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

Culture

Film & TV

Politics

War & peace

23 May 2025

5 min read

The story from a galaxy far, far away that's just made for these times

Andor holds up a galactic mirror to our media-saturated world.

Krish Kandiah

Krish is a social entrepreneur partnering across civil society, faith communities, government and philanthropy. He founded The Sanctuary Foundation.

A montage shows the lead characters from Andor.

It’s an unlikely setup for success: a series set in a forgotten corner of the galaxy, a prequel to a prequel, telling the backstory behind Rogue One - the fourth highest-grossing Star Wars film. It’s a show with none of the original characters—no Darth Vader, no Luke Skywalker, no Obi-Wan. And yet, Andor has garnered widespread critical acclaim and fan appreciation. This Disney+ series has become the first true Star Wars content for grown-ups.

Disney invested heavily in acquiring the rights to both the Marvel and Star Wars franchises, paying $4 billion for each. The returns have been massive—an estimated $13 billion from the Marvel Cinematic Universe and $11 billion from Star Wars. Yet, despite the financial success, something has been lost along the way: mediocre storylines, convoluted time-travel plots, and repetitive tropes have dulled the creative edge.

But Andor stands apart. It offers something different—a grounded, character-driven narrative with rich, resonant themes that speak directly to today’s audience.

Tyranny needs resisting at all levels

Andor follows a number of intersecting character arcs. Although the series is named after Cassian Andor (played by Diego Luna), a disillusioned smuggler turned Rebel Alliance operative, the story is much larger than a single man.

As the Empire tightens its grip—both openly through military might and brutality, and in the shadows with a vast array of spies, surveillance, and an ever-expanding intelligence network—the need for resistance at every level becomes urgent. Those with a voice need to speak up while there is still a semblance of democracy and freedom of speech. Money is required to fund an insurgency and foot soldiers from all walks of life need to be found and prepared to rise and challenge the systemic injustice and rising imperial oppression.

Enter Cassian Andor, orphaned at age six and adopted by Maarva and Clem Andor. His early experiences with poverty and oppression awaken something within him—something that solidifies when Clem is executed by stormtroopers. At the other end of the spectrum is Mon Mothma, born into privilege and political influence. Her arc centres on a moral crossroads: whether she will risk her status, her wealth, and her safety to support the resistance from within the halls of power.

The relevance of Andor's message couldn’t be timelier. In an era marked by rising authoritarianism, disinformation, and increasing political polarization, the show insists that tyranny must be resisted at every level. It reminds us that democratic institutions are fragile, and silence in the face of injustice enables oppression to grow unchecked. Whether it’s fighting against despotic leadership, the erosion of freedom of speech, or systemic inequality, Andor suggests that the burden of resistance cannot simply fall solely on the heroic few. It requires people at every level of society to act with courage, integrity, and purpose before it’s too late.

Truth matters

One important storyline in Andor is how the Empire constructs a moral justification for its actions through state-controlled, propagandist media. Good people can be manipulated, and truth can be twisted. In real time, we witness spin doctors denying or reframing the brutality unfolding around them—even as the Empire violently crushes a peaceful protest in Gorman.

Showrunner Tony Gilroy uses every world-building tool at his disposal to draw parallels with both historical and contemporary injustices. For instance, the costuming of the Empire’s senior leadership and Imperial Security Bureau agents evokes eerie similarities to Gestapo uniforms. In contrast, the Gorman resistance fighters appear as if they’ve stepped off the set of Les Misérables, echoing the June Rebellion of 1832. They even speak in a French-accented galactic dialect, reinforcing the connection.

It's difficult not to read this as a critique of how modern news outlets reframe and re-narrate global conflicts—such as the war in Israel and Gaza—to suit and shape their audiences. This agenda-driven reporting distorts facts and desensitizes viewers, often at the expense of those suffering on the ground. The complicity of the press in disinformation and facilitating or justifying atrocities, is contributing even today to ongoing humanitarian crises in places like Sudan and Gaza.

In a supposedly post-truth era, Andor reminds us that truth still matters. The series holds up a mirror to our media-saturated world, revealing how outrage is manufactured, narratives are controlled, and reality is often mediated through selective storytelling. It challenges us to reflect on the reliability of the news we consume—and on our own role in questioning or accepting the stories we're told.

Which side are you on?

One of the most compelling aspects of Andor is its portrayal of parallel lives on both sides of the conflict. While much of the action follows Cassian’s transformation from smuggler to reluctant operative to key rebel leader, we also witness the rise of Dedra Meero—a driven, ambitious surveillance officer within the ISB, the Empire’s intelligence arm.

Dedra begins as an underdog fighting workplace sexism in a male-dominated bureaucracy. But as her career advances, so does her capacity for cruelty. She becomes one of the Empire’s most ruthless enforcers, willing to sacrifice anything and anyone in her relentless pursuit of Rebel operatives. Her story is a chilling reminder of how authoritarian systems reward efficiency and zeal, no matter the moral cost. Ironically, her single-mindedness may end up helping the rebellion—her recklessness potentially exposes secrets about the Death Star.

Throughout the series, we see similar tactics employed on both sides—surveillance, betrayal, sacrifice. The only difference is the larger narrative arc that ultimately vindicates the Rebellion’s cause. But in building complex, believable antagonists like Dedra, Andor shows us the banality of evil—how ordinary people, convinced they are doing the right thing, can become instruments of oppression.

The question the series leaves us with is chillingly simple: in a world sliding toward growing injustice, which side are you on?

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