For want of better words... the impact of the indescribable

Confronted with a question about belief, Henna Cundill found herself stumbling for words. She contemplates the link between our self-identity and what we can communicate.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A woman stops in her stride down a street and pensively runs her hand through her hair as she looks to the side.

Joseph Frank on Unsplash.

I recently got into conversation with a young man who asked me, “Do you believe in God?” When I replied, “Yes,” I almost regretted it, because his next move was to ask, “Why?” and I found this question troublingly difficult to answer.

Of course, I could have dredged up the old philosophical arguments for the logical existence of God – but none of that would have really captured the thing I have no words for. Belief is like… Oh, what is it like? A glitch… no, a glimmer… no, like a glimpse of… No. Goodness. What is it? I’m lost for a word or even a metaphor that will somehow express what it feels to say “yes” and “I believe in God” and in that moment, even if only for a moment, to feel oneself transported or transposed out of this tiresome, human existence and into something that is... well, it’s something…

I think it's fair to say that conversations about believing in God are unusual these days, especially when the circumstance is an 18-year-old lad talking with a woman in her late 30s – albeit the lad in question was a philosophy undergraduate and we were at Cumberland Lodge, where such conversations are welcomed amongst those of all faiths and none. Even so, it still felt rather unusual to be asked a question like that, not out of hostility but just casually over dinner, and to see him genuinely and respectfully interested to hear what I might have to say in response.

Eventually I did come up with some kind of an answer; I can’t remember what. And naturally, I turned the question back on him. Turns out he did believe in God, in fact he was Jewish, so he stumbled out some kind of answer too, but I think it's fair to say that he was hardly more erudite than I was. Eventually, we both agreed that it was rather difficult to describe the indescribable, and our conversation turned to rather easier topics - the food, the weather, geopolitics...

There is a loneliness to the feeling that there is a bit of ourselves that cannot be valued because it cannot be shared, and it is hard to recognise a part of our inner world as ‘real’ and valid if it cannot be communicated and affirmed.

The question of believing in God was done with. Yet here I am weeks later, still pondering why it was so hard for me to articulate what it means to live with that belief, and why that part of the conversation ended, but still felt so unfinished.

Has faith always been so indescribable? I suspect it rather has not. These dark evenings always tend to lure me to my bookshelves, seeking out my “comfort books” that I read and reread year after year. Mostly cosy fiction of course, but alongside those, a non-fiction favourite is Sheila Fletcher's, Victorian Girls: Lord Lyttleton’s Daughters. The book is a fascinating study of a family of young women in the Victorian era, faithfully compiled from their own real letters and diaries, so that the voices of Meriel, Lucy, Lavinia and May Lyttleton themselves can all be heard clearly on every page. I just love to read this book over and over again, entering into the hopes, sorrows, loves and ambitions of these young women – so similar and yet so different to my own.

One thing that stands out particularly is how clearly and easily they each articulate their sense of faith. They were, of course, heavily schooled in Victorian public piety, but there is most certainly a real faith there too. A favourite passage of mine is an excerpt from the teenage diary of Lucy Lyttleton, recounting the day of her Confirmation. She speaks of a ‘nice and stilling’ drive to church, with her parents either side in the carriage, and then:

I seem to remember nothing very distinctly till I went up and knelt on that altar step, feeling the strangest thrill as I did so… and I know how I waited breathlessly for my turn, with the longing for it to be safe done, half feeling that something might yet prevent it.

Oh, to be so thrilled by a religious ritual, and to have both the words and the courage to write about it. After all Lucy, what if someone might be reading your diary 150 years later?

In mainstream society nowadays, most of us simply don't talk about faith, religion, and what it all means to us personally in that way. It’s not the done thing in a (presumed) secular society. Consequently, it is now very hard to write about it too. Yet, many philosophers in the past century have observed a link between our self-identity and what we can communicate. For example, philosopher Charles Taylor describes how our sense of ‘self’ is formed in “webs of interlocution” wherein what we take to be “good” relies on what we can effectively talk about, and thus have affirmed by those we talk to. If we turn Taylor’s idea around, might we say that when there are parts of ourselves that we cannot talk about, parts for which we cannot find social recognition and affirmation, then we cease to value those parts of ourselves as good, or may cease to recognise them at all?

With that comes a sense of isolation. There is a loneliness to the feeling that there is a bit of ourselves that cannot be valued because it cannot be shared, and it is hard to recognise a part of our inner world as ‘real’ and valid if it cannot be communicated and affirmed.

To me it feels that, as we talk about faith less and less, and as the language of faith becomes ever more confined, not even just to private conversations but to our own inner worlds, our “webs of interlocution” are beginning to shrink and disintegrate – until believing in God can feel more like dangling on a loose and solitary strand than being part of any kind of web. It’s a lonely place to be – there is a part of me that feels important, but no one can affirm it.

And yet, by simply asking the question of each other, and being ready to listen respectfully to whatever answer was forthcoming, it seems that me and a teenage lad managed to connect two lonely strands together. It was of no consequence that we worship in different faith traditions, or that neither of us really found the words to say what we wanted to say – a conversation took place, and a certain web of interlocution started to form. For some, reading this, there may be a feeling of resonance, or a moment of understanding, and perhaps that too adds a little to the web, as different people’s words and thoughts and experiences begin to connect across different times and places.

Webs do more than just create connection; webs capture things too. Perhaps, as this web spreads between different readers and thinkers and speakers, that’s what will happen to this question of believing in God. After a certain point, such a web may even become large enough and robust enough to finally start to capture some useful words, or an apt metaphor, that will really help me to say something about what it means to have faith. To be able to say it is to be able to share it, and in these lonely times, being able to say something is really not nothing.

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.