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Assisted dying

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22 October 2024

9 min read

Assisted dying's language points to all our futures

Translating ‘lethal injection’ from Dutch releases the strange power of words.

Henna Cundill

Henna is a researcher with the Centre for Autism and Theology at the University of Aberdeen.

A vial and syringe lie on a blue backdrop.

Markus Spiske on Unsplash.

In the coming weeks and months, MPs at Westminster will debate a draft bill which proposes a change in the law with regards to assisted dying in the UK. They will scrutinise every word of that bill. Language matters.

Reading the coverage, with a particular interest in how such changes to the law have been operationalised in other countries, I was struck to discover that the term in Dutch for dying by means of a fatal injection of drugs is “de verlossende injectie.” This, when put through the rather clunky hands of Google translate, comes out literally as either “the redeeming injection” or “the releasing injection.” Of course, in English the term in more common parlance is “lethal injection”, which at first glance seems to carry neither of the possible Dutch meanings. But read on, and you will find out (as I did) that sometimes our words mean much more than we realise.

Writing for Seen & Unseen readers, I explained a quirk of the brain that tricked them into thinking that the word car meant bicycle. Such is the mysterious world of neuroplasticity, but such also is the mysterious world of spoken language, where certain combinations of orally produced ‘sounds’ are designated to be ‘words’ which are assumed to be indicators of ‘meaning’. Such meanings are slippery things.

This slipperiness has long been a preoccupation for philosophers of language. How do words come to indicate or delineate particular things? How come words can change their meanings? How is it that, if a friend tells you that they got hammered on Friday night, you instinctively know it had nothing to do with street violence or DIY? Why is it that in the eighteenth century it was a compliment to be called ‘silly’, but now it is an insult?

Some words are so pregnant with possible meaning, they almost cease to have a meaning. What does “God” mean when you hear someone shout “Oh my God!”? Probably nothing at all, or very little. It is just a sound, surely? And yet no other sound has ever succeeded in fully replacing it. We are using the term “God”, as theologian Rowan Williams points out in his book The Edge of Words, as a “one-word folk poem” to refer to whatever we feel is out of our control.

Both of these first two interpretations look at death, in some sense, ‘from the other side’ – evaluating the end of someone’s life in terms of speculation over what will happen next.

This idea of an injection being verlossende seems to me to be the opposite. I find myself hearing it in four different (and not mutually exclusive) ways, each to do with taking control of this very uncertain question of dying. The first, releasing, sounds to me like an echo of the neo-platonic ideas that still infuse public consciousness about what it means to be dead. As we slimily carve our pumpkins for Halloween and the children clamour to cut eyeholes into perfectly good bedsheets, we see a demonstration of society’s latent belief that humans are made up of body and soul, and that at death the soul somehow leaves the body and floats into some unknown realm (or else remains, disembodied yet haunting). If we translate verlossende as releasing then we capture that idea – that of the soul, which longs to be at peace, trapped inside suffering, mortal flesh.

Google’s second suggestion for verlossende was redeeming. This could be heard theologically. Christians believe in eternal life, that the death of this earthly body is only the start of something new – a life where there will be no crying or pain, and people will live forever in the glorious presence of God. In the bible, the apostle Paul encourages those who follow Christ to trust that they have been marked with a ‘seal’, meaning that they are like goods which have been purchased for a price, and that God will ‘redeem’ this purchase at the appointed time. Death, therefore, is not a fearful entering into the unknown, but a faithful entering into God’s promises.

Both of these first two interpretations look at death, in some sense, ‘from the other side’ – evaluating the end of someone’s life in terms of speculation over what will happen next. But there is the view from this ‘side’ also. We do not need to speculate about what death means for some of those who experience acute suffering due to terminal illness, and who wish to hasten the end of their lives because of it. They too might want to speak of a releasing injection or a redeeming injection – given that both terms hint at the metaphor of life as a prison sentence. To be in prison is to have one’s rights and freedoms severely limited or entirely taken away. It is not uncommon to hear a sufferer refer to incapacitating illness as being ‘like a prison sentence’, and one can empathise with the desire to have the release date set, back within the sufferer’s control.

This is the strange power and pregnancy of words – verlossende is able to carry all these meanings or none of them. Until I began researching this article, I had always assumed that the English term, lethal injection, simply meant an injection of some substance that is deadly. This is how the term is commonly understood, therefore, in a sense, this is its meaning. Yet, when I came to consider the possible origins of the word, I realised its likely etymology is from the Greek word lēthē, meaning ‘to forget’. In the Middle Ages, if something was lethal it caused not just death, but spiritual death, placing one beyond the prospect of everlasting life. By contrast, something could be fatal, meaning only that it brought one to one’s destiny or fate.

With this in mind, as we try to speak clearly in the assisted dying debate, the term fatal injection might be a more precise way to describe this pathway to death that is in want of a name. After all, whether you believe in an afterlife or not, dying is everybody’s fate, and I can see that choosing to take control of one’s fate is, for anyone, an act of faith with regards to what comes next.

This article was part-inspired by Theo Boer’s original article Euthanasia of young psychiatric patients cannot be carried out carefully enough, in Dutch newspaper Nederlands Dagblad. Theo is a professor of health ethics at the Protestant Theology University, Utrecht.

Read the original article in Dutch or an English translation below. Reproduced by permission.

Euthanasia of young psychiatric patients cannot be carried out carefully enough

Theo Boer

How is it possible to determine that patients who have suffered from psychiatric disorders for five or ten years and who are between the ages of 17 and 30 have ‘completed their treatment options’, wonders Theo Boer. It also conflicts with perhaps the most important task of psychiatrists: ‘offering hope.’

The patients we are talking about now are not physically ill and therefore do not have the ‘comfort’ of an impending natural death.

A letter was recently leaked in which leading psychiatrists ask the Public Prosecution Service to investigate the course of events surrounding euthanasia of young psychiatric patients.

One death mentioned by name concerns seventeen-year-old Milou Verhoof, who received the redeeming injection from psychiatrist Menno Oosterhoff at the end of 2023. It will not have escaped many people's attention how much publicity the topic has received in the past year or so. Together with a colleague and a patient (who later also received euthanasia), Oosterhoff wrote the book Let me go.

The tenor was: it is good that euthanasia is possible for this group of patients, the taboo must be removed, their suffering is often terrible, they have already had to undergo countless 'therapies' without effect - can one time be enough?

Or would we rather have these patients end their lives in a gruesome way? And who really thinks that psychiatrists make hasty decisions when they decide to comply with a euthanasia request?

To be clear: we are talking about something completely different than what has been called 'traditional euthanasia' for years: euthanasia for physically ill patients with a life expectancy of weeks or months. Given the excellent palliative care that has become available, such euthanasia will actually be less and less necessary in 2024.

Panic

No, the patients we are talking about now are panicky, anxious, confused, depressed, lonely, often unemployed, poorly housed, without prospects. But they are not physically ill and therefore do not have the 'comfort' of an impending natural death.

I have heard several of them say: if only I were terminal, then euthanasia would not be necessary. The fact that there is now attention for this group of patients, with whom we in our hurried and solution-oriented society know so little how to deal, is a gain. At the same time, I am happy with the leaked letter. You can criticize Oosterhoff's procedural approach ('why not an ethical discussion instead of a legal one?'), the lack of collegiality, this perhaps underhanded action ('why did you go straight to the Public Prosecution Service?'). But in my opinion, the letter writers are definitely hitting the mark with this crooked stick. Firstly: how is it possible to determine that patients who have suffered from psychiatric disorders for five or ten years and who are between the ages of 17 and 30 have ‘completed their treatment options’ (a criterion from the Euthanasia Act)?

Review Committee

Nobody disputes that their suffering is unbearable. At the same time, I know from my time on a Regional Euthanasia Review Committee that an illness becomes unbearable when all hope is gone.

A psychiatrist who gives euthanasia to a young adult is also undeniably sending the signal that, like his patient, he has given up all hope of improvement. That is actually risky, because even patients who have suffered for years sometimes recover and, moreover, our brains are not fully developed until we are 25. But it also conflicts with perhaps the most important task of psychiatrists: offering hope. In their training, the risk of transference-counter-transference is consistently pointed out: a patient takes his therapist with him into despair, the psychiatrist transfers those feelings to this and other patients: ‘this kind of suffering is untreatable and cannot be lived with’.

In the recent NPO television documentary A Good Death we see an embrace between a psychiatrist and her emotional patient. In doing so, this psychiatrist offers a unique form of involvement. But does she provide sufficient resistance to the cynicism, despair and negative vision of the future that is also widespread outside psychiatry?

Sensible decisions?

That brings me to a second objection: is it sufficiently recognised how much a psychiatric illness can affect someone’s ability to make sensible decisions? The hallmark of many psychiatric illnesses is a deep desire to die and an inability to think about it in a relative way. As a result, many are unable to think in terms of a ‘possibly successful therapy’.

Boudewijn Chabot

The main character in the book Zelf heeft by Boudewijn Chabot, Netty Boomsma, responds to Chabot's suggestion that there might be a life after depression: 'Yes, but then I won't be it anymore.' She wants to go down with her depression. I know differences. The people with a death wish who remark about a possible therapy: ‘I hope it is not effective, because then I will have to go through it again.’

Another hurdle

If a second psychiatrist is consulted and, for example, suggests trying one or two more therapies, many patients see this as yet another hurdle on the road to euthanasia. They do not see it as a serious opportunity to be able to cope with life again. There are no easy answers here. Nor are pillories appropriate. But let euthanasia remain complicated here, and let us continue to look for hope.

Reproduced by kind permission

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Comment

Wildness

7 November 2024

7 min read

It’s getting harder to be wild in this world

We’ve trapped and tamed wilderness into a commodity.

Elizabeth Wainwright

Elizabeth Wainwright is a writer, coach and walking guide. She's a former district councillor and has a background in international development.

Against a night sky a lit up face is blurred by the camera movement.

Under a Dartmoor night sky.

Yousef Salhamoud on Unsplash.

Some while back, my husband rearranged the books in our house, making sure that they were grouped together by theme. We have a lot of books, and there are now themes and sub-themes. It was quite an operation. Within the nature-related books, he created a separate shelf for books that have ‘wild’ in the title. We joked about it, but it made me think about how I’d noticed ideas of ‘wild’ pop up in lots of places in recent years: on clothing and stationery (with leaves or words like ‘keep growing’ printed), in shop windows (furniture displays draped in plastic greenery and fake animal skins), on social media (there are accounts that have ‘wild’ in the title connected to farming, conservation, publishing, personal development, coaching, poetry, business, and more), and in book shops (of which we apparently have only half the stock).

A quick online search on the topic of wilderness quickly leads me to conservation initiatives and statistics on the state of nature, but it also leads me to nature connection experiences, wild swimming, wild camping, soul work, and more. Wilderness becomes a pliable and hard-to-define term. It can relate to the natural world, to wildlife and natural spaces that have avoided human domination. It can also relate to the inner world, to spiritual experiences or to isolating and challenging times. But however you approach it, wilderness – inner, outer – seems to be having a hard time.

In recent months, wild camping has come under the spotlight. Dartmoor is the only place in England where wild camping is legal, and this this access helped to form me: as a teenager I hiked and camped with friends, encountered Dartmoor ponies trying to steal our food in the night, stomped through bogs and wolfed down boil-in-the-bag meals as the sun set. As an adult I’ve camped alone in a bivvy bag, my soul singing back to the Milky Way shining above me. Now, these experiences feel as much in need of protection as the nature they depend on, since a wealthy landowner decided to try and prevent people from undertaking this ancient practice of sleeping under the stars. The court case is ongoing, but it has highlighted the fragility of our access to nature here in England. Just 8 per cent of English countryside is accessible, and 3 per cent of rivers have an uncontested right to swim. Now, the last remaining right to sleep under the stars is under threat.

It is hard to know what we’re losing when it becomes harder and harder to see and touch the real thing.

We live in a time of crisis not just of the state of nature, but also of how we experience the natural world. In a recent study of nature connectedness, Britain was ranked lowest of all the countries surveyed. Our biodiversity is in crisis and so is our ability to encounter the natural world. This feels heightened by a way of being in the western world that sees us all living in our individual houses, working hard to pay for them, shuttling children and selves through schedules, spending fewer and fewer hours outside and with each other.

And this is not just a problem ‘out there’, because inner and outer landscapes are linked. It is unsurprising to me that in the UK at least, levels of good mental health, biodiversity, and access to nature have all been in decline. Disintegration of one is, I think, deeply connected to disintegration of the other.

These linked crises feel further threatened by the trapping and taming of ideas of wilderness, wrapping it into trends and materialism, commodifying it. There are some brilliant and essential initiatives helping to re-wild our inner and outer worlds. But there are also offerings that use wilderness imagery and the freedom and adventure associated with it to sell products and services, or as backdrop to human endeavour, or as a destination or resource for our consumption. I think a commodified wild can get in the way of the actual wilderness we need both externally and internally. This commodification is, I think, affecting our understanding of what the wild is and why it matters. It is hard to know what we’re losing when it becomes harder and harder to see and touch the real thing.

If real wilderness is everywhere but where we need it right now, how might we re-find it – in the natural world, but also within ourselves and our communities? Answering that question is work that many people are focused on now in all kinds of ways, and a short essay cannot begin to offer a full response. I will write more on this topic. But the question I have in mind at the moment is, how do we invoke wildness and wonder in the landscape of the modern world? – a physical landscape that is being stripped of nature, but also a social landscape that can often diminish our humanity. Perhaps a simpler way to ask the same question is, how do we not just survive life but get excited about it? – How do we love ourselves, our neighbours, and creation enough to deeply and truly care for these things?

Time stops, something says: here, look at this, it is everything.

There are of course structures, systems, and powers that need to change so that people can move out of mere survival, and so that the wild world is restored. I am not exploring those things here. Here, I want to simply share three things that lately, have energised my ability to feel the love, the excitement, and the desire to cherish and protect our hearts, our relationships, and the generous world that hosts us all. Perhaps by reawakening these things, we might find motivation and sustenance for tackling structures and systems.

First, I have been noticing what my young daughter notices. The light shining off a puddle; the way an ant crawls on her hand; the bright silver moon in the sky. I have never struggled to access the exhilaration of the natural world, but seeing through her eyes, I am doing so again. Time stops, something says: here, look at this, it is everything. The medieval mystic Julian of Norwich saw the wonder of the world, and God’s love for it, in a single hazelnut. She recounts her visions in her book Revelations of Divine Love. Sometimes connecting with the specific can help us see and face the global.

Second, there are authors who help me summon wildness and wonder in the landscape of the modern world, and in a future Seen & Unseen piece I’ll take us on a tour of some of those I love the most. Some of the authors are ancient. In Psalm 78, I read “…they forgot what he had done, the wonders he had shown them”, and “…they kept on sinning; in spite of his wonders, they did not believe.” If sin is a kind of disconnection, perhaps our disconnection from creation might lead our gaze to turn inward, and to land on things that do not call forth the best of humanity, rather than the wonder of each other and the world around us. That we are able to forget wonder is something we must remember and work to counter.

Third, I have been thinking through the encounters that have most exposed me to wilderness of the world and of my soul and of relationship – both the uplifting and the challenging. Encountering the vastness of that shining and vertigo-inducing Dartmoor night sky; encountering others in relationships that have helped me slip my skin and enter their unknowability and fragility and beauty; encountering contexts that seem too broken for repair and yet still light enters in. It is in these encounters that I first found God dwelling, and when I followed his trail, I noticed that throughout the Bible there are many people who experience the challenges, joy, and lessons of the wilderness. Wilderness is not just beauty – it can also be unknowable, disorienting, scary. For 40 days in the wilderness, but also in the beauty of the lily of the field and birds of the air, Jesus is right there with us, showing that God can meet us in beauty and barrenness, in wonder and in despair. Again and again in the Bible I see how God loves the world, how he calls it constantly to life through resurrection, through re-creation, through that three-in-oneness of father/son/holy spirit, of self/other/world, of body/encounter/mystery.

Now, I think our souls and societies might benefit from investing in relationships first conjured in Eden: with a garden, with a human, with God and the mystery he points us to. These things feed each other; when one suffers so do the others. As we face a disintegrating and increasingly commodified natural world, a mental health crisis, and an epidemic of loneliness, I think we are being called back to that garden, and to the kinds of wildness it made possible. I’ll look forward to exploring these themes more.