Article

Character

Ethics

General Election 24

Politics

Trust

8 July 2024

7 min read

The problems Keir Starmer faces are not just political - they are spiritual

His greatest battle may be the fight for our trust.

Graham Tomlin

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

The beginning of a new government is a bit like the beginning of a new football season. Nothing yet has gone wrong. The future seems full of promise. The grim memory of last season is in the past. Hope is in the air.

Keir Starmer, in his early speeches as Prime Minister, sound some familiar notes. He speaks of “a weariness in the heart of a nation, a draining away of the hope, the spirit, the belief in a better future that we need to move forward together.” While not quite Margaret Thatcher’s invoking the spirit of St Francis in 1979, Sir Keir was reaching for something deeper than the practicalities of politics, for bigger themes, more resonant ideas. Yet there was one note that caught my eye, not just in these speeches but also before that in the election campaign – a theme that cropped up often – the need for trust.

On the day after the election, when the confirmation came through that Labour had won, in an early morning speech to supporters delivered at the Tate Modern, he said this: “Make no mistake, this is the greatest test for politics in this era – the fight for trust is the battle that defines our age.”

Keir Starmer has put his finger on something. As Martin Kettle in the Guardian put it, “Whether you approve of Keir Starmer’s election strategy or not, it is a matter of observable fact that he has centred it upon the regaining of trust.” The Labour manifesto claimed that “over the last 14 years, trust in politics has been shattered.” It went on: “sleaze and scandal have eroded trust. Just as corrosive has been the inability of politicians to keep promises made to the British people.” Among the main reasons the Conservatives were roundly rejected were the actions of Boris Johnson’s inner circle, who partied in Downing Street while families were avoiding each other and staying away from their parents’ funerals (I know – I was one of them). I'm not sure that he and his party realised how corrosive and damaging that was to public trust in government and the Conservatives in particular. Perhaps now they know.

Trust is built when politicians keep their promises and deliver what they say they will over the months and years. It wilts in the presence of political in-fighting, bets placed by election candidates, or unfulfilled boasts to save the NHS.

Hope and trust are vital things for human life. We cannot live without them. And it’s not just in politics. The Church of England has had its own troubles with trust in recent times. A report, debated at General Synod, lamented the lack of trust in the Church, setting it in the context of a general lack of trust in institutions in our society.

Starmer understands that trust has to be earned. “This lack of trust,” he said outside No 10 Downing Street, “can only be healed by actions not words.” And trust takes time. Trust is built when politicians keep their promises and deliver what they say they will over the months and years. It wilts in the presence of political in-fighting, bets placed by election candidates, or unfulfilled boasts to save the NHS.

However, to be fair to politicians, trust has not only to be earned, it also has to be given. And we have become less trusting as a nation. The IPSOS Trust Index reveals that politicians, the media, bankers and advertising executives are our least trusted institutions. An ONS survey in 2023 revealed that trust in political parties, the media, local government, and international organisations was at its lowest level for years. A survey of over 36,000 interviews across 28 countries revealed “a world ensnared in a vicious cycle of distrust, fuelled by a growing lack of faith in media and government. Through disinformation and division, these two institutions are feeding the cycle and exploiting it for commercial and political gain.”

To break what it called the ‘cycle of distrust’, it recommended demonstrating tangible progress, focussing on long-term thinking and providing credible information. Yet I wonder if the problem lies deeper than that.

Trust is a habit. It is like a muscle. The more you exercise it, the more it tends to grow. Yet the paradox of trust is that without trustworthy objects in our lives, it becomes hard to exercise that muscle. A child growing up with parents who regularly deceive and lie to him, promising but not showing up to sports events, hinting at presents that never actually turn up, quickly learns that trust doesn't work. The disappointment is too great to bear. Cynicism works better. He learns to take everything with a pinch of salt, to be wary of promises, and that a guarded attitude where the default position is not to believe is a safer option.

In a broken and fallen world, trust is a fragile thing. Some people and institutions will be more trustworthy than others, but even the best will get things wrong...

The problem politicians face is that politics, as they say, is the art of the possible, and along the way, whether due to financial constraints, or the need to do deals with allies, political opponents, or (more likely for Starmer, given the size of his majority) within your own party, compromises have to be made, promises ‘re-aligned’ if not actually broken, which is where distrust starts to creep in. Nick Clegg famously made a promise that his party would never increase student fees, yet in the cut and thrust of actually having to govern, he had to break that promise, and his version of the Liberal Democrat party never recovered.

A little while ago, I interviewed Esau McCaulley, an African-American theologian and New York Times columnist with a fascinating backstory. His childhood in the backstreets of Alabama was complicated by an intermittently absent and unreliable father, whose promises were broken again and again. Esau learnt to approach the world with wariness, burned by broken promises. Yet somehow, through the determination of a good mother and the steady influence of a local church, he learnt to trust again. As he put it: “others must own their scepticism, and I my trust, both of which arise out of deeply held convictions about the nature of reality.”

Like Starmer, McCaulley has put his finger on something. The question of whether or not we believe ultimate reality can be trusted lies beneath our cultural tendencies towards trust or mistrust. Ultimately, trust needs a transcendent object. In a broken and fallen world, trust is a fragile thing. Some people and institutions will be more trustworthy than others, but even the best will get things wrong and when those people and institutions that we have trusted implicitly let us down, it is the hardest fall of all.

Judaism and Christianity, in particular the latter, have made a big deal about faith and trust. The Bible is not a list of pithy, timeless aphorisms, but consists of a story across time – and as we saw, trust takes time. One of the central characteristics of the God of the Christian Bible is faithfulness across time. It tells the story of a God who makes a world with a regularity that can be trusted, where the sun rises and sets, light follows darkness, where the fluctuations of a dynamic planet are contained - hence the symbol of the rainbow as a sign that God will not ultimately destroy his creation. When the creation is disrupted by a primeval act of rebellion by the very species that was intended to care for the creation, God promises to send a rescuer from out of that very species to redeem it, a promise fulfilled in Jesus Christ. It then promises the as-yet-unfulfilled hope that the world will one day be healed and brought to its fullness. We do not yet see that, but on the basis of promises previously kept, we are invited to trust. The narrative arc of the Bible is a story that is designed to inculcate trust.

Contemporary spirituality does not have such a focus on faithfulness in time. An appeal to ‘find our spiritual centre’, to ‘accept the present moment’ may bring a temporary sense of peace and serenity. It doesn’t rebuild trust. Because trust, as Keir Starmer has recognised, is built slowly over time by trusting in someone who proves themselves trustworthy.

Having such a transcendent horizon of faith tends to build the muscle of trust. It turns the dial from the default of distrust to that of trust. It becomes just a little easier to handle the disappointments of broken promises in this world because ultimate reality can be trusted.

All this tells us that the deepest problems we face as the new government begins its work are not just political - they are spiritual. I for one hope and pray that Keir Starmer's government will be as trustworthy as he hopes it will be. It would be wonderful if they can rebuild a sense of trust in politics. But there are limits to what politics and politicians can do. They cannot ultimately heal our hearts from the damage done to our ability to trust. Only a faithful God can do that.

Starmer is, well known as an atheist. In seeking to build trust, he has hit the right note. In identifying trust as the key issue of the day, he is perhaps unknowingly reaching out for the God he doesn’t believe in, but who builds trust in those who do.

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.