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Creed

Death & life

1 November 2023

7 min read

How Christianity transformed attitudes towards death

Once we buried bodies outside cities. Then we started burying loved ones inside them. This is why.

Andrew Davison

Andrew works at the intersection of theology, science and philosophy. He is Canon and Regius Professor of Divinity at Christ Church, Oxford.

Dozens of candles in cloured jars and holders litter the ground of a cemetry.

Commemorative candles at cemetery in Srebrniki, Gdańsk, Poland.

Ludomił Sawicki on Unsplash.

‘The last enemy that shall be destroyed is death.’

Seeing things two ways at the same time doesn’t mean ambivalence. Christianity has two things to say about death, and it says both forcefully. They particularly come to mind during November, as the season of the year when we remember the dead. In this month we get the modern secularised rituals of Hallowe’en, but we also get Remembrance Sunday, when we think of those who fell in war; and on 2 November, we have All Souls’ Day, when ‘the faithful departed’ are recalled, and in many traditions, prayed for.

Christianity’s two entwined attitudes to death are lament and hope. On the one hand, death is a shadow; on the other, a light has dawned that will banish that shadow. Both aspects are in that line from St Paul:

‘The last enemy that shall be destroyed is death.’

Death is our enemy; death is slated for destruction.

Whatever a popular funeral poem might claim, death is not ‘nothing at all’. That poem has been suggested a few times when I’ve been planning a funeral. It’s never stayed in the draft order of service longer than it’s taken me to ask the question ‘But do you really think that death is nothing at all?’

Unlike our benighted predecessors, ancient and mediaeval, don’t we now understand that death is natural, just part of being the sort of creatures we are?

I take the opposite approach to funerals. I do not treat death as ‘nothing at all’. I wear black vestments: I do not assume that mourners are ready, only a week or two into their bereavement, to skip to the bright hope of white as a liturgical colour. I make the liturgy solemn. I avoid circumlocutions like ‘he’s moved on’ or ‘she has passed’ (somehow popular at present). No: someone has died, and even if that came after a long illness or a long life, a death is a loss.

The idea of death as enemy, though – ‘the most fearful of bodily evils’ (Thomas Aquinas) – might look out of date in the twenty-first century. Unlike our benighted predecessors, ancient and mediaeval, don’t we now understand that death is natural, just part of being the sort of creatures we are?

It’s almost always a mistake to underestimate our forebears. They knew that we are animals, but also said that we are animals of an odd sort: we are ‘rational animals’. That left them with a conundrum (and here I continue to have Aquinas in mind). On the one hand, we are animals, and animals are mortal, so that makes death natural. On the other hand, Christianity also insists that death is a wrench, a disjunction, an affront.

Reconciliation for this tension rests on that odd status of the human being, as a rational animal. We are animals, but also the sort of self-aware animals who are made for a relationship with God: suited for it, called to it. One model for that relationship, remarkably, has been friendship, with Moses as an example: ‘So the Lord used to speak to Moses face to face, as one speaks to a friend.’ That sort of relationship, that sort of seeing God face to face, would confer immortality on our naturally mortal bodies (‘when we see him, we shall be like him, for we shall see him as he is’). Thus, both parts of the conundrum are true: as animals, we are naturally mortal, yet our animality is called to a destiny beyond its nature. Our tragedy is not that we are animals, but that we are rational animals foolish enough to turn from God, and from the light of immortality.

The message of the Incarnation and the hope of the resurrection turned something around for early Christians. They no longer found dead bodies frightening.

That’s the first half of our opening phrase: death is our enemy because, although mortal by nature, we were originally called to something beyond nature, but lost it. God was turned towards us, but we turned away. However, enmity, tragedy, and loss are not the whole story, and they are certainly not the end of the story. There is also death’s destruction. That’s what the life, death, and resurrection of Christ were about. If death is our enemy, then it’s a routed enemy, overcome, although not fully destroyed, until God recreates the world.

Christians can be so excited about the prospect of death’s destruction that they forget that this destruction is still a promise, and we still live under its sway. For now, the hope and the sadness lie woven together. That is why we read in the New Testament about ‘not grieving as others do who have no hope’. I don’t take that as a blanket injunction against grieving (death is still our enemy, after all), but as standing only against the kind of grief that has no hope (because death’s destruction is assured). Again, here are the two strands, woven together. We also see that two-sidedness in a funeral prayer used by Eastern Orthodox Christians (and at the funeral of the HM Queen Elizabeth II), the kontakion of the dead. Its final lines put place wrenching tears right next to the church’s great word of praise and celebration, ‘Alleluia’:

All we go down to the dust;

weeping o’er the grave we make our song:

Alleluia, alleluia, alleluia.

This duality in Christian attitudes to death shows up in how Christians treat the bodies of the dead. We probably take burial practices for granted, but the idea of treating the bodies of the dead with utmost care and dignity was a point that Christianity really belaboured. Christ, for instance, had given a list of six good deeds in the Parable of the Sheep and the Goats: feeding the hungry, giving drink to the thirsty, clothing the naked, sheltering travellers, visiting the sick, and visiting prisoners. It would be a bold decision to add to any list draw up by Christ, but the church did it, adding a seventh ‘act of corporeal mercy’: burying the dead.

Christianity is definitively the religion of the Incarnation: of God taking up human flesh. Bodies therefore matter. Talk of casting off the body, as if the body were just some old cloak that the soul has outgrown, is not something Christians say. We are bodily creatures, so Christian hope is for the resurrection of the body. (So also – I should add for completeness – is Christian doom also bodily. Those who die at enmity with God and the good, the faith insists, turning down the offer of reconciliation, face the consequences in the resurrected body.)

The message of the Incarnation and the hope of the resurrection turned something around for early Christians. They no longer found dead bodies frightening. In the ancient world, bodies were to be buried outside the city, cast out from the human community. Christians changed that, and started burying their loved ones inside the city. Bodies were to be treasured, not feared. The bodies of their heroes – those who excelled in virtue, and especially the martyrs – were brought right into their churches. Before long, no altar (the communion table) was quite proper unless it was built over the body of a martyr or other saint, or at the very least contained some part or relic.

Veneration of relics has not been so common in the Church of England (the church to which I belong) since the Reformation, nor in the wider Anglican Communion. Slowly, however, it has edged its way back. In 2002, the cathedral where I’m a canon, St Albans, received a shoulder blade of St Alban, England’s first martyr, the gift of one of the dozen remarkable Romanesque churches in Cologne. That bone gets considerable honour on the weekend closest to his feast day (22 June). Relics are also familiar in the church in Philadelphia where I currently celebrate the Eucharist once or twice per week. The altars are usually at least lightly decked with relics. During Eastertide, they groan under the weight of them, including some impressive whole-bone affairs. Only in Advent and Lent – penitential seasons – do the relics disappear to the sacristy, replaced with statues of the prophets in Advent.

It’s easy to grow accustomed to relics after a while. I should remind myself of their strangeness. Defying any trend in religious thought down the ages to denigrate the body in favour of the soul, here the body is holy, recognised as the site of God’s great works. Here, dead bodies are no longer to be feared. They are the most precious things the church owns, and threaten no contamination. Or, rather, if they suggest any contagion, it is a contagion of the good.

Care towards the bodies of the dead reflects both poles of Christian attitudes to death. On the one hand, Christians have preserved the bodies of the dead with great care because death is an affront. Death is the enemy that falls upon us all, even the most holy among us. Lamenting that loss, we keep bodies safe until it is reversed. And there is also the other side of the Christian attitude to death: alongside lament there is hope in death’s destruction.

Christianity, at its wisest, has not skipped through lamentation too quickly, but neither has it given lamentation the final word. Day-by-day funeral practice probably connects most clearly with the sadness, although the hope is woven through. The place of relics in many strands of Christianity (although by no means all), swings more towards an emphasis on death’s defeat. It rejoices in having among us, in all those slivers of bone, fragments poised towards Resurrection, when ‘death shall be no more’.

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.