Share some food and find the antidote to despair

Who we eat with says who we are.

Isaac Frisby

Isaac is a PhD candidate in Theology at Durham University and preparing for priesthood in the Church of England.

Three people stand beside a table and smile.

Lewisham Mayor Brenda Dacres with foodbank volunteers.

Lewisham Foodbank.

In my local supermarket a new foodbank collection trolley has appeared with this sign,

“Gift a toy this Christmas…give a gift this Christmas to those who need it most.”

Setting aside the usual ethical dilemma presented by the existence of foodbanks (why do they exist in such a wealthy country?), the sign prompted a thought on the nature of joy. What is more joyful than the surprise of an unexpected gift? After all, Christmas is around the corner, “Joy to the world!”.

That thought came to mind when I was recently asked; how do we cultivate and foster joy? If I’m honest I was a little stumped by the question. What even is joy anyway?

We can too easily and readily conflate it with lesser feelings like happiness or pleasure, which by their nature seem to be fleeting, like a chocolate bar: here one moment, gone the next. Thinking about it, joy seems to be thrown into relief when it is set against one of its opposites: despair. We all know what despair looks like; loneliness, isolation, a hopelessness which can yawn like a great dark chasm, without edges to get purchase on, or without a hand to hold.

Christmas can be an especially potent time for despair. The days are short and often dimmed by heavy cloud and rain. Children’s expectation that Santa will bring all of the latest goodies drives parents into debt to make their hopes come true. Those in dire straits will struggle to scrape together the food that goes into the usual Christmas feast. This combination of dark days and high expectations can and does drive many further into despair. It is this sense of aloneness, of the weight of the world heaped on your shoulders alone, which fuels despair.

This despair is not only reserved for Christmas. We see the climbing rates of anxiety, depression, and other mental health issues in the younger generations. Having been born into the age of the internet and growing up with social media, the temptation to compare with the heavily edited and curated lives of others, encouraged by the platform algorithms themselves, only serves to make young people feel increasingly alone.

This feeling is not helped by the propaganda of the age; that we are all rational, autonomous individuals, whose fulfilment looks like self-reliance, status, and wealth, without the need for anyone else. All this breeds the solipsism and nihilism that so often morphs into despair.

Foodbanks are the proof that this most basic constituent of joy is a struggle for many, from the sheer lack of food to share

What does this despair tell us about joy? If despair is in isolation, bearing our burdens alone, then joy is in being with other people. To return to that chocolate bar, if happiness (and perhaps the despair which comes from having no more chocolate bar) is scoffing it by ourselves, then joy is breaking off a part and sharing it with another. Human beings are naturally social creatures. It is in our very nature to live with one another. If we remain alone, closed off to others, then we nurture the despair that this breeds.

An incredibly simple way we remain connected to each other is by sharing food. If despair is the isolation from others then sharing food is the negation of this isolation. Sharing food is universally important, whether it’s the realpolitik of American high school films (the jock table vs the dork table and who’s allowed to sit with who, encapsulated perfectly by Mean Girls), or the mystical heights of the Christian eucharist. Who we eat with says who we are, with all the potential for exclusion the examples above show. But eating with others says what we are. Sharing food, especially in celebration at a time like Christmas, reminds us that our humanity is only ever shared. This reminder that we are not alone is not a fleeting happiness; it is a confirmation in our very flesh and bones that we are made of the same stuff, that we are never alone.

Many of us will have this joy as part of our everyday lives; foodbanks are the proof that this most basic constituent of joy is a struggle for many, from the sheer lack of food to share. The sign that appeared in my local supermarket is more proof that we already know how simple joy can be. Many foodbanks organise specifically festive food for this season, because we know that not only sharing food, but celebrating in that sharing is crucial to what it means to be human. Even in the morally mixed ecosystem of the foodbank, the need for joy shines through; sharing food in celebration is one of those antidotes for despair. In sharing our food we find our humanity, and what is more joyful than that?

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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.