Article

Comment

Freedom of Belief

26 June 2023

7 min read

The right to believe – or not: how's the UK doing?

As the UN passes its first ever resolution on freedom of religion, Philip Mounstephen, author of the UK Government review, appraises progress on the issue.

Philip Mounstephen

Philip Mounstephen is Bishop of Truro and Founding Chair of the UK Freedom of Religion or Belief Forum.

A person stands in the burn out shell of a church in Nigeria.

The shell of a burned out Nigerian church.

Open Doors.

I had an unusual start to my Christmas in 2018 when I was rung up by the Archbishop of Canterbury to ask me if I’d be willing to lead a review of the way the Foreign Office had addressed - or otherwise - the persecution of Christians. It became clear that this was a request from the then Foreign Secretary, Jeremy Hunt, who was very moved by the issue and clearly concerned both about the human stories of Christians caught up in persecution, and worried that his department just wasn’t doing enough about it.

Six hectic months later, almost exactly four years ago, my review was published and the Government (and not just the Foreign Office) accepted my recommendations in full. So how has the UK got on with their implementation?

Before I address that, however, let me deal with two key aspects of my findings and recommendations which are vital for getting inside this issue.

First, I argued that the most effective way to address the persecution of Christians is to guarantee freedom of religion of belief for all – and that includes the right not to believe - and my recommendations were all framed around that conviction. To argue for special pleading for one group over another would be deeply un-Christian. It would also, ironically, expose that group to greater risk, by isolating them and unintentionally portraying them as agents of the West. We must seek freedom of religion of belief for all, without fear or favour.

Second, we need to understand why this is a such a serious issue in today’s world.

If you lift the stone of persecution and look underneath, what is it that you find? You find authoritarian, totalitarian regimes that are intolerant both of dissent and of minorities; you find aggressive militant nationalism that insists on uniformity; you find religious zealotry and fundamentalism in many different forms that often manifests itself in violence; and in contexts where governments are weak you find gang welfare on an industrial scale driven by drug crime. And you often find those phenomena combined too. In other words, we find massive threats to human flourishing and harmonious communities and ultimately we find in those things significant threats to our own security as well. We can no longer say that this is a sidebar issue of a special interest group. These are huge issues that we face in the world today.

And, the global situation as regards freedom of religion or belief is getting steadily worse, not better, not least in the world’s two most populous countries, China and India. It has certainly worsened significantly since my Review reported. It’s for that reason that the last of my recommendations was that implementation of them all should be independently reviewed three years on from their acceptance. That piece of work was published last summer, just before the UK hosted a major International Ministerial Conference on this issue.

So what did the reviewers conclude? To quote their report:

There has been a positive overall response to the Recommendations, with active steps being taken towards implementing an overwhelming majority of them. However, some of those steps have been taken relatively recently.

I think we can unpack that statement a little. What does ‘There has been a positive overall response to the Recommendations, with active steps being taken towards implementing an overwhelming majority of them’ mean? It means what it says, but it also means that a number of recommendations are in the process of being implemented, but have not yet been completed. And of course it also means that some recommendations remain to be implemented. And what does ‘some of those steps have been taken relatively recently’ mean? Well, it might imply that there was a certain rush of action in the light of the review team’s work being undertaken – all of which underlines the wisdom of including that final recommendation in the first place.

Also of note is the response that the then Foreign Secretary, Liz Truss, made to the reviewers’ work:

We welcome and accept this expert review on progress and in line with the findings, accept their assessment for the need to continue to work to promote and strengthen Freedom of Religion or Belief as a fundamental human right for all…

The independent assessment concludes that the majority of the recommendations are either at an advanced stage of delivery or in the process of being delivered, whilst noting that there is still more to do.

Those skilled at reading statements such as this will point out to you the significance of the Foreign Secretary not just welcoming but accepting the findings. And note too the force of that phrase whilst noting that there is still more to do.

And, as I said, that assessment of progress was published just before the UK hosted the International Ministerial Conference last year. And a great event it was. Through it the UK put down a significant marker as to the significance it attaches to this issue. And we have also taken a leading role in the recently established inter-governmental International Religious Freedom of Belief Alliance, with Fiona Bruce MP, Prime Minister’s Special Envoy for Freedom of Religion or Belief currently holding the chair. I take no personal credit for this, but I doubt that either the UK would have hosted the Conference or that Mrs Bruce would have chaired the Alliance had not Jeremy Hunt launched the review – a review which earned him very few political ‘brownie points’ – four and a half years ago.

And yet not all in the garden is rosy. There has been a marked reluctance in some parts of the Foreign Office to recognise the religious dimension in some contexts.

Consider the approach that had been taken to the Middle Belt of Nigeria and the phenomenon of the conflict associated with the Fulani herdsmen. The standard Foreign Office line has been that this is an old conflict between contrasting lifestyles exacerbated by climate change. In other words, the religious dimension is significantly underplayed. A year or so ago the then relevant government minister claimed in a letter to be ‘unaware of substantiated evidence that extremist Islamist ideology is a driver of intercommunal attacks’. I’m afraid that is so completely at odds with the evidence, including that cited in my Review, as to be literally incredible. And, of course, if the Foreign Office claims there is no religious component to the violence they will fail to come up with religiously literate responses to it.

Happily, however more recent statements, in a clear change of tack, have begun to recognise the religious dimension to this unfolding tragedy.

Or take the recent violence in the Indian state of Manipur, with hundreds of churches targeted and destroyed, several killed and thousands displaced. Foreign Office replies to Parliamentary questions about it have been anodyne in the extreme. They remind me of the egregious attitude of the East India Company 250 years ago which protected trade at any price, even in the face of human rights abuses they could otherwise have addressed. Plus ça change.

However even as this article was being written there’s been a further and very significant positive development. Recommendation 20 of my Review called for the UK to sponsor a UN Security Council resolution on this issue. The panel of experts who reviewed implementation last year were not optimistic that it could be achieved. However, on 14 June 2023 the Security Council adopted resolution 2686, a UK-UAE joint resolution on tolerance and religious freedom. Its text addresses growing concern at hate speech and incitement to violence, and calls for action on the persecution of religious and other minorities in conflict. This is the first ever Security Council resolution on this issue, putting it firmly on the international geopolitical table.

In the UK, as elsewhere, we need to recognise that a commitment to freedom of religion or belief is not a ‘nice to have’ in today’s world, additional to the hard world of realpolitik. Not at all it. It touches upon and highlights some key issues in today’s world such as the rise of fundamentalist, nationalistic and authoritarian regimes of all kinds the world over whose treatment of vulnerable minorities is often not short of appalling and whose actions threaten not only the lives and livelihoods of those minorities but also threaten to destabilise international order, increase insecurity, (including food insecurity, as we have seen in this last year) and make it all the harder to address big ticket global issues such as climate change.

Indeed I believe that the wholesale denial of freedom of religion or belief is just one such a big ticket item and I hope and pray we remain sensitised to this issue and appreciate the vital importance of all of us, governments, churches, other faith groups, civil society, and individuals, addressing it with the seriousness and urgency which it undoubtedly requires.

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.