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.

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Truth and Trust

13 November 2025

6 min read

The BBC and the quest for Truth

Space for neutrality is shrinking; two French philosophers explain why

Graham Tomlin

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

BBC.

Watching American news always feels very different from the British version. Changing channels from CNN to Fox News feels like you're switching to a different universe altogether, as on each one you're getting a very different interpretation of events. The BBC has always been thought to rise above this. In the UK and beyond, through the World Service, the Beeb has, until recently, been viewed as an oasis of impartial, authoritative reporting in a world of propaganda and state-run media.

Now, allegations of bias, with evidence that BBC editors doctored a speech of Donald Trump to make it sound worse than it was, one-sided coverage of transgender issues, and perceived anti-Israel prejudice, have led to doubts about the truthfulness of BBC reporting, and the resignations of the Director General Tim Davie and its CEO, Deborah Turness.

It does seem that the BBC has fallen into an echo chamber, reflecting the generally liberal, metropolitan left-leaning ethos of the chattering classes. And that is a problem, especially for a taxpayer-funded corporation. At the same time, it is much harder for media companies these days to be neutral. Once upon a time, there was perhaps a broad space for impartiality and a general trust that institutions like the BBC could be trusted to tell the truth. Trying to be politically and culturally balanced these days, however, is like trying to walk along an ever narrowing mountain arête with an increasingly slim path of independence, while the steep and sheer slopes of the culture wars beckon on either side. The idea of a media platform maintaining strict neutrality is becoming harder and harder to sustain these days.

In Britain, that narrow arête has become smaller and smaller, with the BBC perceived as falling on one side of the debate, and GB News emerging to offer a perspective from the other, offering different assessments on what's going on, increasingly mirroring their American counterparts.

Now there is a reason why this space for neutrality is narrowing, rooted in cultural and philosophical developments over the past 50 years or more.

Foucault’s challenge

In the 1970s and early 80s, French philosopher Michel Foucault taught a whole generation of students - and his ideas became embedded in universities across the world - that claims to truth were in essence assertions of power. Foucault had been a Marxist, believing that power had to be wrested away from the hands of the ruling classes and placed in the hands of the proletariat. After the Paris student riots of the late 1960s, he changed his mind and started to believe that power is never concentrated in one place. It flows in multiple directions in any human relationship or institution. In such interactions, all kinds of power dynamics are at play, and you need to be very watchful to notice how they work. Power produces ‘truth’ - in other words a justification for its existence - and such ‘truth’ produces power, in that this ‘truth’ reinforces the power relations it was designed to justify. He often claimed not to be making a moral judgement – in fact moral judgments were irrelevant: “My point”, he said, “is not that everything is bad, but that everything is dangerous.” If all truth is power, then nothing is neutral. Everything is dangerous. You can’t trust anyone.

The result is that there is really no such thing as a neutral, absolute truth. All claims to truth come from a particular perspective on things. There is no ‘view from nowhere’ that stands above all our limited perspectives, and therefore the idea of finding ultimate absolute truth is fruitless.

Foucault’s target was the idea inherited from the Enlightenment that we could find truth through impartial rational inquiry. So for him, the idea that something like the BBC was an arbiter of neutral, rational truth was a mirage all along. The irony is that if the BBC has drifted into a left-leaning echo chamber, it has wandered into space deeply influenced by Foucault’s ideas – ideas which by definition make its claim to any kind of neutrality increasingly difficult to sustain.

The prevalence of these ideas explains why it is harder and harder for news outlets to remain neutral, or claim to offer the truth of things.

Pascal’s perspective

So what does Christian theology say to this? At one point in his Pensées, another French philosopher, Blaise Pascal (unlike Foucault, a Christian one from the seventeenth century), says to the Foucault-type sceptic of his own day:

“I maintain that a perfectly genuine sceptic has never existed. Nature backs up helpless reason and stops it going so wildly astray.”

In other words, it's impossible to be a total sceptic about truth. Even the most progressive philosopher puts the kettle on and expects it to boil. He wakes in the morning expecting the sun to rise. There is such a thing as capital-T Truth and an order to the world that we didn’t create, and can be relied upon. We simply have to receive it and be grateful for it.

So far, so conservative. Yet Pascal then casts doubt on our ability to know that truth absolutely:

“Let us then concede to the sceptics what they have so often proclaimed, that truth lies beyond our reach and is an unattainable quarry, that it is not to be found here on earth, but really belongs in heaven, lying in the lap of God, to be known only in so far as it pleases him to reveal it.”

Perhaps surprisingly, Pascal agrees with Foucault, that absolute truth is unattainable to us here, at least if we think we can find it by some process of impartial human reason. Only God knows the truth. Our perspectives are inevitably limited and the only way we can know the ultimate truth is if it is revealed to us.

Which points to the heart of what a Christian believes about truth - that ultimately it is not so much rational and propositional but personal. Jesus does not say ‘here is the truth’, or ‘this is the truth’, but ‘I am the truth’.

Truth, in other words, is not just something you read on a page. It is not the product of brainy people sitting in a room analysing the data. Data always has to be interpreted and that's when fallible, inevitable and unspoken human prejudice creeps in. Truth is personal. You see it in a life – most perfectly in the life of Jesus. And if it is to be found here and now, it comes out of a life that has learned to be like Jesus, truthful in all kinds of simple personal interactions, honest even when it's inconvenient, generous even when you have little to give.

Truth, in Christian understanding, is a quality of life. It is not something that can be expected to arise from some august body of clever people – the Royal Society or the BBC. The BBC, like ITN, GB News, CNN, and Fox – and like the rest of us - will always be biased - and maybe it’s better to acknowledge that than try to hide it. To have a limited take on things is part of the human condition.

The only way we can rise above that to the ‘truth that comes from above’ as the Bible calls it, a truth which is “pure, peaceable, gentle, full of mercy, without a trace of partiality or hypocrisy” is the spiritual path of inner growth, through prayer, the practice of goodness and compassion.

Truth is not something we possess but something we grow towards. When the BBC – or any corporation for that matter - embraces the spiritual path of yearning for the ‘truth that comes from above’, then we might get nearer to trusting it again.

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