Article

Comment

Politics

Suffering

20 July 2023

6 min read

Why begging ‘bothers us tremendously’

We need a public discussion on begging which avoids the unhelpful polarization between naïve compassion and harsh cynicism, argues Jon Kuhrt.

Jon Kuhrt

Jon Kuhrt is CEO of Hope into Action, a homelessness charity. He is a former government adviser on how faith groups address rough sleeping.

A beggar sits cross legged against a glass railing holding a sign.

Photo by Jean-Luc Benazet on Unsplash.

Recently I was in Birmingham New Street station when a man approached me, saying he was homeless and asking for money for food. We were right next to a Greggs so I suggested I buy him some. As there was a queue, we got talking and he said:

‘I’m not really homeless you know, I’m just so bored and I live in a s**t-hole.’

For many people living or working in towns and cities, being asked for money like this is an everyday experience. It can often cause feelings of distress, guilt and confusion. What is the best way to respond to someone asking you for money? In thirty years of working with people affected by homelessness, it is by far the most common question I have been asked.

Earlier this month, Matthew Parris wrote in The Times about his experience of giving £25 to someone begging after being told they needed money for an urgent train ticket. The following week he saw the same person using the same story and he realised that he had been suckered. It is an experience that many of us might relate to.

I used to be the manager of an emergency hostel for young homelessness people in Soho in central London. Most of our residents had complex problems which were complicated and intensified by drug addiction. Begging was a key source of income.

Some residents used the duvets that we gave them as begging props to indicate they were sleeping rough. We would often overhear them telling passers-by that they ‘needed money to get into a hostel’. Often, they could raise large sums of money based on their articulated need for food, accommodation or travel. But none of the money was ever used for these purposes.

Matthew Parris is right when he writes ‘begging and sleeping rough bother us tremendously.’ They are some of the most obvious and visceral indicators of poverty and this ‘bother’ gives the issue considerable political capital. As Parris says:

'Any minister or prime minister who could associate their name with making a visible difference would reap a harvest.'

We need a compassionate realism about the nature of the problems which surround those who beg and honesty and bravery about how best to respond.

But as well as high profile, homelessness and begging are both very sensitive issues. Thankfully, gone are the days in the 1980s when newspapers like The Sun would routinely describe those who sleep rough and beg as ‘dossers’. Today, the public discussion is couched far more sympathetically, but this change in tone can create difficulties in talking honestly about the reality of begging. It can be a minefield where those cautioning against giving money can easily be viewed as mean-spirited or judgmental.

We need a public discussion on begging which avoids the unhelpful polarization between naïve compassion and harsh cynicism. Neither of these help anyone. And we should remember, that whilst we should avoid judgementalism, we cannot help people effectively without showing good judgement. We need a compassionate realism about the nature of the problems which surround those who beg and honesty and bravery about how best to respond.

We live in a time of severe economic and housing injustice. The years of austerity, cuts to public services, the pandemic and now the cost-of-living crisis have all deepened the challenges for poorer communities. Our country urgently needs to address the chronic shortage of affordable housing.

But does this rise in wider poverty mean that we should give money to people begging? My answer is ‘No’, because I don’t believe that it is an effective way to help people. These are my reasons.

The material need and physical destitution are symptoms of the deeper issues of trauma, poor mental health, broken relationships and the addictions.

Firstly, it is important to remember that the issue of rough sleeping and begging are related but are not the same. Many of those who beg are not sleeping rough, and the majority of homeless people do not beg. In fact, begging has much more of a direct link with addiction or criminal gangs than it does with rough sleeping. In the last 10 years there has been a growth in the coordinated use of immigrants, many trafficked, to beg in city centres. Your cash donation will not truly help the person.

Secondly, we need to appreciate that immediate material resources are not the key problem for people begging. Whilst there is a deepening crisis of poverty in the UK, there are many day centres, charities and community groups offering emergency food and clothing. The material need and physical destitution are symptoms of the deeper issues of trauma, poor mental health, broken relationships and the addictions which have developed in response. These deeper problems are often compounded, rather than helped, by gaining money through begging.

Thirdly, we need to focus on the true needs of the person begging rather than on our need to respond. Our feelings of awkwardness and guilt may be assuaged by handing over money, but this does not mean that what we have done is right. The temporary ‘feel-good feeling’ is not to be trusted. If more people gave money to people begging then it will not result in a more just world. Allowing untruthful and manipulative behaviour to succeed in eliciting cash helps nobody. It can literally be ‘killing with kindness’.

Fourthly, we need to recognise the lack of truth in the exchange between someone begging and a potential donor. Often a scenario presented is designed to place emotional pressure on the hearer to do what is being asked. For example, that money is needed to pay for a hostel bed, to get a hot meal or travel money to see an ill child. But hostels and shelters for homeless people do not charge on the door - they are either free or the rent is covered by housing benefit. In my experience, the vast majority of the scenarios presented in the begging exchange are simply not true.

Underneath these points are key principles around how we help others. Despite the retreat of Christian faith in public life, the injunction to ‘love our neighbour’ is still a foundational one in our society and culture. And authentic love is always made up of both grace and truth.

Our instincts to show compassion and care are part of what makes us human. We are moved and motivated by seeking to address suffering and hardship. We have a desire to show grace to those suffering.

This does not mean being cynical. Authentic change is possible, and I see it every day.

But this grace must remain connected to truth. We must take responsibility for how our instinct to show grace can be manipulated. The reason that begging is never a positive aspect of someone’s recovery journey is because it is a transaction rarely based on truth.

We may long for a simplistic world where good intentions are enough and where all donations given in good faith are well-used, but this is not the world we live in.

This does not mean being cynical. Authentic change is possible, and I see it every day at Hope into Action. We help people who have been homeless by offering them a quality home with both professional support and befriending in partnership with a local church. Last year we housed over 400 people and it’s a privilege to walk with people and help them on their journey of recovery. One of our tenants said to me:

‘Hope into Action didn’t just give me a ladder to get out of situation, they showed me how to build my own staircase.’

The best services for homeless people show grace in their acceptance and welcome, but from this base they explore the truth about the challenges people face. And truth is a key ingredient in all effective recovery, counselling and rehabilitation programmes.

Change is possible but truth is always a critical ingredient. It’s the truth that sets people free.

How should we respond to someone begging?

When someone begs from you, look them in the eye when you respond and speak as confidently as you can.
If you have time, stop and talk with them. Ask them their first name and share yours.
If you have the time and money, offer to buy them a cup of tea, or some food.
Research what drop-in centres, charities or churches are open for vulnerable people in the area where you live or work. Knowing what is available allows you to ask the person if they know about these and whether they have used them.
If you are worried about the vulnerability of someone sleeping rough then contact Street Link on 0300 500 0914 to inform them. This is a coordinated phone line which informs the local homeless outreach teams.

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.