Russia’s waiting reformation

Putin’s world is not the only take on Russia.

Simon Burton-Jones

Simon is Bishop of Tonbridge in the Diocese of Rochester. He writes regularly round social, cultural and political issues.

Graffiti on a wall, spells out in Russian character the name Navalny.

Anti-Putin pro-Navalny graffiti, Saint Petersburg.

Dor Shabashewitz via Wikimedia Commons.

When I presented the book I Love Russia by Elena Kostyuchenko for purchase at the counter, my only thought was for what the bookseller would think. Was I a Putin sympathiser and apologist for the war in Ukraine? It says a lot about how we have unconsciously embraced Putin’s world as the only take on Russia. There is an indigenous saying that Russia is not Moscow and Moscow is not Russia. By the same token, Putin is not Russia, however much he would like us to think this; it is naïve and prejudiced of us to allow the largest country in the world to be defined by its dictator.

Elena Kostyuchenko, and Alexei Navalny in his posthumously published book Patriot, belong in different generations to Putin and inhabit another moral universe. Navalny has done more than anyone to call out the epic levels of corruption and dark cynicism of the Putin era. This is a Mafia state, as Luke Harding observes. Navalny believes there are twenty people who rule in Russia, with staggering levels of visible and hidden wealth, and a further one thousand who eat from their trough. The rest of the country includes those who are duped by state media, those who don’t want to know or keep their heads down or don’t care, and those who testify to the truth.

This latter cohort shows remarkable courage, because they are being silenced, one by one, through prison or murder. Navalny died in prison after previously being poisoned in Siberia; Kostyuchenko was poisoned while in Germany and has been targeted for assassination elsewhere. Before them lies a sobering roll call of journalists and politicians like Anna Politkovskaya, Boris Nemtsov and Igor Domnikov whose murders are clearly attributable to what they have said about the crimes of Putin and his associates.

Elena Kostyuchenko’s journalism takes her to Russia’s abandoned people and places. Derelict and decaying hospitals where the young, the addicted and the dispossessed gather; the mothers of Beslan who are beaten up and persecuted because they want the truth about that fateful siege; psychiatric hospitals with no resources or patient care; landscapes depleted by corrupt extractive industries. She is inspired by the fearless reportage of Politkovskaya and her writing bears the imprint of Svetlana Alexievich, with its gift for listening and attention to the wonderful ordinariness of human life. Her walk down the dark parade of Russia’s casualties is a tribute to the finest traditions of journalism, which carry the echo of the voice of Christ in their attention to those who lose out in this world.

In prison, Alexei Navalny learned the Sermon on the Mount by heart; his conversion from the routine atheism of his Soviet upbringing being triggered by the birth of his and Yulia’s first child, Dasha. He is wry, sardonic, stubborn, implacable – displaying an other-worldly willpower. It is hard to compute the courage it took to return to Russia after being poisoned with Novichok, knowing it would surely lead to imprisonment, mistreatment and death:

One day I made the decision not to be afraid. I weighed everything up, understood where I stand – and let it go.

Of the pain inflicted on him in prison for speaking the truth about Putin’s Russia, he says:

I have decided that this is my own pared-down version of suffering for the faith, a moment of suffering for being a believer. Happily it does not entail being dismembered, stoned to death, or having the lions set on me.

And yet the totality of his life was not far short of this. He skates over much of the abuse, but references being woken every hour of every night for a personal roll call. When other prisoners were primed to shout at Navalny for long periods from close range, it is deeply moving to visualise him shouting back and not backing down. Over time, his bespoke prison regime became steadily more abusive and isolating, directed in his view from the Kremlin.

There is absurdity at the heart of the system and he confronts those responsible for it, rather than meekly submitting to it. In the late Soviet era, criminal law was so comprehensively drafted that anyone could be picked up for an infringement if this was politically expedient. In Putin’s Russia, we have returned to the Stalinist period where offences are simply made up in a dark Wonderland. It is rule by law, not of law.

The editor of Novaya Gazeta, Dmitry Muratov, uses a particular metaphor. He says that Putin and his Kremlin officials act like priests who mediate a believer’s relationship with God. They have become intermediaries for how Russians are supposed to experience their country, telling them what to think and feel about it. If so, then Russia is ready for a new reformation, where people claim their own organic relationship with a nation that means so much to them. There are already enough martyrs for this new reformation while Putin continues to speak power to truth. Those of us who care about its people and its future do not need Putin’s malign priesthood to interpret Russian life. There is a different Russia, waiting to be discovered.

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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.