Cross-check what matters when voting

Three perspectives to inform how we vote wisely.

Sam Rylands

Sam recently completed a doctorate in political theology and is the Vicar of St Andrew's, Fulham Fields.

A pen draws a cross in a box on a ballot form.

What principles will shape your vote this Thursday? What or who will primarily guide your decision in the ballot booth? Podcaster and former political advisor Alastair Campbell’s old adage “we don’t do God” suggests that religion and politics don’t mix. Yet some of the most important movements for social and political justice in modern history had Christians at their heart. Think Wilberforce, Fry, Bonhoeffer, Martin Luther King Jr., Desmond Tutu, or the lesser-known but worth-a-google, Melanesian Brotherhood.

What wisdom might the Christian faith have to offer when thinking, not just about this election, but how to approach politics in general? Like lions on the England football shirt, all good things come in threes– so, here are three Christian perspectives that can inform political engagement.

First, earthly kingdoms are penultimate. God’s kingdom is ultimate.

Perhaps the moment that Jesus is drawn most explicitly to comment on the politics of his day, was when he was asked about paying taxes. “Is it lawful to pay taxes to the emperor, or not?” Given how frustrating it can be watching politicians avoid responding directly to any question posed, we might sympathise with those who wanted a direct answer here. But for Jesus, to say yes would position him as a traitor to the Jewish people who wanted to resist and subvert the authority of the Roman Empire. To say no, however, would be to signal revolutionary intentions to lead a rebellion against the occupying Roman force.

Set within this political trap, Jesus responds by asking for a coin and turns the tables by asking, “whose face is on this coin?” “Caesar’s,” comes the reply. “Then give to the emperor what belongs to him,” says Jesus. Yet, before we allow this response to justify opting out of political practice or hallow every existing ruling power, Jesus continues: “But give to God what belongs to God.” And what belongs to God, we ask? Well, as the writer of the ancient Psalms poetry put it, “the earth is the Lord’s and all that is in it.” Nothing short of the whole universe and beyond belongs to God, the creator of heaven and earth. So, in taking the coin, Jesus is not giving a blanket affirmation of Caesar’s rule, but challenges each and every earthly kingdom by relativising it in the light of God’s eternal kingdom. What has sustained so many Christians in challenging and renewing the political context of their day is the trust that before, behind, and beyond the rising and falling of each earthly authority stands God’s eternal kingdom. This kingdom is not in competition with the kingdoms of earth, vying to secure its own territory, but is a kingdom inaugurated by a king who wears a crown of thorns, forgives his executioners, and is raised from the dead to proclaim, “peace be with you!” The call to follow Christ within the political is to retain the perspective of this eternal life.

Second, politics needs a perspective beyond personal interest.

Holding an eternal perspective, however, is not to say this world or politics does not matter. In contrast, justice, compassion, and seeking a world as God intends it to be matters precisely because of eternity. How we live here and now has eternal significance. How we treat one another and care for all of creation has eternal significance. What belongs to God? We all do. Each person is made in God’s image. As a coin bears the image of its ruler, so we are marked by the image of God. When we consider our political responsibility, therefore, we must do so not with our own cares or concerns alone, or even primarily. Rather, we should ask what political responsibility we have towards others? How do my political decisions or actions impact my neighbour, both local and global– particularly those on the underside of the political power of the day? As the Archbishop of York, Stephen Cotterill, recently shared, “as a Christian, I’m hoping and I’m praying, that when I vote, when you vote, we won’t be placing our vote according to what’s best for us, but for what’s going to be best for God’s world.” If God’s power is displayed most fully in Christ who came, not to be served, but to serve, giving his life for the sake of the world, then political power cannot be a means for securing our own advantage over and against others. A Christian approach to politics recognises that my flourishing is bound up and inseparable from the flourishing of all others.

Third, let’s disagree well.

However, even if we could agree on the importance of politics beyond personal interest, we won’t all agree on what this looks like in practice. For instance, whilst two people might agree on the need to ensure a welfare safety net for the most deprived in society, their perspectives on how best to achieve this might differ greatly. Christians are not immune from such disagreements and (not that you would know it from the promises of each political party) no political system can deliver heaven on earth. How then are we to reconcile our political differences?

Returning to the theme of belonging and image bearing, the church bears the image of Christ. The church is the Body of Christ, comprised of many different members yet united, as one body. One of Jesus’ final acts on earth was to pray that the church would be one in the same way that God, the Father, the Son, and the Holy Spirit are one. Unity in difference. This image offers a counterweight to how political differences are played out across the news and social media platforms. Here, to vote or think differently is often to become an enemy, or even to forfeit one’s belonging as a bearer of God’s image, another person worthy of inestimable dignity and value.

Belonging to Christ, however, is to know that belonging together runs deeper than divisions of race, gender, societal status, and political tribalism. It is to trust that my sister or brother in Christ, with whom I might strongly disagree politically, is a gift to me, a showing of Christ, that I would otherwise fail to see on my own. If Christ really is the way, the truth, and the life, then the truth is beyond my final possession of it. This does not mean indifference or relativism. As the former Archbishop of Canterbury, Rowan Williams, writes, “unity is Christ-shaped, or it is empty.” But if we can recognise one another placing our penultimate political judgements under the same scrutiny of Christ’s coming kingdom, then even in our disagreements, the church, bearing together in costly communion, reveals a belonging together that anticipates the ultimate: a world where things can only get better.

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.