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.

Article

Belief

Church and state

Comment

Nationalism

Politics

3 September 2025

5 min read

Sorry, Danny Kruger, a Christian nation is a bad idea

Quite simply you cannot build a nation-state on the teaching of Jesus

Sam Tomlin

Sam Tomlin is a Salvation Army officer, leading a local church in Liverpool where he lives with his wife and children.

An English flag flies on a church tower.

Different Resonance on Unsplash.

Danny Kruger has become one of my favourite politicians in recent months. His contributions in parliamentary debates on assisted suicide and abortion have endeared him to many Christians including myself as he has led the charge (along with other notable parliamentarians and thought leaders) against what has been dubbed the ‘parliament of death,’ exposing the shaky ethical foundations on which they lie.

He entrenched this reputation with many Christians with a recent speech on the ‘Christian foundations’ of England (‘out of which the United Kingdom grew’) and a passionate plea to recover such foundations. This speech went viral in Christian circles as it articulated the aspirations of many to re-establish Christianity as a national force, specifically in the physical representation of power, the House of Commons. The speech ticked all of the ‘Christian nationalist’ boxes: Christianity should be the ‘common creed’ of the country; England was founded ‘uniquely among the nations’ on ‘the basis of the Bible’; it is the ‘oldest Christian country’; ‘the story of England is the story of Christianity operating on a people.’ A remarkable set of claims to make the butterflies flutter in any Christian’s stomach, surely?

This vision of a ‘Christian nation,’ however, typically represented by Kruger is based on an understanding of Christianity which bears little resemblance to its central character: Jesus. There is much talk of ‘nationhood’ and ‘biblical values’ in such thinking, but tellingly little about Jesus himself (Kruger’s speech makes one passing reference to him). The reason is not complicated. Quite simply you cannot build a nation-state on the teaching of Jesus.

Every nation-state (including England, the ‘prototype’ of such a concept, according to Kruger) was formed though violent subjugation of rival tribes and narratives, establishing a monopoly on the means of legitimate violence to centralise power for princes to wage war and protect private property. Jesus’ commands to love one’s enemies, pray for those who persecute you, not resist evildoers and give away possessions are not simply an inconvenience to such a programme, but are profoundly impractical. Like an embarrassing and awkward family member turning up uninvited to a wedding, they stand opposed to a ‘civilisational Christianity’ which seeks to be the ‘chaplain of nations’ as Kruger suggests, resisting any attempt at baptising and polishing a version of what remains Machiavellian statecraft.

These two forms of Christianity are in fact little more than two sides of the same coin and there is a more fundamental distinction to be made.

Like a cricketer putting on extra padding to face a fast bowler, Christian ethics softens the blow of such radical expectations by suggesting that Jesus can’t really have meant what he said, especially for modern, enlightened folk today. Perhaps Jesus expected the Kingdom of God to arrive more quickly than it did and as time progressed, we needed a more practical ethic. Not wanting to abandon Jesus, his teaching is reduced to general ‘values’ like ‘love’ or ‘justice,’ the content of which in fact become the precise opposite of what Jesus taught. ‘Jesus may have said to love enemies, but we will be less safe if we do, so we had better kill them.’ ‘Jesus may have said not to love money, but our economic systems which seem quite good at alleviating poverty rely on this, so greed isn’t so bad.’

It may sound as if I am opposing Kruger’s vison for the alternative option in the culture wars. It is often suggested that there are two ‘Christianities’ at work in the West: one represented by Kruger might be called the ‘Christian right,’ which emphasises family values, patriotism and the importance of place, the other (at which Kruger takes aim in his speech), a left-wing or ‘woke’ Christianity which stresses welcoming the stranger, economic justice and identity politics.

This is a red herring, however. These two forms of Christianity are in fact little more than two sides of the same coin and there is a more fundamental distinction to be made. For while they might disagree on content, the method is remarkably similar. Left-leaning Christians may disagree with Kruger on his definition of a Christian nation but would uphold the desire for the nation-state to be founded on values they consider Christian. The common assumption is that Christianity is a ‘civilisational’ force, ideally enacted by Christians and their narrative taking hold of the levers of power and influence and dominating the ‘public square.’

If Jesus’ teaching is not supposed to be embodied by the nation-state, however, what is its purpose and does this not leave the public square to malevolent forces, as Kruger suggests? Jesus’ teaching is indeed directed at a particular body of people who are supposed to embody it publicly, and that is the community explicitly committed to follow and structure social life around the living presence of Jesus; this is the church. The New Testament even suggests the language of nationhood is appropriate for this body as a new nation is being formed around the person of Jesus who commands the allegiance that modern nation-states claim for themselves.

Kruger’s vision of the Church of England’s parish system is where ‘we are all members, we all belong, even if you never set foot in your church from one year to the next, even if you don’t believe in its teachings, it is your church, and you are its member.’ This is a million miles away from the vision of the New Testament where entry into this newly formed community implies active repentance and a collision with the ways of the world represented by mere ‘values.’ If that makes me part of ‘another eccentric denomination’ according to Kruger, then so be it.

To suggest that this alternative vision cedes the ‘public square’ to malevolent forces also betrays a lack of imagination around the public nature of the church. It is assumed that if Christians retreat from the ambition to explicitly and directly make our nation-state Christian then we relegate our religion to the realm of the ‘private’ and succumb to the worst elements of Enlightenment fears about religion in the public square. The earliest Christians had no explicit desire to ‘transform the Roman empire and make it Christian’ but simply took Jesus at his word on wealth, forgiveness, welcome of the stranger and proclamation of salvation and the life made possible by Jesus’ death and resurrection. This was their public witness and it just so happened that it utterly transformed the communities in which these followers of Jesus were situated at the same time. This vision certainly has a place for Christians engaging in politics as Kruger has in debates on assisted suicide for instance, exposing the shaky foundations of any form of life not founded on the life made possible in Jesus. This is most appropriately done, however, without reaching for language that implied the state has salvific qualities, language Christian teaching rightly reserves only for God himself.

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