Article
Comment
Justice
5 min read

Facing up to justice

The crimes and sentencing of baby-murderer Lucy Letby is driving fresh conversations about justice. Edward Smyth examines the confusion and contradictions within them.

A writer and speaker in the field of criminal justice and faith, Edward Smyth is now pursuing doctoral research on the 'through-the-gate' experiences of individuals who have found faith while in prison.

A prisoner looks into the camera.
Lucy Letby's Police file photograph.
Cheshire Constabulary.

‘Christians need to be ready for the inevitable moment when Lucy Letby declares that she’s found Jesus in prison.’  

So read one of many tens of thousands of tweets posted on the day Letby was sentenced to spend the rest of her natural life behind bars. I probably saw several hundred of those tweets that day; yet this one has lingered, niggling away at me whenever my mind is drawn back to a consideration of the appalling facts of a case that surely takes its place amongst the worst ever to have been prosecuted in this country.  

One of the things about the Letby trial which has caused the most consternation has been her refusal to appear in court for some of the verdicts, and for her sentencing hearing. The strength and volume of the response to what is being almost universally termed her ‘cowardice’ has some challenging things to say about what contemporary society means – or thinks it means – when it talks of ‘justice’. And, as I write, the Government’s response has been to force criminals to appear. An interrogation of these responses might just help us all begin to be able to think through where this leaves us, too.  

The sense seems to be that in refusing to enter the dock at Manchester Crown Court for her sentencing, Letby has somehow evaded what we might term her ‘just deserts’; and that her victims and their families – and indeed society – have been cheated out of some of the justice to which they feel entitled. If the act of receiving the sentence is viewed as itself part of the punishment (not an assumption by which I am wholly persuaded, but one which sits at the heart of this argument) then the outrage caused by Letby’s avoidance of her sentencing speaks to a certain weighting of the importance of that one morning in court as against the next forty or even fifty years Letby will spend in prison. What this boils down to, then, is retribution pure and simple. We think offenders should be made to listen to the impact of their offending because we want them to feel all the things that we believe they deserve: guilt, shame and pain. We want this because of some innate, deep-rooted sense of balance and fairness which dictates that an appropriate response to the imposition of pain is, in turn, the imposition of pain.  

Our legal system exists, in part, to ensure that this remains proportionate: the state censures offenders to avoid the inevitable disproportionate vigilante or retaliatory action which would otherwise ensue, exercising what some criminologists refer to as its ‘displacement function’. Prisons, of course, are out of sight and usually out of mind which perhaps explains the importance of the sentencing hearing in cases like this: it is the only opportunity we have to see the convicted person suffer – and we need to see it with our own eyes to make sure that, even if we think ‘prison is too good’ (i.e. insufficiently painful), we have at least seen the convicted person suffer some pain. 

Letby may have avoided being deluged by the waters of justice rolling down upon her ... in the dock, but we should be in no doubt that those waters are rising from the floor of her prison cell as we speak.

For Christians, though, the elephant in the room is that Letby has been sentenced to a ‘whole life order’. In passing that sentence the state is saying ‘we have no interest in your rehabilitation’; and that is something which should give all pause for thought especially Christians. I do not think there is a ‘correct Christian response’ to this issue, as it happens: personally, I would rather we didn’t have whole life orders, but equally I have no objection to someone spending the rest of their life in prison if that is the only safe course of action. If we were designing a Christian system of criminal justice, then whole life orders would be indefensible on the grounds that we have no right to make impossible redemption; but we’re not designing – or operating under – a Christian system of criminal justice; and redemption in the theological sense is still possible in prison. I struggle – particularly in light of cases like this one – to get too worked up about it.  

But perhaps that’s the point. Perhaps the fact that my own theology opposes whole life orders but, when exposed to the facts of a case like Letby’s, I find it difficult to care very much is exactly the kind of confusion and contradiction of which I spoke at the outset of this article. And in that confusion and contradiction perhaps we find what it is to be a Christian, our instinctive and culturally conditioned human responses coming up against the teaching of the ultimate countercultural being and, so often, overwhelming it in our hearts.  

Those hearts ache for the victims of Lucy Letby and their families. Have they received justice? She will spend the rest of her life in prison: I think they have. Is that justice compromised because she did not appear for her sentencing? I think it is not, on both secular and Christian grounds. Secularly speaking the state has performed its ‘displacement function’ and the punishment is being carried out whether she was there to hear it or not. The victims have – for better or worse – been removed from the conversation, which is why criminal cases are listed as ‘The King v. ...’ rather than ‘[Victims’ names] v … .’ Theologically speaking Letby may have avoided being deluged by the waters of justice rolling down upon her (as Justice is described in the Bible) in the dock, but we should be in no doubt that those waters are rising from the floor of her prison cell as we speak, and she will be soaked through soon enough. 

The case of Lucy Letby – as with any case of great evil – is a violent challenge.  For the Christian, it is one which can only be met with prayer, thought, and introspection. In short: they must pray their way to their own response. But whilst they are doing that as Christians in an increasingly secular world; a world where the responses that they know their faith obliges them to make are so quickly and easily monstered – I can only hope that they and we find in our Church an institution willing to preach that countercultural, unpopular Gospel.    

'Modern man often anxiously wonders about the solution to the terrible tensions which have built up in the world and which entangle humanity. And if at times he lacks the courage to utter the word “mercy”, or if in his conscience empty of religious content he does not find the equivalent, so much greater is the need for the Church to utter this word, not only in her own name but also in the name of all the men and women of our time.'  
Pope John Paul II 

  

Article
Assisted dying
Comment
Politics
7 min read

Assisted dying hasn’t resolved Swiss end of life debates

Despite attempts to normalise it, new challenges still arise.

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.