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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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Eating

23 January 2024

7 min read

Why hold on to Veganuary anymore?

As commercial promotion of plant-based diets falter Trystan Owain Hughes digs for the real roots around a ‘reverence for life’.

Trystan Owain Hughes

Trystan Owain Hughes is a theologian and vicar based in Wales.

A man stands at rest, one arm holding some vegetables.

NordWood Themes on Unsplash.

For many people, the month of January has been rechristened 'Veganuary’. Through this global campaign, which is celebrating its tenth anniversary this year, numerous people have embraced a plant-based diet.

Founded by a married couple from York, Veganuary has become a worldwide phenomenon, with more than 700,000 making the pledge last year. A YouGov poll suggests that numbers participating informally are far higher, perhaps as many as 4 per cent of Brits, 7 per cent of Americans, and almost 10 per cent of Germans. The campaign has also gained celebrity backing, with Paul McCartney, Joaquin Phoenix, Deborah Meadon, and Billy Eilish amongst the many star names backing the movement in recent years.

Yet there are some signs that the vegan bubble may have finally burst. The pace of interest in non-animal diets has started to level off and some analysts believe that “peak vegan” in the UK was way back in 2019. Figures by consumer intelligence company NIQ seem to confirm this. UK sales of both chilled and frozen meat alternatives have fallen sharply in recent years and prominent companies, including Oatly, Nestlé, Innocent and Heck, have withdrawn various vegan products.

Recent years have also seen an increasing number of posts and memes on social media feeds that are antagonistic towards the vegan lifestyle. It seems attitudes towards animals are slowly becoming incorporated into the cultural wars, with veganism often regarded as part of an over-righteous so-called “woke” ideology.

Some Christians subscribe to such an attitude and are hostile to those who embrace plant-based diets. Others, on the other hand, take a very different stance in considering their scriptures and theological traditions, emphasising the absolute necessity of a holistic awareness of diet, not least in light of animal cruelty, uncompassionate means of food production, and environmental concern. There are, after all, numerous affirmations of the precious and holy nature of the created order in the Bible. This would have differed profoundly from non-Judaic teaching in the Ancient Near East.

When he was surrounded by suffering and death... he came to regard a transcendent ‘reverence for life’ as the only way of living that made sense.

The moral imperative to care for the environment and value all creatures is clear from the very first pages of the Bible. After each day in the Genesis account of creation, God regards what he has formed as tov, a Hebrew word meaning good, pleasurable, and delightful. At the end of the creative process, God then looks at the whole of his handiwork, and he sees that the wonderful harmony of the complex, intricate, and balanced ecosystem is tov me’od, meaning ‘very good’. Later, in the New Testament, Jesus asserts that only God himself is good. It therefore follows that creation can, in some way, reveal the goodness of God directly.

And so there are many Christians who are drawn to an awareness that everything in this wonderful world has value and significance – the strangers we pass on the street, our pets who share our houses, the squirrels who dart across our paths in the park, the snowdrops breaking through the soil in our gardens, and even the slugs in our flowerbeds. No wonder the biblical images of the glorious eschatological, heavenly future are ones in which natural world is at harmony.

The German phrase that theologian Albert Schweitzer used to express the ramifications of the biblical concept of the goodness of the creation is ‘Ehrfurcht vor dem Leben’, which is often translated as ‘reverence for life’. The word Ehrfurcht, however, expresses far more than its English translation implies. It suggests an attitude of awe and ultimate respect, and so carries with it an overwhelming sense of moral responsibility towards creation. For Schweitzer this was no abstract intellectualism. His principle of ‘reverence for life’ came to him as he worked among the sick in the heart of tropical Africa. While prominent atheists like Richard Dawkins and Stephen Fry maintain that cruelty in nature is one of the main stumbling blocks of belief in the divine, it was not a sanitized version of nature that led Schweitzer to his God-centred conclusion. Rather, when he was surrounded by suffering and death, both in the hospital in which he worked and in the unforgiving natural world of the jungle around him, he came to regard a transcendent ‘reverence for life’ as the only way of living that made sense.

We are not only shockingly merciless towards each other, but we extend our cruelty to the creatures with which we share the planet.

Nature may well be ‘red in tooth and claw’, to use Lord Tennyson’s phrase, but humanity has been gifted with the potential to bring compassion and love to a world of pain and suffering. Most people already regard human life as inherently precious, but Christianity stands alongside other faiths in challenging people to consider the value the lives of non-human creatures. After all, Schweitzer suggested that every creature holds to the importance of its own life, albeit unconsciously, and this should lead people to solidarity with all forms of life. In this sense, an individual’s relationship with nature is far more intimate than we might think. ‘Wherever you see life,’ he wrote, ‘that is yourself!’

This recognition of humankind’s profound bond with other living creatures allowed Schweitzer to apply Jesus’ core teaching on love to the wider world – ‘the ethic of love widened into universality’, as he put it. This stands in marked contrast to the present status quo which views the only real value of non-human life to be its usefulness. No wonder that so many animals in modern industrial farming experience what Richard Holloway describes as a ‘double-dying’, as their everyday existence is as pitiful as their death. They live out wretched lifespans in disease-prone torture before being transported hundreds of miles in overcrowded trucks to their slaughter. But our society continues to turn a blind eye towards heartless factory farming practices. They are not only tolerated but justified with the argument that animals are little more than unfeeling machines who don’t really ‘suffer’ in the human sense of the word.

Such attitudes contribute to what the 1995 papal encyclical Evangelium Vitae refers to as the ‘culture of death’ of the modern world. We are not only shockingly merciless towards each other, but we extend our cruelty to the creatures with which we share the planet. In the large global corporations that dominate the food industry, animals are viewed as products to be reared to supply fast-food outlets. They are bred specifically for death. While nature itself is cruel, each creature is endowed with a fighting instinct for survival and a means to achieve it through armour, speed, disguise, poison or odour. We humans, though, offer no chance for such defensive capabilities to be utilised. Nothing is as uncaring and ruthless in nature as the hungry human.

Not that this recognition necessarily leads us to a purely plant-based diet. Even Schweitzer himself, who was a proponent of vegetarianism, ate meat on occasions. Perhaps the indigenous hunting communities of our world today can help us to bridge the gap between reverence for life and the killing of animals for food. While they are principally carnivores, many of these communities appreciate their utter dependence on the animals that are sacrificed so they might live and thrive. There is, therefore, a deep empathy and affection towards the hunted. In fact, compassionate ceremonies and rituals are often performed to show gratitude to the animals for the gift of their lives. The tribesmen of the Kalahari Desert will, for example, symbolically enter into the suffering of their dying prey by enacting their final death throes. Contrast this with our own food system, which is largely controlled by a small group of multinational corporations who attempt to hide the truth about what we are eating and the harsh treatment of both animals and workers in their factories.

In a YouGov survey, participants in Veganuary were asked to list their incentives for taking part. The main reason given, above environmental regard and personal health, was animal welfare. The concept of 'reverence for life’ speaks into this concern. As such, in embracing the concept that all life is equally worthy of our attention, respect, and love, Christians could have so much to offer contemporary debate. Their perspective could have huge implications on the moral and ethical matters that we face today – climate change, food production, health care, emerging technologies, animal care, AI, and energy development. ‘Do not do any injury, if you can possibly avoid it,’ the great Welsh Celtic saint Teilo is purported to have said while reflecting on creation. The anthropocentric, human-centred paradigm does not, then, reflect a truly Christian worldview. Instead, Christianity holds that every part of creation reflects God’s goodness and non-human life deserves respect for its own sake, not simply because of its usefulness. The whole, wonderful web of life is considered to be valued and loved by God, not merely one strand of it, and the daily call of the Christian is to live out the compassion, care, and love that such an awareness demands.