Explainer

Assisted dying

Comment

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

Column

Atheism

Belief

Comment

12 April 2024

5 min read

Defining cultural Christianity

There’s already a backlash against Dawkins and the New Theists.

George Pitcher

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

A speaker turns from the podium against a backdrop reading 'Centre for Sckeptical Inquiry

Richard Dawkins speaking at a sceptics event, 2022.

CSI

“Richard Dawkins says he’s a cultural Christian,” I said over breakfast.

“What’s that?” she asked.

I had a stab at it. “Someone who doesn’t buy the Christian faith, but likes hymns and churches and to live in a nominally Christian country, because it’s decent. Apparently.”

“So what’s new?” she said.

She has a point. I’ve just completed a decade as a rural parish priest and plenty of people came to church because it’s a respectable, middle-class thing to do. It’s as comforting as it is comfortable.

But cultural Christianity is a thing of the moment not just because of the pop-atheist Dawkins. To be honest, he’s struggled to retain his increasingly embarrassed atheist flock over the past decade, so in the public sense he’s not much of a trophy. But there are those of higher and more surprising profiles, who have come out for Christianity as the very essence of our culture and the bulwark against something much worse (for which read Islam).

The backlash against New Theism has been swift. And, strangely, most of it hasn’t come from humanists and atheists.

A key text for cultural Christians is Tom Holland’s Dominion: The Making of the Western Mind. It posits, inter alia, that Christianity is the foundation of our civilisation, even the bits that try to destroy the faith. Holland has more recently experienced a miraculous cure from cancer through intercession (which sounds suspiciously like deal-making prayer, but never mind).

Then there’s Ayaan Hirsi Ali, whose journey from Islam to atheism to Christianity traces her developing conviction that secular humanism is a reed in the wind against the threat to the West from militant Islam. Holland and Ali, among many others, including women’s rights activist Louise Perry in her apologia for traditional Christian morality, The Case Against the Sexual Revolution, fuel the enthusiasm of Justin Brierley for a new renaissance in his joyful book, The Surprising Rebirth of Belief in God.

Collectively, these are called the New Theists, who ride against the four horsemen of the atheist apocalypse (more accurately, perhaps, the four hacks of the new millennium), Dawkins, the late Christopher Hitchens, Daniel Dennett and Sam Harris.

The backlash against New Theism has been swift. And, strangely, most of it hasn’t come from humanists and atheists, but from what one might call established Christians. I have heard the likes of Ali and Holland called cosplay Christians and their faith derided as Christianity-lite.

Dawkins still says the Christian faith is nonsense, but who’s to say the spirit isn’t moving in him?

Robert Thompson, a north London priest, has posted that “we will be in the midst of Christian revival… when we actually reorder our lives around the abused Christ and raise the abused Christ’s body”. He argues against Brierley’s championing of London’s oldest church, St Bartholomew the Great, because it’s “the gayest church in town” (no, I didn’t follow this line of argument either) and critiques Brierley’s account of Holland’s witness (if not conversion) by comparing it with “the worst Easter Day sermon I’ve ever heard”.

I accept that this is a savage paraphrase in its brevity. But it’s all there and it comes not from any of the (now old) New Atheists, but from someone ordained to the priesthood. Meanwhile, Chine Macdonald, director of the Christian think tank Theos, writes in relation to his claims of cultural Christianity that “Dawkins isn’t actually a fully paid-up follower of Jesus” and that she’ll save her excitement over New Theists until they start “talking about the ways in which their lives have been turned upside down by the radical love of Jesus Christ.”

Frankly, all this sounds a bit snobbish and patronising, as if there’s a minimum bar for Christian entry, as if it’s cosplay Christians indulging in Christianity-lite. Sure, Dawkins still says the Christian faith is nonsense, but who’s to say the spirit isn’t moving in him? Frankly, I have people at my communion rail who say the same thing. And, to be brutally honest, I can count on one hand those of my very many Christian friends who claim that their world has been turned upside down by the radical love of Jesus Christ.

To be clear, Thompson and Macdonald have important things to say. Thompson writes movingly about his pastoral experience of cystic fibrosis patients in hospital, to take theological issue with Brierley for writing about “an unbiblical God who simply does not exist” as he waited with his patients “until they died… generally well before their 40th birthday.” No Holland miracle cures, please.

Macdonald writes usefully about the difference between the word “Christian” as an adjective and a noun, the New Theists being Christian adjectives in action. She also speaks of Dawkins’ talk of Christianity as a “decent” religion (as opposed to Islam) and his feeling “at home” in a Christian country as code for “whiteness”. To my shame, I hadn’t thought about that.

This would all be an ecclesiastical spat, like arguing about angels on a pinhead, if it weren’t for a darker danger beneath it. I think of former nun Karen Armstrong’s work on the dangers of religious fundamentalism when outsiders are excluded. In that context, I worry even more about those who claim that the New Theists are the work of “the enemy”, or Satan, because they “hollow out” our faith more insidiously than atheists.

In contrast to that, Bishop Graham Tomlin gave a sermon at Lambeth Palace the other day in which he referenced Dietrich Bonhoeffer’s claim to a faith that proclaims Christ at its centre, rather than worrying too much about the boundaries of the Christian community, which are always a bit fuzzy. I like that, because with fuzzy boundaries it becomes harder to exclude New Theists.

It’s tough being a Christian, whether new or old. When a rich young man comes to the Nazarene and asks how he can acquire the kingdom of heaven, he’s told to sell all he has, give the money to the poor and follow him.

None of us can reach that bar. But the implication I hold on to is that he’ll walk alongside us anyway. And that applies to everyone in this column, without exception. Now that’s what I call radical love.