Here's why we need to keep democracy holy

It's much more than a utilitarian deal that benefits the most.

George Pitcher

George is a visiting fellow at the London School of Economics and an Anglican priest.

A sign reading 'polling station' stands by the entrance to a church.

Red Dot on Unsplash.

One of the more ludicrous constitutional contributions of late has been the parliamentary petition, with well past two million signatures when I last looked, demanding another general election be called, because the Labour government, elected in July, has “gone back on the promises they laid out in the lead-up to the last election.”

Prime minister Sir Keir Starmer has surprised precisely no one by saying that he won’t be calling one. And so we’ll move on. But, in passing, what is truly breathtaking is how little our democracy is understood and, apparently, how unseriously democracy in the west is now taken. If that sounds unduly censorious, I have a two-word response: Two million!

Little time need be spent on demolishing the premise of this spurious petition, other than to wonder how many of those signatories would have appeared on one calling for, say, a fresh mandate after the coalition government of David Cameron and Nick Clegg (where is he now? Ah yes) performed a massive reverse-ferret on a manifesto pledge not to raise university tuition fees.

Or how many of these same fearless electors believe the result of the Brexit referendum should be voided because of the lies of the Leave campaign, most notable the one painted on the side of Boris Johnson’s battle bus. But no – two million residual, self-righteous righties can only be mobilised against a Labour government.

This event none the less raises valid questions about what our democracy is (and is not) and why we should want to protect or even cherish it. These questions become the more critical because there’s a tangible feeling of slippage in western democracy, as if we’re growing a bit tired and even contemptuous of it.

There’s the ominous re-growth of nationalism across Europe. And not a few bien pensants – me included, to my shame – might admit to a feeling after Donald Trump’s re-election as US president that democracy is too important to be left to the people.

Slightly more seriously, we need to ask ourselves what the qualities of democracy are that we should seek to defend. The first of these is, quite obviously, the rule of law. Should a political actor seek to overthrow a democratically established electoral process, then that is a crime within the rule of law. Witness the horrors on Capitol Hill in Washington DC on January 6 2021.

That’s the Feast of the Epiphany as it happens, but nothing to do with the coming of wise men. With Trump at the centre of it. Draw your own democratic conclusions – and weep for the rule of law.

Natural justice is to ensure that vexatious petitions don’t overthrow legally elected governments, either by lobby or violence.

Again, why does this matter and what is it about democracy that we hold sacred, even holy? It can’t simply be that we hold dear a kind of hard utilitarian ideal that what we elect to do is for the benefit of most of the people, for most of the time, as decided by popular mandate among the demos.

If we believe in democracy, as I believe most of us do, we’re presented with a choice: We can look to secularism as a solution, universal Enlightenment principles built on citizenship and equality before the law. Or we can look to a multiculturist model, keeping the peace between essentially separate communities and the state.

Or we can shape something on Augustinian Christianity, that recognises the limits of political democracy, which would eschew undemocratic theocracy, but which would hold that no political order other than the Body of Christ (the Church) can claim divine authority.

We’re in classic Rowan Williams theological territory here: “[T]he Body of Christ is not a political order on the same level as others, competing for control, but a community that signifies, that points to a possible healed human world.”

Unsurprisingly, I buy that. Williams goes further to state this spiritual effect on the political environments in which we find ourselves is likely to be “sceptical and demystifying.” Which seems to be a reasonable manifesto in a democracy.

The principle of election can be a worrying one in theological terms. We don’t “elect” God, though some secularists would claim that the Godhead is our invention. Rather, it has sometimes been perceived to be the other way around historically.

Reformational Calvinism would hold, among many other things, the rather terrifying view that we’re elected by God. “The Elect” are those who will be saved, while the rest of us (I presume) can rot in hell. Little democracy there.

Less deterministically, a more modernist worldview would argue that the Christian faith, on which foundation western civilisation is built, offers a viable moral definition of the lawful state, with which politicians of all (democratic) persuasions can tackle issues of global justice.

One such issue of natural justice is to ensure that vexatious petitions don’t overthrow legally elected governments, either by lobby or violence. That’s an important aspect of Christian witness and will require true grit in in its application during the years ahead. That’s, if you will, our grit in the democratic oyster.

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.