Article

Change

Politics

20 January 2025

7 min read

Hope is a choice, insist on it

Amid loveless politics, remember hope cannot exist in isolation.

Elizabeth Wainwright

Elizabeth Wainwright is a writer, coach and walking guide. She's a former district councillor and has a background in international development.

A crowd of people stand in the side steps of the Lincoln Memorial

Easter services, Lincoln Memorial.

George Pflueger, via Unspash.

The other day – a cold grey day, the kind of day that makes summer seem as distant as a star – I encountered a woman who stood out. She was cheerful despite everyone else’s winter gloom, and she was wearing a home-made tabard. The tabard was covered in a layer that seemed to be made of tape and clingfilm, and underneath it were little Ukrainian flags, images, facts, and small everyday items like soap. I have seen her before dressed the same way. She stood out, I think, because of her attire but also because of the defiance she radiated – a defiant joy, but also belief that it is worth hoping and acting in the ways we can, even when all the evidence seems to tell us those actions make no difference. The news of Russian’s invasion on Ukraine in 2022 has lost its initial shock power. We are creatures who like stories, and so we like news that has a clear beginning or end. The messy middle can be hard to stick with, precisely because we do not know what comes next or how long it lasts. And so our attention moves on. This, coupled with our felt powerlessness in something so big and distant, can mean it is easy to lose hope, to stop taking action.

But the woman who raises awareness most days in this creative way, with suggestions for what items to donate or how to send funds or how to host refugees, has been making me re-look at hope. Her posture – her insistence on hope as choice – feels life-affirming and countercultural. For a moment, she snaps me out of despair for the world. She faces looks of bemusement and seems to say, if not this, then what?

What keeps us moving forward when the world seems heavy? Where does hope spring from, even in the face of overwhelming odds? Hope, I have learned, has been tangled with humans for as long as we’ve walked the earth. It ensured the survival of our ancestors because it drew them towards a future that might be better than today. It kept them going.

In Greek mythology, Pandora opened a box out of curiosity despite being told not to. All kind of curses contained in the box spilled out into the earth. She wrestled the lid back on but not until it was almost too late. Almost, but not entirely. One thing remained in the box: hope. This myth always brings to my mind memories of visiting a slave fort that still stands on the coast in Ghana. The walls were oppressive, the words above the gate that led to the slave ships were haunting: ‘door of no return’. And yet I learned that there were songs. Spirituals and other songs that passed the time, helped members of different tribes feel connected when they were all shoved together, and conjured hope despite all the evidence to the contrary.

Optimism asks us to sit back and hope for the best; hope knows that we have work to do to bring forth a better future.

Ideas of hope have been with us always. And yet I find that hope can feel hard to conjure now, staring into the face of an increasingly unknowable and uncertain future: authoritarian leadership that seems to be on the ascendancy, impacts of the climate crisis that are coming into startling clarity, and loneliness that has been declared a global health concern by the World Health Organisation. It is easy to feel that things are falling apart. Faced with these things and more, hope can seem naive, wishful, hard to get hold of.

Perhaps one reason for this is that hope, in the age of the individual, is harder to come by because hope is relational, it cannot exist in isolation. It is transmitted through community, story, and care for others. Those old slave songs sang of hope because, I imagine, people had the reality or memory of each other. Hope said: people have been good, and they will be good again. Hope is insistently communal. It asks us not to bear the weight of the world on our own, but to face each other and distribute that weight via a web of relationship. Perhaps now, accessing a hope that can carry our burdens and our fears means first re-finding each other.

Hope and blind optimism are, of course, different things. Rabbi Jonathan Sacks said that “Optimism is the belief that the world is changing for the better; hope is the belief that, together, we can make the world better.” Optimism asks us to sit back and hope for the best; hope knows that we have work to do to bring forth a better future. And so perhaps that’s why lately, hope has felt exhausting. I’ve worked with communities internationally and locally for two decades on all kinds of projects, always asking, is this how things have to be? How might we imagine and build better? And yet still the climate worsens, inequality persists, bad leaders get into positions of terrifying power. It is easy to stand back and despair, to question, to wonder if all the hard work has been in vain.

Jesus knew this exhaustion. He knew what it was to work, encourage, and love hard, often to face rejection, mockery, and ultimately death. But still Jesus chose to enter into the persistent mess of the world. He chose the day in, day out work of becoming flesh. He affirmed the dignity of the marginalised, calling them into action, knowing that action would keep that dignity alive. He knew that new life would come through suffering, not by denying it.

Strongman authoritarian leaders aren’t the problem, they are a symptom of a society who are divided and not encountering each other well

Perhaps hope is hard too because though it is a posture which faces the future, it also asks that we live with integrity, love, and care right now, in this fractured world. Hope is not writing off the present in favour of some distant time or place. It is not wishing this world away so that we hasten to another one. It says, we can work for a better future, but we should not put off good work until then. That better future will only come if we invite it into our present, whatever the outcome might be. Hope is in living deep and timeless and world building values, even if there are no obvious or immediate results. Czech playwright and former dissident Vaclav Havel who led his nation after the collapse of communism said that

“Hope is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.”

If a principle is right for the future, it is right for now, even if that requires work. If I espouse values of kindness, love, community, and imagine a future where these things rule, and yet ignore the marginalised, or distrust people not like me, or cut off people I don’t agree with, then my hope for the future is no more than optimism, because I am not willing to do the difficult work of living as if that future were here now.

Hope is turning outwards and living these values with others, even when honestly sometimes it seems easier and more appealing to turn inwards and single-handedly try and fix things — a myth that has grown in our age of individualism, celebrity, and our self-referential rhythms of life.

Hope has lately been asking me to take a Beatitudes perspective on things. In his Beatitudes, Jesus flipped the logic of the world on its head. The last will be first, the poor will inherit the kingdom, the weeping will find joy. Like the Beatitudes, hope asks me to take a different approach. When I look at the world through this lens I find new ways to think. Perhaps, for example, things aren’t getting worse but instead are becoming clear, truths are being unveiled – and so climate change is not the problem, rather, it is a symptom of a greedy economic system in which we are all complicit; Strongman authoritarian leaders aren’t the problem, they are a symptom of a society who are divided and not encountering each other well, and of money and distrust having too big a say in how we govern ourselves. This doesn’t mean we should stop addressing the symptoms, but that we have new possibilities in our scope for action.

Now, as we enter another cycle of — at best — strange politics that is steeped in lovelessness and will have unknowable outcomes near and far, the thing I search for alongside wise voices is hope. And searching for hope means living a good future now, and finding others who can carry both despair and beauty with me. Novelist and critic John Berger said that

“Hope is not a form of guarantee; it’s a form of energy, and very frequently that energy is strongest in circumstances that are very dark.”

So let us call on that energy, that light in the dark today. It is how we build the future.

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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.