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.

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Nationalism

8 October 2025

5 min read

One flag two nations: the view from Leicester

Raising the national flag won’t secure the future for our grandchildren

Cameron Wiltshire-Plant

Cameron is a curate in Leicestershire

A suburban English street with St George's Cross flags on lamposts.

Mtaylor848, CC BY-SA 4.0, via Wikimedia Commons

I was in the local pub the other week and overheard a conversation at the bar prompted by Operation Raise the Colours, the campaign group that advocates for the Union flag and the St George’s Cross to be hung in public places.

Striking was the opinion of one man who repeatedly stated that he was not a fascist or a racist but supported anti-immigration policies and the deportation of migrants and asylum seekers for the sake of his young granddaughter. It was a lack of hope for her future, he kept asserting, that meant politicians needed to take a more aggressive stance against people arriving in this country hoping to live here. He therefore supported the raising of the St George’s Cross as a sign of the national identity he hoped his granddaughter would grow up to experience.

In the last hundred years the St George’s Cross has been a sign of Empire, military might, hooliganism, English Nationalism, xenophobia, fascism, and other violent and oppressive worldviews. It meant for many who did not want to be associated with these things that they could never raise or recognise the flag at all.

But there has also been some reclamation of our national symbols. Cool Britannia and Britpop under New Labour saw a new pride in the Union flag; England’s football team under Gareth Southgate and the ‘proper’ English Lionesses were successful, articulate, and diverse under the Cross of St George. It's why even now it’s hard to discern whether someone with a Cross of St George stuck to their house endorses Tommy Robinson, or whether they’re showing their support for the England women’s rugby team, who are swept all opposition before them whilst cavorting in pink cowboy hats and redefining all kinds of feminine stereotypes.

These myriad options for painting identities onto national colours seems particularly clear in Leicester, where I live and work. We live in the outer suburbs, meaning two miles in one direction, humans are outnumbered by sheep, and two miles in the other is the incredibly diverse edge of the city.

Leicester famously has the most diverse street in the UK, Narborough Road, where people from many nations live and work, generally in relative harmony. Skills are shared: help with government forms for those without good English are informally bartered for meals, haircuts, or produce. Christians, Jews, Muslims, Sikhs, Hindus and many other faiths worship within close proximity. It seems a place symbolic of one kind of England: diverse, tolerant, enriching the lives of one another by the sharing of culture and skills.

It’s easy to point to recent riots between Hindu and Muslim populations in the north of the city as proof of the opposite. Nevertheless, having worked in a diverse city centre church and visited schools and hospitals where many cultures and faiths study and work together, there are large pockets of the city that do generously manage to embody this vision. Faith leaders are overwhelmingly committed to mutual tolerance and respect.

I know many people in the county also wish for this version of England, but it has been striking to see how many villages surrounding the city have joined in with Operation Raise the Colours. Its anti-immigration message provides a clear-cut visual contrast. In the city there are no St George’s Crosses but innumerable signs of inter-culturalism brought by immigrants, asylum seekers and refugees. It is the first city in the UK where being white British does not put you in the majority. In the county, these flags seem to state that these signs are not welcome. That to ‘Unite the Nation’ is to expel those different to us. That the only culture available is the one they want to equivocate with the St George: white, British, suspicious of outsiders.

Both of these contexts seem to be fully fleshed out alternatives for the future of England. Who do we want to be? Tolerant, inter-cultural, diverse? Or exclusive, suspicious, nativist? The guy in the pub was staking his hope for the future on one of these alternatives, and I’m sure he’s not unique. There will be others who are fully devoted to the opposite: a diverse and welcoming state of which Leicester appears an imperfect harbinger.

It’s important to note that a fair reading of the Bible cannot help to highlight the theme of welcoming foreigners, perhaps particularly those who are not able to contribute financially. The Israelite faith of the Old Testament specifically commands farmers to leave a border of crop unharvested for such struggling migrants.

One of the most beloved stories of the Jewish scriptures is that of Ruth, an Edomite woman who comes destitute to Israel and finds provision in the righteous life of Boaz, who has left such a border of crop for her to glean. Eventually they marry, and their offspring is blessed by God: including King David and Jesus Christ. I do believe that welcoming foreigners, and particularly those who have been affected by poverty or war is just. Any form of Christianity which puts nation before those different to us or those who suffer is a false one.

But, just as I believe that man in the pub is wrong for putting his hope in the tightening of borders, anybody who puts their hope in any philosophy or system a flag can represent is mistaken. Liberal policies towards immigration and open hearts towards those who must seek asylum or refuge will always fail and fade. Neither England represented by the city and county of Leicester can or will last a millennia, let alone an eternity. Neither can guarantee a better future for our descendants.

Jesus spoke of a Kingdom without flags, without an army, and without borders. One in which all tribes and tongues will be welcomed as the foreigners we are to the Holy God. One which is already recreating the Earth to be a place without death, enmity, and suffering and one day will bring this work to fulfilment. This Kingdom of God is the only political entity in which hope can be securely placed because it keeps its promises and never passes away. Our political parties, national identities, and nation states may be more or less like the Kingdom of God but they are never secure foundations for our future.

If I were braver, I might have broached this reality with the man at the bar. I might have suggested he makes an error in placing hope for the future generations of his family in a particular understanding of the national flag. I could have invited him to see the truer potential for hope in a Kingdom which is not directly seen but nevertheless is more real and secure, and discussed with him about what that means for our temporal reality. And challenged him to see past the flag to a Kingdom which will provide for his granddaughter without measure.

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