There’s fear or fascination as cultures confront death

If Western society discussed death more openly, would Halloween’s appeal hold such sway?

Rahil Patel

Rahil is a former Hindu monk, and author of Found By Love. He is a Tutor and Speaker at the Oxford Centre for Christian Apologetics.

A bronze statue of a resting angel sits atop a low stone grave.

A grave in a Dresden cemetery.

Veit Hammer on Unsplash.

Watching Christians jump and sing “death is defeated” was a strange experience.

As a new believer in Christianity from a Hindu background, I was struck by how Christians approached death. While I had seen reincarnation as a path to heaven, I couldn’t understand why the church either hesitated to talk about death or celebrated it so intensely. Why were Christians sometimes dancing and other times, silent about death?

During my early years in Christ if ever the topic of death arose from the fun times I was having with Christian friends it was almost always met with a dead silence - excuse the pun. On one occasion, the husband of a close friend in our small church community had passed away due to cancer. I was one of the first to make a call to his widowed wife. When my friends heard that I had done this the response was unusual, “well done Rahil!” “That’s so good Rahil.” Strange. I was sensitive over the phone, but it wasn’t that hard. Then I asked the others if they were going to make a call and the response was equally peculiar, “erm, I can’t” or “I just can’t do that... ” Puzzling.

Recently, I came across the GodPod podcast, which shed some light for me on this hesitation. In an interview with Dr Lydia Dugdale about her book The Lost Art of Dying, a surprising statistic caught my attention: “In the 18th century, one-third of church sermons were about death and eternity.” I had to play that line back multiple times. In contrast, today’s sermons often focus on personal purpose, calling, or spiritual gifts. All important, but are we missing a vital balance—one eye on eternity, the other on our present lives?

Why didn’t the British or ‘international’ media film the funerals taking place in Britain? Why hesitate with death at home and yet have a somewhat fascination with it in the East?

This avoidance of death became even more apparent during the Covid pandemic. When the Delta strain hit India in 2021 it caused a massive widespread devastation and death. The funeral pyres were filling the sacred river banks up and down the country. At one point there was no more wood left to burn the bodies. It had run out! Urban crematoriums were overrun and so people left their deceased loved ones to simply float down the nearest river in the hope that the next life would be easier.

I followed the detailed footage of the funeral pyres and bodies choking various holy rivers. It was meticulously covered by the western media. Even PM Boris Johnson at the time cancelled his trip to India because the Covid death crisis was “out of control.” It’s Interesting how the western media flippantly assumed that death could be controlled. And then an eminent academic in India wrote a remarkable article for Project Syndicate. Brahma Chellaney’s opening paragraph was,

“When reporting on any mass tragedy, a basic rule of journalism is to be sensitive to the victims and those who are grieving. Western media, which double as the international media, usually observe this rule at home but discard it when reporting on disasters in non-Western societies.”

The author’s accurate observation demanded my attention. Why didn’t the British or ‘international’ media film the funerals taking place in Britain? Why hesitate with death at home and yet have a somewhat fascination with it in the East? Although Chellaney uses the concept of ‘grieving’ for his argument, there really isn’t such a spiritual concept across Indic faiths as Christianity knows of it. Of course, there is sadness and loss but grieving in the deep spiritual sense, not really. Is that why the Western media found it easier to cover death in the East? Because the secular (although Christian) West knows of the concept of grief so well at home? Or is it because the West do actually want to confront death without hiding and when they see other cultures do it so openly (and a tad bit casually) they are drawn to it? As morbid as it sounds (and I’ll do the British thing and apologise here) there might actually be a healthy interest with the way certain cultures embrace death that the west is seeking to find an expression for.

Brahmar Mukherji chaired the Department of Biostatistics at Michigan University. In an interview with the Carnegie Endowment for International Peace in 2021 she stated that India as a society sees death differently which is why the death toll along with so many other complex and practical issues was so high in that nation during Covid. They embrace it more easily. I am not promoting reckless behaviour around rules. One can’t play with a rattlesnake and then call it faith. My hope is that the reader finds hope when confronting death with a Christian lens. Why have themes of Euthanasia and Assisted Dying become such a big thing in the West and not in the East?

Which brings me to Halloween. It’s a leap, I know, but think about it: if Western societies and churches discussed death and eternity more openly, would Halloween’s macabre appeal hold such sway? Dressing up as a ghoul or a skeleton seems to be a playful, yet safe way to confront our fear of death—something we’re eager to do from behind a mask. That lighthearted, but jarring moment in the Barbie film comes to mind: “Do you guys ever think about dying?” Maybe that’s the real question we should be asking ourselves. Not just on Halloween, but frequently. How do we truly confront death—with fear, with fascination, or with the hope of something beyond?

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.