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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

Article

Comment

Trauma

9 May 2024

5 min read

Bitterness and weaponised words can’t soften scars

Finding peace for Daniel Anjorin, Salman Rushdie and Bishop Mar Mari.

Krish Kandiah

Krish is a social entrepreneur partnering across civil society, faith communities, government and philanthropy. He founded The Sanctuary Foundation.

A man sits being interviewed and holds a hand to the side of his face, one lens of his glasses is tinted black.

Salman Rushdie discusses his attack.

BBC.

Knife crime around the world is unacceptably high, and with around 50,000 offences expected this year in the UK, it is sadly no surprise when we hear tragic news stories involving knives and sharp instruments. Recently, it was the terrible circumstances of the death of Daniel Anjorin that made the headlines. The gentle, much-loved, 14-year-old boy was on his way to school in East London when he, along with several others, was randomly attacked by a man with a sword. He died from his wounds shortly after being taken to hospital.

I happened to be in the middle of listening to Knife, a memoir by Salman Rushdie, when the news broke of that tragedy. It is another heart-rending story. Rushdie describes how, in 2022, during a speech he was giving about the need to protect writers, a man ran onto the stage and frantically stabbed him 15 times. Rushdie was airlifted to a hospital and survived the attack but lost an eye. Then began his difficult physical and emotional journey towards recovery, documented in the book he never wanted to write.

It was not the first time Rushdie had been the victim of aggression. In 1988, following the publication of his novel The Satanic Verses, the Iranian government called for Rushdie’s death by issuing a fatwa against him. His book was perceived to be blasphemous to the Islamic faith, and despite ten years of round-the-clock police protection in London, he faced several serious assassination attempts.

The fatwa was lifted in 1998, but twenty-four years later, Rushdie was clearly still not safe. He recounts the moment when he saw the man running at him in the darkness as he gave his lecture.

“My first thought when I saw this murderous shape rushing towards me was: So it is you. Here you are…. It struck me as anachronistic. This was my second thought: Why now? Really? It’s been so long. Why now after all these years? Surely the world had moved on, and that subject was closed. Yet here, approaching fast, was a sort of time traveller, a murderous ghost from the past.”

I can’t imagine how I would cope in his shoes. I have not had to experience the daily fear of assassination for decades as Rushdie has. In all my years of delivering speeches and sermons on stages around the world, I have never had cause to even contemplate the possibility of an attempt on my life. Nevertheless, I was surprised to hear in Rushdie’s voice, the words he chose to say to his attacker:

“If I think of you at all in the future it will be with a dismissive shrug. I don't forgive you. I don't not forgive you. You are simply irrelevant to me, and from now on, for the rest of your days, you will be irrelevant to everyone else. I'm glad I have my life and not yours and my life will go on.”

Rushdie admits that his words are his weapons – and he certainly uses them to good effect. They are sharp. They are designed to eviscerate. They are calculated to cause pain. They express derision towards his attacker. Part of me cheers him on: a defenceless man in his seventies who walked into a lecture hall expecting to give a speech to rapturous applause but left barely alive as the victim of a brutal frenzied attack. Like the plot of every action movie I have ever seen, the story seems to have a happy ending – the hero is saved, the bad guy is locked up and justice is seen to be done.

But there is another part of me that knows these Hollywood endings can’t be trusted. Those 27 seconds of violence have clearly left Rushdie reduced to spitting insults at a young man in prison. He claims his life now is “filled with love”, but sadly there is little evidence of it in the way he addresses the radicalised 24-year-old. Bitterness and weaponised words, however eloquent, can’t soften the scars, nor do they make the world a safer place.

Indeed, I have found it difficult to forgive the comparatively trivial experience of being metaphorically stabbed in the back.

I can’t help but compare Rushdie’s reaction with that of Bishop Mar Mari Emanuel. The day before Knife was published, the Iraqi-born bishop was preaching at his church in Sydney, Australia, when he too was attacked by a young man with a knife, and, like Rushdie, ended up losing an eye. The attack was an overt terrorist act against Bishop Mar Mari, a controversial figure who has spoken dismissively about the Islamic, Jewish and LGBTQ+ communities.

Despite the striking similarities between the two men’s terrible ordeals, the contrast in their response couldn’t be starker. Speaking just two weeks later at a Palm Sunday service, Bishop Emanuel affirmed that he had forgiven his teenage assailant:

‘I say to you, my dear, you are my son, and you will always be my son. I will always pray for you. I’ll always wish you nothing but the best. I pray that my Lord and Saviour Jesus Christ of Nazareth, to enlighten your heart and enlighten your soul your entire being to realise, my dear, there is only one God who art in heaven…. the Lord knows it is coming from the bottom of my heart. I’ll always pray for you and for whoever was in this act. In the name of my Jesus, I forgive you. I love you, and I will always pray for you.”

Woven into the fabric of every form of Christianity is a commitment to love and forgiveness, clearly exemplified for us here by Bishop Mar Mari. His words resonated around the world this week as he returned to the pulpit where he was stabbed, bandage over one of his eyes, to speak out with kindness and compassion.

I am deeply challenged by the bishop’s response. I have never experienced the physical pain and emotional trauma of a knife attack. Indeed, I have found it difficult to forgive the comparatively trivial experience of being metaphorically stabbed in the back. I know how hard it is, to be gracious to those who deliberately cause pain to me or to my family members through their actions. Like Rushdie, I sometimes I would like nothing more than to see them locked up, living a loveless, meaningless, irrelevant life. But this is not the Christian way. I follow Jesus who forgave the soldiers driving nails through his hands and feet, so I must strive to be compassionate to those who do us much lesser harm, as well as seek, in his name, to tackle the underlying causes for the greater dis-ease in society.

The issues that lead to knife crime are many and complex. They include poverty, fear of victimisation, gang culture, radicalisation, distrust of authorities, lack of education, experience of violence in childhood, and much more. Whatever we can do to tackle these problems, we do for the sake of love and peace in our world. Perhaps as we seek to overcome these things together, we can work towards a day when what happened to Daniel Anjorin on 30th April can never happen again.