Northern Ireland’s imminent danger is distraction

Distraction damages much more than your concentration. Its consequences could cost Northern Ireland its future.

Andy Flannagan

Andy Flannagan is an author, organiser and musician.

Smartly dressed politicians sit or mill around a round table.

Rishi Sunak with the leaders of the Northern Ireland Government.

Prime Minister's Office.

Should you be reading this article right now? Are you meant to be working? Perhaps you’re working from home with the glorious ‘freedom’ that brings? Forgive me for judging, but it’s just that I know myself all too well. Dear reader, I must confess to you that in the course of writing this article I have already ‘cut away’ to cricket scores or my fascinating chess match with covidchessfun34 more than a few times. We are an increasingly distractable people. But you’re here now, so whether you landed here through word of mouth or social media, welcome. Much as you would (I am sure) love me to deconstruct yours and my individual psychology and boundaries, my hopefully more important point here is that distraction also operates at a political level.

It’s been a frustrating few years for the people of Northern Ireland. Which when placed on top of the devastating history of the last 50 years seems a tad cruel. Just when the Good Friday Agreement seemed to have pulled off a miraculous balancing act on the high wire of a divided island with contested history, Brexit came along to throw off NI’s centre of gravity. It was in fact thrown off to such an extent that NI was left just trying to cling on, balance and survive, rendering no forward progress possible. Sadly, the circus metaphor seems appropriate in more ways than one.

Given that context, you can appreciate how the people of Northern Ireland felt this week when Prime Minister Rishi Sunak flew into Belfast and attempted to educate them. He urged the newly formed Northern Ireland executive to focus on ‘things that matter’ rather than constitutional change. With hospital waiting lists that rival Sierra Leone and some roads that rival, well, Sierra Leone, I think that folks in Northern Ireland get that ‘things that matter’ are the things that matter. Of course, what the Prime Minister is talking about is Northern Ireland’s obsession with the elephant in the room - the border, or the desired removal of it. We don’t just talk about the elephant in the room. We study her in minute detail. We build brand new scientific devices just to study her. So, to be fair to the Prime Minister, ‘Don’t get distracted by the border’ is at a surface level an important thing to hear. Especially as Northern Ireland’s new First Minister Michelle O’Neill has not been shy about putting a United Ireland firmly on the agenda in her first days in office.

Condescension from someone that knows more than you is challenging, but condescension from someone who knows less than you do really grates.

But what has grated the good people of Northern Ireland is that this sermon to not be distracted by constitutional change was delivered by one of the chief exponents of Brexit – the biggest constitutional upheaval for Northern Ireland in a generation. The time spent and the regulatory gymnastics involved in trying to do a job of Brexit damage limitation for Northern Ireland has sucked the political energy and life out of these last seven years in Belfast and beyond.

None of us enjoy condescension. It is that annoying thing that happens when people know more about a subject than we do and lord it over us. But what the people of Northern Ireland have had to endure in this last decade is being lectured by the Jacob Rees-Moggs of this world about the wonders of Brexit, when it became patently clear to most Northern Irish folks that not only had the particular challenges of NI not been fully considered but that even senior Brexit-supporting politicians didn’t actually understand the logistics how NI currently operated within the EU. Condescension from someone that knows more than you is challenging, but condescension from someone who knows less than you do really grates. And that’s only the nuts and bolts we’re talking about. Probably more detrimental was the ignorant blind spot around identity and psychology that was exposed. A palpable lack of knowledge was exposed regarding how the Good Friday Agreement combined with EU membership had created a remarkable ‘safe space’ in Northern Ireland where people who wanted to feel Irish could feel Irish and people who wanted to feel British could feel British. Condescension feels even worse when it seems that people don’t understand your circumstances or care about you.

The force(s) of darkness are not idiots. They don’t waste time for most of us tempting us with the big stuff. In short, they try to distract us.

So, I put it to you that the consequences of distraction can be large. Those of us with Irish DNA need to hear the challenge that our obsession with the border has led to us not loving our neighbour as ourselves and stolen decades of healthy existence from our island. But might it be wise to at least consider that the distraction of Brexit has stolen and may continue to steal decades of focus on climate change, strengthening family life, healthcare, immigration, economic justice, international peacebuilding, and maintaining local service provision from local councils. In short, ‘things that matter’.

The temptation is to see distractions as whimsical, temporary things. We think, “ah that quick scroll through Facebook or Instagram may make me less efficient, but it won’t kill me”. But that is exactly how temptation works. If you believe in an invisible battle between good and evil (and I do), then there are some dynamics that are worth considering. If there is a person or an impersonal force tempting me, then it is unlikely to tempt me to do things that are socially and culturally inappropriate in my world. I am not likely to be tempted to murder someone this morning. That would be an inefficient tempting strategy. But it would appear from the state of the world that whoever is in charge of tempting is actually quite good at it.

That’s why I believe we are more usually tempted not to swing dramatically one way or the other but by a small shift of the needle. Just a little bit more than the day before. Not tempted to kill someone but tempted to score that point in a social media discussion. Not tempted to rob a bank, but tempted to ‘creatively’ adjust small increments in our tax reporting. Not tempted to commit adultery, but tempted to linger too long in a conversation or on a website.

The force(s) of darkness are not idiots. They don’t waste time for most of us tempting us with the big stuff. In short, they try to distract us. Just a little wander off the main path. Won’t hurt anyone. Won’t take up much time. Except that habits form and unhealthy practices and opinions start to solidify, and ever-so-subtly the wheels may start to come off. Multiply that by a few million people and a whole country can end up hacking through gorse and bushes rather than driving on the track.

Sure, a marriage can be patched up after innocent distraction becomes a porn addiction, but there will be wounds and scars. We need to acknowledge and repent to allow healing. The people of Northern Ireland know all too well that real reconciliation needs the hard yards of repentance and forgiveness.

My prayer for the new Northern Ireland executive is that they can avoid further distractions and keep the main thing the main thing. At present only seven per cent of young people in Northern Ireland attend an integrated school. That means that the vast majority of people are growing up not getting to know kids from the other side of the religious divide. In that vacuum the fear, ignorance and prejudice can fester. Our own secret apartheid. That would be one place to start.

Speaking of which. Get back to work.

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.