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

Belief

Creed

Leading

Politics

17 October 2025

5 min read

Let's keep hope weird, Zack

Amid growing grief for the future, the Greens' leader is calling for 'ordinary hope'

Lauren Westwood

Lauren Westwood works in faith engagement communications for The Salvation Army.

Zack Polanski returns to Manchester.

The Green Party

The recent Green Party’s political broadcast has been praised for its emotional clarity, moral urgency and a call to action that has seen party membership surge.

Looking down the lens, recalling his years growing up in the north of England, party leader Zack Polanski sighs,

“There was something in the air… a kind of ordinary hope.”

As he walks through a typical British city, filmed in Manchester, lined with terraced houses and bright-white lights beaming over takeaway shops and industrial bins, he diagnoses the collective hopelessness of a ‘people too tired to fight, to sleep.’

In just under four minutes, Polanski disarms objections to his cause with a sensitive, poetic script. He opens by referring to the common experience of a satisfying bowl of cornflakes – before plainly illustrating the socioeconomic injustice facing the everyman. He then makes the case for fair wealth taxation, and closes with the cheery challenge:

‘Let’s make hope normal again.’

It’s a compelling appeal that resonates with those weary of cynicism. But what does it actually mean?

To be clear, I call this to question because I desperately want good things for our country. Warm homes, clean air, safe streets and an NHS that works for all – I believe these things should be normal. But I’m not sure I want to normalise hope.

Because real hope is weird.

Hope is not to be confused with optimism, or good prospects, or a positivity about the future reserved for the privileged. It’s not increased with social mobility or sitting comfortably in a five-year plan. Hope is not even the belief that things will get better. Real hope is much truer than that. It is a deep knowing that all shall be well, even when that seems foolish – a glance through the ancient literature of the Bible points to hope as singing in a prison cell, relief in the wilderness, resurrection in the face of crucifixion.

As NT Wright, the theologian, puts it: ‘Hope is what you get when you suddenly realise a different worldview is possible, a worldview in which the rich, the powerful, and the unscrupulous do not after all have the last word.’ This kind of hope doesn’t waiver with the housing market, interest rates, or inheritance tax. It’s not the result of good policy or strong polling. It’s the stubborn belief that love wins – and has, in fact, already won – even, or especially, when it looks like all is lost.

This is where Polanski’s got it right. There is a present and growing grief for the future. Across the UK, millions feel disengaged, disrespected and undervalued. Distrust of politicians, division in communities and loss of faith in the systems supposed to be for our benefit seem to be at an all-time high.

Polanski’s call to hope comes at a time when a redeemed order seems impossible or, at best, several generations away. But, instead of accepting the kind of ‘ordinary hope’ Polanski experienced back in his youth, the answer to our deepest longing lies in realising we need something extraordinary to happen and knowing that we’re allowed to believe that it will.

We don’t need to be desensitised to hope – we need the opposite. We need to be reawakened to everyday glimmers of redemption – the neighbour who pops by for sugar and stays for a safe conversation, the health worker who acknowledges a former patient with a grateful smile, the family whose fear is soothed by the kind gesture of an elderly white neighbour – and recognise our share and our part in bringing it on, believing there is yet more and better to uncover.

Polanski is incredibly perceptive in his address to the concerns of the hard-working plumber and the fledgling hair salon owner, nervous that their hard earnings and ambition will be cut short: ‘I wondered, “Why did they think I was talking about them?” And now, I get it. It’s because it’s too hard to picture.’

Hope, too, is hard to see. A better world is hard to imagine. Though Polanski is advocating for a public reform and reimagination of what it means to be taxed, our souls are capable of the sudden realisation that another way is possible. We can experience life-altering revelation that leads to fresh vision, both for what is seen and for the yet unseen.

For the Christian, hope is not some far-out abstract concept, but a gift made real through belief in the life, death and resurrection of Jesus Christ – a Middle Eastern man who walked the earth two thousand years ago, held no title, had no place to lay his head, and called himself the Way, the Truth and the Life. See? Real hope gets weird.

Instead of being content to accept an ordinary hope – made small, palatable and unremarkable – we can embrace hope as it was designed. A liberating reality that brings steady assurance to every thought, every reaction, every decision and, yes, every vote. This confidence comes not because we are sure of our own rightness, but precisely because we are not. We submit to its mystery because a hope that we can control, mediate and measure will never lead to the transformation we most long for.

Do I long to see an increased hope for the future across the UK? Of course. But do I believe we should ever grow accustomed to hope? I don’t think so. We need contagious hope – wild and holy and strange, anything but normal.

Tax the super-rich so that children can eat, parents can sleep, and ordinary people can be lifted out of extraordinary poverty, if you want – but let’s keep hope weird.

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