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.

Article

Creed

Death & life

Easter

Film & TV

14 April 2025

9 min read

Harry Potter and the mysteries of death

Horcruxes and our digital consciousness

Jonny Torrance

Jonathan is a priest and theologian who researches theology and comedy.

Hermoine rests her head on the shoulder of Harry Potter.

Harry and Hermione at the grave of his parents.

Warner Bros.

A couple of years ago I had a conversation with some friends that has stuck with me. One of them is a palliative care doctor, and we were discussing medical trends which seek the extension of life at all costs. My friends are Jewish, and we as were comparing religious notes, it was unsurprising that they asked me: "well what do Christians think about death?"

I replied, without really thinking: "Well, death is the enemy that is defeated." Somewhat to my surprise, their response was quite negative. "Oh, I don't like that idea. That pushes us towards denying our mortality, and trans-humanism, and the inability to let aged relatives go. We need to become better at welcoming death, at recognising it as part of our humanity."

And as I groped to try and explain why that wasn't quite what I meant, the best analogy I could find for articulating what Christians think about death came from Harry Potter. And in the years since that conversation, it is still the best analogy that I can find to talk about mortality.

So, here is the version of what I wish I had said.

The Harry Potter books have many themes, but above all they are about death. That may sound unlikely for a series of books apparently aimed at children, but the evidence stacks up...

The main character is an orphan, and the majority of people he comes close to will die across the seven books. (Now seems as good a time as any to mention that the rest of this article will basically all be spoilers, so maybe stop now if you've been putting off reading the books for the last 20 years. I'm also going to assume you are at least reasonably familiar with the plot).

Harry's life is defined by the death of his parents and his own close shave with mortality as a baby, and as the books continue the body count gets almost ludicrously high.

Indeed, the author J.K. Rowling has said that Harry is "the prism through which I view death in its many forms."

Unsurprisingly, given how central the theme is, there is a certain amount of explicit reflection on death, even if it is somewhat vague. Thus, we find that: "to the well organised mind, death is but the next great adventure." Dying hurts not at all, but is "quicker and easier than falling asleep." Those who die can "go on," perhaps by "boarding a train."

If all of this sounds a touch sentimental and the sort of thing that might appear in bad funeral sermons, it is paired with descriptions of grief that are visceral and deeply moving. (I may have cried more than once whilst doing the "research" for this article).

But where the discussion of death gets really interesting, at least to me, is in the plot, and the metaphysics that underpins it. By metaphysics I just mean the whole picture of the structure of reality that makes the world of Harry Potter work.

And in this metaphysics we find that death is indeed an enemy. This becomes clear partly through the sheer excruciating depiction of loss that runs through the books - how could something that causes this much pain be anything but an enemy? - but in book seven it is also made explicit.

In one of my favourite moments of the whole series, Harry stands before his parents' gravestone, and reads the epitaph:

'"The last enemy that shall be destroyed is death"... A horrible thought came to him, and with it a kind of panic. "Isn't that a death Eater idea? Why is that there?"

"It doesn't mean defeating death in the way the Death Eaters mean it, Harry," said Hermione, her voice gentle. "It means... you know... living beyond death. Living after death."'

In Harry and Hermione's reaction to the quote on his parent's tombstone we find that there are multiple ways for death to be an enemy.

The Deathly Hallows sounds eerily like a current technological advancement: the rising trend of griefbots.

Book seven, in fact, presents three ways to defeat death, and they are highly illuminating.

Firstly, there are Horcruxes. This is Voldemort's project for immortality: the division of his soul via murder and the darkest magic, and the implantation of those parts of the soul into objects which guarantee that, even should he die, he will live on.

This is, I think it's fair to say, not a vision of the death's vanquishing which the books present as appealing - Voldemort is the darkest wizard of living memory, and the creation of his Horcruxes takes him deeper into evil than anyone has ever gone. Yet it has strange parallels to various current attempts at death defiance. Dividing your soul up and placing it in objects sounds pretty similar to me to uploading your consciousness into a computer.

Now I'm not saying that all transhumanists are evil wizards whose projects rely on murder, but I do wonder if the same impulse lies behind Horcruxes and downloaded consciousness.

There is, in both, the same fear of death, the same refusal to accept that my life might end. And there is the same default assumption that the body doesn't really matter - that the centre of my being is somewhere else, and that I can separate it from this inconvenient vessel which is so subject to injury and decay. The inevitability of bodily death is acknowledged, but life can go on even if my body fails, because I can place myself into objects. What matters is my consciousness, and that can be made eternal.

The second option is a little more complex: the Deathly Hallows. These are three strange, mysterious objects, possession of which promises to make the bearer "master of death." The wand that gives murderous power. The stone that brings back the dead. The cloak that conceals.

The Hallows dress up their promise in esoteric garb - they offer a quest for the initiated that requires a certain embrace of mystery, and they certainly seem friendlier than Horcruxes, since no one has to die to make them.

But in the end, as Dumbledore admits, they are not really that different from the Horcruxes, for those who seek them also respond to the temptation to defy death, just like Voldemort. And if Horcruxes are about preserving the soul in the face of the inevitability of bodily death, the Hallows tease the possibility of avoiding death altogether, through the exercise of power.

The wand gives the power of invincibility and conquest: the avoidance of death through the murder of all who might threaten to kill.

The cloak gives the power to hide, to keep out of trouble, to evade death by escape.

And the stone? The stone overcomes the loss of death by bringing its victims back, by refusing to accept that those we love might leave us.

Again, the Deathly Hallows sounds eerily like a current technological advancement: the rising trend of griefbots. There is the same attempt to respond to grief by clinging to simulations of those whom we mourn, and the same despair at the end of the line. For the dead do not belong with the living, we are told, and legend has it the first owner of the stone was driven to suicide.

The Hallows attempt to deny death through power, and this is why Dumbledore found them so alluring, and so destructive: they promised to wind back his own loss while giving him the victory he thought would give his life meaning.

And yet, in reality, even when Harry unites them all, they don't give what they promise. Indeed, they only work to their full power when they are used for humbler ambitions: to hide friends from danger, to perform wondrous magic without boasting in the glory of the wand, or to face death with the comforting presence of those who have gone before.

For the stone only becomes available to Harry when he finally embraces the third way to defeat the death. The way his parents believed in.

Death, in the Potter books, is defeated by dying. Or perhaps more specifically, by dying for love - love of children, love of friends, love of a world gone tragically wrong.

Harry's mother protected her son from dying multiple times, through the power of her sacrificially loving surrender. Dumbledore, in a complex way, protects Malfoy and saves the Elder Wand from Voldemort, thereby protecting the whole wizarding world, through his voluntary death. Even Snape, in the bitterest and most twisted story of them all, ends up giving Harry what he needs to win and finding a measure of redemption, in and through his own murder.

And, in the climax of this long, convoluted story, Harry avoids death by going willingly to die. Because he loves his friends. Because he hates others dying for him. Because he recognises the terrible duty he faces, the terrible path Dumbledore has laid out for him, and he loves too much to run.

Voldemort is wrong. Love does conquer death.

The parallels to the Christian vision of death are stark. The quote on the tombstone which sparks these reflections for Harry (and for me) is in fact from the Bible. "The last enemy that shall be defeated is death" is a profoundly Christian idea.

Yet my friends were right to react negatively to what they thought I meant by death being an enemy.

For, just like the good guys in Harry Potter, Christians have traditionally been suspicious of attempts at immortality on our own terms. The Bible, I would suggest, knows nothing of a technological defeat of death, whether through downloading our consciences, or radical life extension, or technologies of power. Death cannot be staved off by any of our own work.

But this does not mean that death is a good thing, simply a part of human existence which we would do well to welcome and learn to get along with (though I do think we would do better to think about death more, and be more honest about its existence).

Death is an enemy. It is the final enemy. We are right to rage against it. To grieve those whom we lose. To feel its existential weight.

Yet, perhaps paradoxically, we should not fear it. For death is an enemy that has been vanquished, but vanquished through Jesus' death.

Immortality is not, for Christians, something we achieve, but something that is given to us. We believe in the Saviour who dies, and who rises again, and in whose resurrection, as strange as it may sound, we also will be raised. Death is defeated by love, but it is not our love, it is God's love for us.

This gift, according to the early Christian writers, can only be received by going through death, not by avoiding death. Indeed, Paul's letters, which make up most of the New Testament, are full of the insistence that the pattern of Christian life is always death first, then life. Death in baptism, to new life in Christ. Death to sin, to life in freedom. Bodily death, to bodily resurrection.

And so, what I should have said to my friend, is that Hermione is right. Death is the final enemy to be defeated, but this does not mean the ways of the Death Eaters. It does not mean projects of immortality, whether rooted in science, or a mystery cult, or power over others.

Rather it means it life after death - a life that is given to us, by our saviour who has been through death and defeated it.

Death is the enemy but it is not our enemy to defeat. That victory was won for us, on Easter Sunday 2000 years ago, in a cemetery near Jerusalem, when Jesus rose again.

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