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Assisted dying's language points to all our futures

Translating ‘lethal injection’ from Dutch releases the strange power of words.
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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Politics needs some deep stirring emotion

In politics, the struggle between our reason and desire is a fair fight.
A young woman in a blue suit stands at a wooden box in a parliamentary debating chamber looking upward while speaking.
British Youth Council parliamentary debate.
British Youth Council.

“The government you elect is the government you deserve.” So goes the famous quote, variously attributed to Thomas Jefferson, Joseph de Maistre and George Bernard Shaw. Of all these thinkers, Maistre is perhaps the most interesting, describing the business of government as a kind of religion, a political “faith” – one complete with dogmas, mysteries and even ministers.  

Maistre was, somewhat surprisingly amid the turmoil of eighteenth-century France, a staunch monarchist. His argument was that, if the authority of a political leader was only a product of social convention, then that authority would always lack a sufficient degree of legitimacy, leaving the door wide open for violence and strife. His solution was to defend the divine right of kings. This was a controversial position, as much then as it is now.  

Aside from his famous quote about elections, Maistre’s political philosophy is oft-criticised as polemical, hearkening back to a golden era of European monarchy that never really existed. Nevertheless, within his writings, Maistre laid bare a reality that we often prefer to keep veiled: that our political will is as much about what we find to be emotionally compelling as it is about what we find to be rationally convincing, indeed, the latter is very much dependent on the former. The more social scientists are able to demonstrate the reality of subtle phenomena such as confirmation bias, unconscious bias, and racial prejudice, the more we see that we are often being governed by pre-cognitive or non-cognitive instincts, even those of us who like to think that we are better than that. In the end, we have to concede that when it comes to politics, as with so much else, the struggle between our faculty of reason and the desire of our heart is a fair fight.  

  

“They have few standards by which to judge between falsehood and truth in revolutionary movements.”  

Amy Buller
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In 1930’s Europe, there was certainly a lot of emotionally compelling politics around. Fascinated by the language and culture of the German people, thinker and educator Amy Buller made repeated visits to Germany from the 1920’s onwards, often accompanied by reading parties of British academics, church leaders and university students. In those decades, as the political landscape of Germany began to shift, her purpose became less about countryside walks and studying, and more about the facilitation of urgent, open and honest dialogue between Buller, her fellow travellers, and their German counterparts in the churches and universities wherever she had contacts. As Hitler rose to power, and even before the full horrors of Nazism became widely known, Amy was compelled to find out why so many people, especially young people, were being attracted by what she saw as a “brutish” ideology.  

In 1943, amid the violence and destruction of World War II, Buller published a book, Darkness Over Germany, which gives a first-hand account of the many people that she and her travelling parties had met, and the conversations that had taken place. Like Maistre, Buller proposed that without God, politics was a dangerous kind of faith in something, one that tended towards violence. In the introduction to her book she writes of “…the tragedy of a whole generation of German youth, who, having no faith, made Nazism their religion.”  

It’s common these days to hear complaints about the political apathy of the young, with polls commonly reporting that only about 50 per cent of British 18 to 24-year-olds are intending to vote in the next General Election. However, there are those who raise the caution that this may not be a symptom of apathy, so much as a symptom of the cultural and structural injustices that put barriers in the way of young people engaging with our nation’s political life. Young people are not likely to “believe in” a political system from which they feel excluded. As Buller’s writing notes – when this happens, young people are likely to put their “faith” in something else.   

Maistre’s solution was perhaps too extreme for modern sensibilities: asking the politically minded populace to believe that their leaders were imbued with the authority of God, by God. In the twentieth-century, Buller took a more moderate view. As the Nazis began to view her with suspicion, trips to Germany became increasingly difficult to arrange, so she travelled elsewhere to places such as Hungary and Bulgaria. Wherever Buller went, she found more and more young people who wanted to talk to her about their political hopes and ideals. Summarising the whole, Buller suggested that Europe’s political landscape was eschewing “shallow rationalism” and instead being shaken by a “deep stirring” of emotion, particularly among young people. She recorded the observation: 

“They all want change, and they all want a chance to play a part in that change, but so few have any religious faith, which means that they have few standards by which to judge between falsehood and truth in revolutionary movements.” 

In a recent report, published by the Jo Cox Foundation, increasing the public’s “political literacy” was highlighted as a key response to prevent the outbreaks of abuse, intimidation and violence towards elected officials. As any educator will tell you, literacy is a two-way street – it includes not only the “shallow rationalism” of knowing information, or knowing where to access information, but also the ability to communicate that information effectively to others. Such communication comes from a much deeper, embodied kind of knowing, one which requires one to have assimilated knowledge and worked with it, feeling its malleability, and testing its apparent truth-claims against an internal standard of what is true and false, or right and wrong.  

For Buller, this internal standard was inextricably linked to faith. To the end of her life, she remained open minded as to what form this faith might take, albeit her own religious practice was firmly Christian. Cumberland Lodge, the educational charity she set up to promote her aims, was from the start open to those of all faiths and none, and she warmly welcomed dialogue between those of different faith groups, including atheism. But in 1943, as Amy Buller looked with hope towards the prospect of a post-war Europe, she summed up the political landscape as follows:  

We are now faced with the greater task of bringing healing to the nations, including our own, I am convinced this cannot be done without a faith in God adequate to the tremendous task of reconstruction.  

Given Amy Buller’s open-mindedness, one can read the word “God” in this statement its broadest possible sense, as referring to whatever moral compass one takes as an internal standard of what is true and false, or right and wrong. But the point remains that the political will is therefore not a matter of rational thought, or not only of that, but is an expression of feelings and instincts that run far, far deeper.  

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