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

Church and state

Comment

Community

Trauma

5 August 2025

5 min read

After Southport: how to communicate amid tragedy, rumour, and riot

Handling the media in the aftermath brings dread, discretion and dignity

Stuart Haynes

Stuart is communications director for the Diocese of Liverpool.

A media pack await a press conference in a street.

Media covering the Southport attacks.

The Emperor of Byzantium, CC BY-SA 4.0, via Wikimedia Commons.

Working from home in the quiet town of Ormskirk, about four miles from Southport, the first I noticed was a cacophony of sirens accompanied by our local Facebook groups buzzing with speculation over what it was this time. The news started breaking. An incident in Southport, vague details at first but enough to start that feeling of unease.

Then the phone call and email. The local vicar and one of our Archdeacons seeking advice as inevitably the media would be looking for comment. I’ve taken a similar call many times over the 20 years I have worked with the church. It sets a mix of contradictory emotions. Selfishly you can’t help thinking there goes my plans for the day before you are sharply brought up to the knowledge that the reason for this is a tragedy for others.

Southport brought out a further emotion. When I was a student, I lived for a year close to the location of the stabbings. 30 years on and the suburban area I knew was seemingly unchanged. Yet everything was different.

The role of the press officer at this point involves navigating a tricky balance. You have a job to do, the journalists you deal with have a job to do. You are constantly fielding phone calls, jotting messages juggling time slots. You have a relentless barrage of people putting interview requests in and you want to ensure the right voices are heard and that those who represent aren’t worn out by interview upon interview.

Then you remember what caused the story in the first place. You think of the emergency services working hard to support those in need. Above all you think of the victims and the families – at that time not knowing how many or how serious. And the sense of gloom deepens as the rumours of how serious the situation spreads before you get word of a police conference fearing the worst before the worst gets confirmed.

At these times the mood amongst the media teams always feels strange. Acutely aware of the pain of the situation and sympathetic to what’s happened they can’t escape the job they have to do. I have seen this over many years mainly through the management of the press pens outside funerals at Liverpool Cathedral and churches across the region. You get to know some of the pack well, mainly and somewhat grimly reuniting at the next tragedy. They are massively co-operative with a strong sense of camaraderie, yet you can feel the pressure coming down to them from their news and picture desks. So, a sharing of resources and support occurs underpinned by a hint of journalistic competition.

The press officer’s role here is to feed the machine. It’s hungry. They have time to fill and very often, particularly so close to when the event happened, everyone is more speculative than informed. The machine needs feeding whatever and the church voice can be a calm voice of authority speaking the anxieties and wishes of the local community. However, we don’t want to be rent-a-voice, we are not helpful if we seem to be trying to grandstand over someone else’s grief. We need to show the compassion and love that our faith and Christian values teach us.

That became critically important on the second night when things turned ugly and the story was hijacked by rioting right wing mobs. Having been to the peaceful and respectful vigil on the afternoon I drove back past the scene of the stabbings on my way home. You could smell the tension in the air as people were converging on the streets exuding a purpose that did not seem like the sorrow from earlier that day.

The media aftermath for the church was then to support the efforts showing the community rebuilding whilst also calling for harmony, standing shoulder to shoulder with representatives from all faiths.

And on to the funerals.

There are many patterns to organising press coverage at a funeral. Usually, we need a pen to marshal the cameras in a way that enables them to get the pictures they need whilst maintaining a respectful, sympathetic distance. It feels there is a nigh on obligatory picture of the service order, my hand featuring in many of these shots. There is a lot of standing and waiting, clarifying the minutia of the service so the reporters can tell the story and capture the atmosphere.

Yet for me each funeral is different as I try to ensure the family’s wishes predominate. Southport was a case in point. Of the two funerals in Anglican churches (one victim was from a Roman Catholic family) one family wanted no coverage and my role was simply to make sure that wish was honoured. The other saw cameras in and around church and a full suite of reporters so we work hard with them to ensure respect. Mostly that involves a combination of setting consistent fair rules and supplying enough for them to tell the story. Journalists can cope with told they can’t do something provided their rivals are getting the same message. Lose the consistency you lose the pack as I experience outside Ken Dodd’s funeral when I had to scream at the press pack to get back in their pen before the cortege arrived.
I see this as a ministry. I have learnt techniques over the years, witnessed fights in graveyards, stood soaking waiting for the funeral to end and the coffin to leave so I can relax. Doing this is a privilege which spills over into the funerals I conduct as a priest. As do the learnings from those funerals that, in turn, inform my ministry. Get it right it becomes a fitting, respectful and dignified way for the wider community to say goodbye to a victim.

Then when it’s done we move on. The press pack to the next day’s story myself to the tasks from the routine job that I had to ditch. That’s easier for us. But the families and loved ones can’t easily move on from their pain and grief.

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