When tradition deserves a break

Upsetting a convention caused uproar, so is it right to break with tradition?

Yaroslav Walker

Yaroslav is Vicar of Christ Church, Hampstead.

A robed and seated man, in a speaker's chair talks and gesticulates.

The House of Common's Speaker.

Parliament TV.

“Nearly a quarter of a century has passed since a speaker of the Commons stood down from its high chair with dignity and to applause.” Thus wrote Andrew Rawnsley in the Guardian this Sunday. Last week the House of Commons erupted. An unedifying lava-spew of recrimination and anger flowed through the corridors of power as the Speaker of the House, The Right Honourable Sir Lindsay Hoyle, broke parliamentary convention to the seeming benefit of the Labour Party. Memories of his predecessors’ playing fast-and-loose with Parliamentary procedure pushed buttons. The SNP’s Gaelic fury founded a flurry of calls for the Speaker to step-down, and it was not until he gave a near-tearful apology that some calm seemed to be restored. Opponents cried foul - ‘how dare he upend the conventions of the House!?’ - while supporters jumped to his aid - ‘he was just trying to protect MPs from further harassment over the Israel-Gaza debate!’ - and everyone was unhappy…

The technicalities of this convention (that multiple amendments are not called upon for voting during an Opposition Day Debate) are less interesting to me than the fact that the convention exists. ‘Convention’ is another word for ‘tradition’. Traditions are important. Our famously ‘unwritten’ Constitution relies heavily on tradition, especially for the smooth running of Parliament. Rather than having the process of legislating and governing micro-managed with procedural minutiae, the Commons operate on the basis of nurturing and conforming to its traditions. In essence, the House of Commons operates on the basis of respect - by respecting the traditions of the House, Parliamentarians grow to respect each other as fellow followers of tradition. Exterior action builds-up interior disposition. Practice influences sentiment.

At least, that’s my romantic take on it. Traditions give some coherence to a society - from the society of elected MPs right through the society of a nation - and allow it to flourish. Traditions bind people together. Traditions unite. You may come from a different part of the country than your neighbour, have different family values, have a different religion or skin-colour or education-level, etc…but you can be united in the traditions you follow. Whether it’s having a roast on a Sunday, going to a Carol Service in December, singing Three Lions in a World Cup year, the traditions you share despite all other differences give you a common cause with those around you.

This is not to say that traditions can’t have a dark side. Some traditions can alienate guests. Some traditions can stifle creativity and innovation. Some traditions can be maintained purely to bamboozle the uninitiated for the benefit of those in the know. In extremis, some traditions can lead to groupthink, to the othering of those who don’t share them, to jingoism and hatred; St Paul wrote that it was the zeal for the traditions of his fathers than led him to persecute the first Christians. Traditions should never be taken for granted or left unexamined. Traditions are roses - beautiful and sweet-smelling, but always in need of pruning. But let the gardener prune carefully - you want some roses left for the garden.

When the scribes and Pharisees try to trick and trap Jesus with impossible thought experiments, they often quote their traditions. Jesus always wins the debate. He wins in the face of their traditionalism. He wins by being a radical. RADICAL! His radicalism is not marked by the abandonment of the concept of tradition, but by deep respect for it. The Sermon on the Mount is probably the most famous speech about the importance of tradition - “You have heard that it was said to those of ancient times…But I say to you…” - keeping the traditions of God in the face of the self-serving traditions of men. The scribes and the Pharisees are the White Witch to Jesus’ Aslan: ‘“It means,” said Aslan, “that though the Witch knew the Deep Magic, there is a magic deeper still which she did not know. Her knowledge goes back only to the dawn of time.”’

Not every critic last week will have genuinely cared about the traditions of the House of Commons. Many will have mouthed the words but would have happily stood by if the breaking of convention benefited them. Nevertheless, we must take tradition, and it’s breaking, seriously. Traditions nurtures the relationships of MPs. Traditions nurture the relationships of neighbours and fellow citizens. Traditions nurture relationship with God, as the traditional rhythms of religious practice and Church seasons help order prayer and worship. Perhaps we’ll look back on the upturning of this particular Commons tradition and recognise it as the right rejection of an outdated convention…but let's be cautious. Traditions are important. Break them with care.

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.