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

Feminism

Migration

Trauma

10 October 2025

6 min read

“Defending our girls” is less about safety, more about scapegoating

The men who finally care about violence against women — just in time to blame immigrants for it

Belle Tindall

Belle is the staff writer at Seen & Unseen and co-host of its Re-enchanting podcast.

A protestor holds a blue smoke canister towards the camera lens.

An asylum hotel protester, Epping.

Something has profoundly shifted in the way we are speaking about male violence against women and girls. Or perhaps I should say, the shift is precisely that we are speaking about male violence against women and girls.

Wait.

Would you allow me to slightly amend that statement once more?

I say ‘we’ are talking about it, what I really mean, if I may be so blunt, is ‘men’. Men are talking about male violence against women and girls.

Therein lies the shift.

Women have been speaking about this epidemic of violence for years, they have been having endless conversations about the complexities of their own sense of sexual safety, relentlessly sounding the alarm. And, all too often, being ignored. It has so commonly felt as though women could scream about this topic at the top of their lungs and be met with an exasperated eyeroll. Perhaps that’s ungenerous of me, maybe the lack of political interest has been more about despondence than disbelief. Either way, it has continually appeared as though male violence against women and girls has sat, slumped and hopeless, at the bottom of the political agenda.

Until now, that is. Now, it is the crux of many campaigns, sitting right at the forefront of multiple political conversations. One conversation, in particular.

Earlier this year, Conservative MP, Robert Jenrick, wrote an article in which he stated that he fears for his daughters’ safety, not wanting them to live near ‘men from backward countries who broke into Britain illegally and about whom you know next to nothing’. Political party Reform UK has a concern for women’s safety sitting at the forefront of their campaigns; again, Nigel Farage (leader of Reform UK) has continually suggested that it is the immigrant communities in the UK who are posing the threat. Signs that read ‘defend our girls’ have been ever-present at many of the anti-immigration protests that have happened throughout the summer months, the same phrase was chanted by those taking part in the ‘Unite The Kingdom’ march, organised by far-right activist, Tommy Robinson.

So, we have a direct line being drawn between immigration and the epidemic levels of violence against women and girls. A common enemy is a powerful thing, isn’t it? A uniting thing? An energising thing, even? This line from A to B (‘A’ being the violence and ‘B’ being people who have come to this country from another) is one that I cannot draw myself. I find no biblical nor sociological justification for doing such. In fact, I’m hit with quite the opposite.

I’ll get biblical, but shall we start with the sociological?

Violence against women – be that physical, verbal, sexual, financial, or any other nuanced kind – is a tragic reality here in the UK, as well as globally. We know this and there can be no denying it.

One in three women will experience domestic abuse.

A woman is murdered by a partner/ex-partner every four days.

One in two rapes against women are carried out by a partner/ex-partner.

More than 90 per cent of perpetrators of rape and/or sexual assault are known to their victims.

One in three adult survivors of rape experience it in their own home.

These facts are heartbreaking, stomach-churning, worthy of our indignation and fury. They do not, however, imply that the dominant threat to women are strangers who have come to UK from other countries. Such claims, while being spoken of loudly and continually, are unfounded.

There’s almost an ‘if-only-ness’ about such claims, isn’t there? And so, if I lower my hackles, I can sympathise with wanting such claims to be true, albeit momentarily - if only we could solve male violence against women and girls so easily.

If only it were so neat.

Instead, we have to sit in the utterly overwhelming, and often debilitating, reality that violence is being carried out against women in every age group, every socioeconomic group (although it must be acknowledged that women who can’t access public funds, such as welfare support or housing assistance, are three times more likely to experience violence), every ethnic group, and in every corner of the country. As a woman, if a man is shouting at me while I’m alone – it makes no difference what language he’s shouting at me in, tragically, I’ve learnt to be scared regardless.

The notion that it is an imported problem that can therefore be a deported problem, is wrong. And, dare I say it, undergirded by racism.

It’s perhaps also worth mentioning that there is footage from the recently held ‘Unite the Kingdom’ march, during which the mandate to ‘defend our girls’ was continually chanted, of men chasing female counter-protesters down the street. While a call to defend women was chanted one minute, a call for women to expose themselves was chanted the next. Furthermore, it has been reported that 40 per cent of those arrested during the 2024 anti-immigration protests had previously been reported to the police for domestic abuse. In my home city of Bristol, it was two-thirds of those arrested.

So, while women’s safety seems to be at the forefront of political and social movements right now, I can’t help but be deeply suspicious of the intentions behind it. It seems to me that the same people who have spent the last five-or-so years responding to women’s pleas for help with an irritated ‘not all men’ chant, are now more than happy to point at a marginalised group of people and declare ‘but probably all those men’.

But this isn’t simply sociological, nor is it purely political. For me, there are theological reasons why I can’t help but wince at what is happening.

I simply don’t think the Bible gives us the option of pitting one marginalised group against another; it’s clear on the fact de-humanisation can never be a tool in our societal toolbox. In fact, if we’re going to get biblical with it, vulnerable women and ‘migrants’/’foreigners’/’strangers’/’sojourners’ – they’re always on the same list.

‘He defends the cause of the fatherless and the widow, and loves the foreigner residing among you, giving them food and clothing’ – that’s the book of Deuteronomy. And this – ‘Do not oppress the widow or the fatherless, the foreigner or the poor. Do not plot evil against each other.’ – is the book of Zechariah.

I could go on.

We have a shared humanity and, therefore, a sacred responsibility to protect both the women and girls who are facing unspeakable injustice, and those who are being unfairly scapegoated for it. It’s an uncomfortable tension, I can’t deny it. It refutes quick-fixes, it raises its eyebrows at cheap blame, and it absolves any comforting notion that the problem flows from elsewhere - Christianity simply does not offer such a luxury. Compassion cannot be finite, love – as Graham Tomlin has argued – cannot be a limited commodity.

And this is precisely why such things being increasingly carried out in the name of Christianity makes no sense to me. Surely, this cannot be espoused in the name of the Jesus who destabilises the boundaries between ‘Our Sort of People' and 'Those Others Over There?’ (to quote Francis Spufford)

We cannot be fooled, fear and distrust on the basis of someone being different from ourselves is not – I repeat, not - a Christian value. One vulnerable group’s pain being unjustly weaponised against another vulnerable group has no hint of Jesus about it. Plus, doing so knowingly compromises the care we can offer to both groups.

I’m getting a little weary of being told that, as a woman, this hate will ensure my safety. Both sociologically and biblically, I’ve found the grounds to call time on such a claim.

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