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.

Article

Comment

Gaza

Israel

War & peace

6 October 2024

7 min read

Gaza-Israel: bankrupt ideas still capture too many of us

One year on, we’ve turned no pages, learned no lessons, made no progress.

Todd Deatherage

Todd is the Executive Director and Co-Founder of Telos Group. It forms communities of American peacemakers across lines of difference and conflict, including Israel/Palestine.

A graffitied concrete border wall stands below a blue sky and dusty ground

Border wall between Gaza and Israel.

It’s the first anniversary of October 7, and we’re left with the grim task of finding a way to appropriately honor the dead, stand in solidarity with the bereaved, and mourn with all who mourn. And we do this as we acknowledge our ongoing collective failure and the unimaginable and avoidable loss of so many innocent lives, each one with its own promise and possibility forever denied. In the end, it’s hard to find a way to commemorate the horror of that day because it’s still going on. We’ve turned no pages, learned no lessons, made no progress.

Someday there will no doubt be a grand and somber memorial that tells the story of the brutal October 7 attack. The victims of that day will be remembered, the captives and their fates memorialized. And some day there will be a museum that tells the story of what many already believe will be characterized in the historical record as a genocide in Gaza. To what we already know of the massive destruction of a place and a people will be added details that will be excavated from the rubble, testimonies from the traumatized survivors, heartbreaking tales of orphans and of the destruction of entire families. Maybe these places of collective memory will offer greater context for the world in which the tragedies that created them took place, some kind of “never again” lessons to learn, and no doubt some sharp analysis of the failures that led to these days of great darkness. If these attempts at memorialization are honest, they will hold many of us up to withering critique. We’ll be in the museums too, enduring rebuke for the indifference that led us here or for our zero-sum thinking that could only imagine a world born of and sustained by violence in all its forms.

These are lone and lonely voices in a land besieged by brutality, dehumanization, and ideologies of ethnic and religious supremacy. But they are not unicorns.

You may also like

If we don't want the story to be about our blind complicity, but about our courage, we still have time to own our agency. Because this isn't over yet. We can mark this day by remembering that it will continue to be like all the others until we all do our part to achieve a ceasefire, a release of captives, and an end to support for systems of inequality and control. In whatever ways great or small that we can, we have to reject the logic of violence and the ideologies of hatred and exclusion. And to be active participants in cultivating in ourselves and in our communities an imagination for the way each human life is sacred and our flourishing is tied to that of our neighbors.

We do this even as we pause and honor the innocent dead in Israel, in Gaza, in the West Bank, and now in Lebanon. We mourn with all those who mourn. But we do that with people still dying in Gaza, with millions of Palestinians still displaced, with disease and hunger rampant, with Israeli hostages still being held, with massive street protests calling for a ceasefire being ignored, with hundreds of thousands of Israelis still displaced from their homes in the north and the south, with Hezbollah rockets still falling and now with the war more fully advancing into Lebanon, with a wider regional war ever a distinct and terrifying possibility, with settlers rampaging in the West Bank with impunity, with ideological zealots setting the terms of debate, with economic catastrophe as hundreds of thousands of West Bank Palestinians have endured a year with no income, and with palpable fear among Palestinian citizens of Israel.

The bankruptcy of the ideas that have prevailed this past year remain firmly in control and continue to capture the imagination of too many. And yet there are those who know that violence begets violence begets violence, and that this is how we got here, not how we get out.

I spent a day in New York City last month with four members of the Parents Circle/Families Forum, an organization made up of 700 Palestinian and Israeli families, each who have each lost a loved one in the conflict. In addition to the pain of loss they share, they also share a commitment to a rejection of the very notion of revenge and an embrace of the work of reconciliation. Four members of this group traveled to the United States for a two-week tour to help us understand our part in their shattered and unjust reality and to let us know that there is another way if we can find the courage to pursue it. That way is mutuality. It is an embrace of security, dignity and freedom for all the people of their traumatized shared homeland, Israelis and Palestinians alike, in equal measure.

Each member of this unlikely tribe has a unique story of personal loss, and as they speak, they tell of the worst day of their lives, over and over again. But there is exponential power in the fact that these stories are told in one voice. Two members visiting the U.S. are mothers, one Israeli and one Palestinian, who have lost children in the conflict and have been transformed by the deep realization that they share the same pain. One was a young man whose ten-year-old sister was killed by an Israeli border policeman and after some years of anger-fueled stone throwing as a teenager, he began to channel his trauma into the work of resisting occupation and violence via the collaborative work of justice, freedom and security through reconciliation. And one of the newest members of this work is a man whose mother, an internationally recognized Israeli peace activist, was killed in a kibbutz on October 7. He has chosen to pick up his mother’s work and devote himself to a just peace for himself and for all his neighbors, Palestinians included.

These are lone and lonely voices in a land besieged by brutality, dehumanization, and ideologies of ethnic and religious supremacy. But they are not unicorns. There are others there whose stories need to be told and whose work needs our support.

My church is preaching a sermon series reflecting on the leadership and choices of the kings of biblical Israel and Judah. Their stories are old but their inclinations to violence, their neglect of care for the poor and the widow, and their lack of concern for justice are timeless. In a recent sermon I was struck by my pastor’s observation that even those of us who have regularly engaged with the Bible all our lives don’t always know much about the kings, but we do know something of the prophets. They are, in his words, “the ones who hold the story for God.” And in times like these, as we descend ever deeper into darkness and inhumanity, they are the ones who share in the pathos of God, to borrow from rabbi Abraham Joshua Heschel. But they also show us the way out. Warmongers in the Middle East and here in the West are creating massive destruction. We too easily and readily live within the world created by their corrupted imagination. We can’t ignore them. But we don’t have to listen to them. Listen to the prophets, those who hold The Story of God’s shalom, of his kingdom of justice and peace. They are still among us. One of our responses is to make sure we’re listening to these voices, amplifying them, and following their lead.

As a Christian, over this past year, I have found myself being drawn more deeply into the life and the person and the divinity of Jesus of Nazareth. The deep love of the maligned and suffering, enemy-loving Jesus, he who was accused by the religious establishment, executed by one of the great empires of history, mocked and spit upon, all for the threat he posed to those addicted to power, control, exclusion and the violence needed to enforce it all. This is the Jesus who boldly declared liberation of the captives, vision for the blind, food for the hungry--a new kingdom of justice and mercy, of wholeness and shalom.

None of these things I believe absolve me from acting. Jesus is not my cop out, he’s my way out. What if we who seek to follow him were to repent of our propensity to violence, our fascination with the zero-sum binaries we use to create hierarchies of exclusion, and our failure to demonstrate our love for God by showing love of our neighbor? We might not solve all the problems that are destroying us but we’d at least stop contributing to them. And imagine what a more generative and healing presence in the world we would be if we joined our voices with others of different faiths and none who also believe in a world more just and whole. I would argue that the world in all its diversity and complexity needs Christians to mark this day and this moment is by taking Jesus so seriously that we start to live out his calling to be active participants in the work of justice, healing and repair and living reminders that all are made in the image of God, violence begets violence, and the simple truth of Mother Theresa who said, “If we have no peace it’s because we’ve forgotten we belong to each other.”