Article
Character
Comment
5 min read

Work isn’t working, it’s killing us

We mistake the nature of work and our purpose within it.
Two people sit beside each other working on laptops, One looks askance to the other who frowns.
Resume Genius on Unsplash.

What is work for? In our individualist society we perhaps might zoom in on the minutiae of the specific role that we fulfil. Work is for the success of the company I work for, work is for building up my CV, work is to earn money enough to live, work is for seeing people I don’t have to live with. But what about work? The burden that humans have always had to gather enough resources to provide for themselves. We are mistaking the nature of work and our purpose within it, and it is beginning to kill us. 

Each of the recent generations have had different, and askew, attitudes to their work. Baby boomers- those who got a job and a sensible haircut in the 60s, conceived work as a contract. They worked well at almost anything and the reward was home ownership, resources to provide for a family, and saving for leisure. The purpose of their work is the lifestyle it creates. To some extent, their successors in Gen X had the same perception and the same contract- stick at any industry and the reward will be generous enough to make the graft worth it. 

But what happens when that contract is broken? When work no longer leads to those rewards? The Millennial answer is to seek out work that gives purpose, to accept the reward will not be fulfilling and so to find the purpose in the end of the work itself. Even if that means a lifetime of renting and scrimping, because the reward is not to be found in the payment. 

A slow generational drift from the true purpose and boundaries of work has left us confused about its point and struggling to engage. 

The Gen Z answer to this broken contract is the most fascinating of all; a reluctance to work at all. There is ‘quiet quitting’ whereby you do as little as possible whilst remaining employed, ‘bare minimum Mondays,’ and, of course, ‘lazy girl jobs.’ The purported aim of this generation is to find jobs where they can work from home, do almost nothing, and still receive a generous salary. Others are living the ‘soft life.’ They move in with mum and dad (usually boomers who have run the rat race and received the benefits of the contract) and do something creative part-time, earning little but doing little. It's a bit of the old baby boomer attitude seeking pleasure outside work but without the corresponding work ethic or career mindset. 

On top of this is the mental health crisis, which prevents many of Gen Z from working, with one in three non-graduates out of work with mental health conditions. Bosses receive calls from parents of those in their 20s explaining that their children are too unwell to work. 

I suggest that these things are linked, and a slow generational drift from the true purpose and boundaries of work has left us confused about its point and struggling to engage. We must look outside ourselves to understand what work was created for. In Genesis, the Christian origin story, God conceives work as a place of dignity and purpose. What Adam and Eve did in the garden mattered- they were the leaders of creation, and God even gave them the responsibility of naming other creatures. Humans were made to have responsibility, made to express this in their work. Even in the drudgery of repeated physical, administrative, or household tasks, we have the freedom to find purpose. We can take pleasure and pride in making things, fixing things, restoring things, even if just to the state they were in when we cleaned last week.  

Find the purpose in the making, fixing, restoring, the very task itself. 

The ‘quiet quitting’ of Gen Z or the dry contract of the boomers will not cut it. Even in jobs we don’t like, or tasks we find overwhelming, the same reframing is needed, perhaps even more so. Work itself brings purpose, and that is worth giving our whole selves to, otherwise listlessness and sadness will get us. We were made to find purpose and joy in the task of whatever is in front of us, no matter how simple. 

Millennials have swung the pendulum too far in the other direction. Yes, this generation have found the importance of purpose in their work. But only in work that has an end outside of itself. Work has been created with an internal, permanent purpose. Suggesting that meaning only comes from employment with obvious altruistic ends means that any other kind of work, domestic or employed, is devoid of this meaning. The same listlessness ensues in any role not found to have such an end. 

St Paul elevates work explicitly even beyond this created place of purpose. In his letter to a church in Colossae, he writes, ‘Whatever you do, work at it with all your heart, as working for the Lord, not for human masters.’ In other words, work is an act of worship, acting as if the task we are completing is for God, and putting the requisite effort in.  

Of course, this is a massive challenge. How many of us put as much work in to satisfy our bosses as we would if they were the ultimate director of our eternal destiny? But it does redeem those moments where we wonder what the point of what we’re doing is, who will see it, and if it is really worth doing properly at all. God sees. God knows. And that makes it worth doing properly. 

Paul also makes it clear here that work is not just what we get paid for. Work is everything we do that is not rest. Whatever we do - employed, at home, inrelation to our families. And this allows those who cannot work, in an employment sense, to take part in God’s purpose for humanity by working in a way in which they can. Whether it’s caring for a relative, nurturing a tiny veg patch, creating a piece of art, or hoovering the carpet. Find the purpose in the making, fixing, restoring, the very task itself. Do it as if God were watching. And feel yourself become more human. 

Article
Assisted dying
Comment
Politics
7 min read

Assisted dying hasn’t resolved Swiss end of life debates

Despite attempts to normalise it, new challenges still arise.

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.