment

Education

Language

7 August 2025

6 min read

Cutting language learning is a moral failure

Learning someone’s tongue is a deeply humble and empathetic act

Jonathan Rowlands

Jonathan is a theology lecturer and Liverpool FC fan.

A check list shows 'thank you' in different languages.

When you go abroad, how do you navigate language differences? Do you just stick everything through Google translate? Or put a few weeks into Duolingo before you go? Or maybe you just speak a bit louder in the hope that that will somehow smooth over any misunderstandings?

Recently, my wife and I went to Italy for a week. Neither of can speak a word of Italian and we were taking our toddler Zachary with us (who can speak even less Italian), so we booked into a big resort where we knew staff would be able to speak some English if we needed anything for Zach. Even so, we tried learning a few words and phrases:

‘please’,

‘thank you’,

‘could I have …?’,

‘where is the …?,

‘please forgive my toddler, he hasn’t learned to regulate his emotions yet’.

That sort of thing. Just some basics to get by.

Of course, what happened was exactly what happens every time I speak another language. I try my best to make an effort, people immediately realise I’m a struggling and they put me out of my misery by replying in English anyway.

All this reinforces the importance of deep and rigorous language learning in society. All this makes the continued diminishment of university modern language programmes rather odd, and more than a little unsettling.

The University of Nottingham has announced it is terminating the employment of casual staff at its Language Centre. This will see the end of numerous classes for students and others in many languages, both ancient and modern, including British Sign Language.

Nottingham is not alone in this. The news comes in the immediate aftermath of a review into the University of Aberdeen’s decision to scrap modern language degrees in 2023, which found the decision “hurried, unstructured, and dominated by immediate financial considerations.” (Not that we needed a review to tell us this). The University of Aberdeen has partially reversed the decision, continuing its provision of joint honour degrees, if not single honour language degrees.

Elsewhere, in January, Cardiff University announced plans to cut 400 academic staff, cutting their entire modern language provision in the process. In May, the University revealed that it would reverse these plans, with modern languages continuing to be offered (for now), albeit it a revised and scaled-down manner.

The situation is bleak. As a theology lecturer who works for a Church of England college, I’m all too aware of the precarity my friends and colleagues in University Arts and Humanities departments face across the sector. But I was also naïve enough to think that languages might be one of the subjects that would be able to survive the worst of education’s deepening malaise given their clear importance. How wrong I was.

There are the obvious causes for despair at the news of language department cuts. One the one hand is the human element of all this. People are losing their jobs. Moreover, as casual workers, the University had no obligation to consult them about the changes or provide any notice period, and so they didn’t, because why would a university demonstrate courtesy towards its staff unless it absolutely had to? As well as losing jobs and whole careers, people will lose sleep, and perhaps even homes and relationships as a direct result of the financial and emotional toll this decision will take on staff. My heart breaks for those effected.

And yet, the move is also evidence – as if more were needed – of the increasing commercialization of Higher Education. A statement from the University said the decision to cut languages in this way was the result of the Language Centre not running at a “financial surplus.” The cuts will instead allow the University to focus on “providing a high-quality experience for our undergraduate and postgraduate students.”

And there we have it. Not even a veneer of pretence that universities operate for the pursuit of truth or knowledge. No, nothing so idealistic. A university is business, thank you very much, here to offer an “experience”. And when parts of businesses become financially unsustainable, they’re tossed aside.

Languages aren’t just ways of describing the world we see, they’re also ways of seeing the world in the first place.

But cutting language offerings isn’t just a personal and a societal loss, it’s also a huge spiritual and moral failure. And that’s because of what language fundamentally is. Let me explain.

It can be tempting to think of words as simply ‘labels’ we assign to objects in the world, with different languages using a different set of ‘labels’ to describe the same objects. As a native English speaker, I might see something with four legs and a flat surface on top and call it a ‘desk’. Someone else with a different native language might call it a Schreibtisch, or a bureau‚ or a scrivania, or a tepu, or a bàn làm việc. You get the point: we might be using different labels, but we’re all ‘seeing’ the same thing when we use those ‘labels’, right?

Well, it’s a bit more complicated than that. Languages aren’t just ways of describing the world we see, they’re also ways of seeing the world in the first place. As such, languages have the capacity to shape how we behave in response to the world, a world itself suggested to us in part by our language(s). As twentieth-century philosopher Ludwig Wittgenstein once wrote, “the limits of my language mean the limits of my world.”

Let me give you just one example. English distinguishes tenses: past, present, future. I did, I do, I will do. Chinese does not. It expresses past, present, and future in the same way, meaning past and future feel as immediate and as pressing as the present. The result of ‘seeing’ the world through a ‘futureless’ language like this? According to economist Keith Chen, ‘futureless’ language speakers are 30 per cent more likely to save income compared to ‘futured’ language speakers (like English speakers). They also retire with more wealth, smoke less, practice safer sex, eat better, and exercise more. The future is experienced in a much more immediate and pressing way, leading to people investing more into behaviours that positively impact their future selves, because their view of the world – and their future selves’ place within the world – is radically different because of their language.

Different languages lead to seeing the world differently which leads to differences in behaviour. In other words, there are certain experiences and emotions – even certain types of knowledge and behaviours - that are only encounterable for those fluent in certain languages. And this means that to learn another language is to increase our capacity for empathy. Forget walking a mile in someone’s shoes, if you want truly to know someone, learn their language.

In my day job as a lecturer, when I’m trying to encourage my students – most of whom are vicars-to-be – to learn biblical Greek and/or Hebrew, I tell them it will make them more empathetic people. It may make them better readers of the Bible, it may even make them better writers too but, more than anything else, students who learn languages will be better equipped to love their neighbour for having done so. They will get a better sense of the limits of their world, and a greater appreciation for the ways in which others see it too. Show me a society that is linguistically myopic, and I’ll show you one that’s deeply unempathetic. I can guarantee you of that.

We ought to be deeply, deeply concerned about the diminishing language offerings in the UK’s Higher Education sector. To open oneself to other languages is to open oneself to other ways of seeing the world. It is to be shown the limits of one’s own ways of seeing. Learning a language is a deeply humble and empathetic act. And isn’t humility and empathy in desperately short supply at the moment?

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