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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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8 min read

The emerging frontier: renewing courage in geopolitics

Narcissistic moralising needs to stop, and we can learn from Churchill too.
Military personnel, wearing camoflague uniform crowd round a computer monitor.
U.S. Space Force guardians assess a threat.
U.S. Space Force.

In August 1939, the Polish poet Kazimierz Wierzyński reflected on a “Peaceful bliss which had become Europe’s chloroform.” Yet, then as now, crises shake us from moments of calm, especially when we abandon vigilance. We let our guards down, nonchalance replacing serious deliberation toward action. 

A shroud of darkness has descended on the world over recent years, with new conflicts emerging just as – or perhaps because – democratic populations turn inward. These conflicts – whether the Russia-Ukraine War, the Israel-Gaza War, or the US-UK led battles in the Red Sea – demonstrate the courage of peoples sacrificing for their nations, families, histories, and traditions. 

Yet, in much of the political West, narcissism – rather than courage – has become the focal point of our culture.  

Christopher Lasch describes this narcissism in The Culture of Narcissism: American Life in an Age of Diminishing Expectations as a conceit of the present. Lasch notes that we have become a consumer society focused on individual self-absorption that leads to present-focus, sense of isolation, and disconnection from history.  

The psychoanalyst Erich Fromm argues in The Heart of Man: Its Genius for Good and Evil that narcissism is an attachment to “self-image,” which “distorts rational judgment.” Yet, Fromm later reflects “If the feeling which the Greek poet expressed in Antigone’s words, ‘There is nothing more wonderful than man,’ could become an experience shared by all, certainly a great step forward would have been taken.” 

This wonder of man is in the freedom to act in a world that is yet to be determined.  

This is a position of “deep faith.” It encourages full participation in the world, affirming the self through action, though always in relation to something much greater.  

The philosopher and theologian Paul Tillich similarly states “this is just what participation means: being a part of something from which one is, at the same time, separate. Literally, participation means ‘taking part,’ in the sense of ‘sharing’ or ‘having in common.’”   We play, as legendary Notre Dame football coach Knute Rockne once said, "For everyone that came before us, and everyone that will come after us."

If common history is needed as our foundation for current action in geopolitics, to what then might we turn?  

We propose a refocusing and modern renewal of alliances underpinned by Winston Churchill’s A History of the English-Speaking Peoples, a project he initiated in the early 1930s as the threats of Nazism and Fascism had taken centre stage.  

This refocusing reprioritises courage in geopolitics, maintaining the light amid descending darkness. It is badly needed given the modern tendency to look inward rather than to sources of value outside of the self.  

This is a pathway to vigilance in anticipation of the thief in the night, who may arrive at an unexpected hour.

Churchill – recently demonised by influential conspiracy theorists – emphasises the common cultural and political heritage of the English-Speaking Peoples, including the rule of law, individual rights and parliamentary democracy, which shaped the modern world.  

Churchill reminds us of the global influence of English-Speaking Peoples in spreading democratic ideals and governance structures across the world, believing that the global spread of these ideas was instrumental in shaping modern life. He underscores the unity of the English-Speaking Peoples in facing global challenges, particularly in the context of the World War he foresaw. And he viewed the cooperation between the UK, the US, and other Allied nations as crucial to the survival of freedom and democracy.  

It is important, now as much as ever, that we remind ourselves of Churchill’s wise words, building on them to address with courage the challenges of our present times.  

Specifically, we must adapt Churchill’s emphasis on the English-Speaking Peoples to a focus on nations working at the frontiers of Western civilisation to resist rising darkness which seeks to corrupt the good. Ones not necessarily actually speaking English too. 

Building on these unique and complementary strengths, these agile nations united as upholders of the values of English-Speaking Peoples should reindustrialize, rearm, redraft and recommit to a common goal in a world of increasing geopolitical conflict. 

The sharing of expertise and overall close collaboration between these agile nations can facilitate rapid preparation for conflict at any moment, proactively addressing Wierzyński's dangerous “peaceful bliss.”  

In other words, this is a pathway to vigilance in anticipation of the thief in the night, who may arrive at an unexpected hour.

Renewed partnership is necessary between these nations. There is a need for these nations to re-assert their historical courage, underpinned by vital modern capabilities. 

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Alongside the United States as the focal point, these nations are Canada on the Arctic frontier; the United Kingdom as a Northern frontier; Poland as the Eastern frontier; Israel as the Southeastern frontier towards the Eurasian landmass, and Australia, with its recent experiences confronting neighbour China, on the Far East frontier.  

Each of these nations serves as a regional center of power and influence: Canada in the Arctic and Atlantic; the US into the Caribbean and broader Latin America; Israel in the Middle East with the Abraham Accords and North Africa; Poland into Central and Eastern Europe, and Australia in the Indo-Pacific. Each of these nations possesses vital agility, given their small geographical sizes or populations.  

These frontier nations respond to United States CIA Director William Burns’ 2023 Ditchley Lecture, in which he focused on “[hedging middle power countries who] see little benefit and lots of risk in monogamous geopolitical relationships. Instead, we’re likely to see more countries pursue more open relationships than we were accustomed to over several post-Cold War decades of unipolarity.” The focus here is courage with a long-term view, building a frontier-focused alliance rather than seeking relations based on short-term material interest only.

In this frontier model, it is currently Israel demonstrating the courage to uphold the values captured in Churchill’s account of the English-Speaking Peoples. Hamas’ brutal October 7th attack was predicated on the notion that over the last decades, Israel transformed into a consumer society, focused on short-term economic incentives and leisure pursuits. Israel provides technology and experience in fighting modern wars of various types, as well as persistence and proactiveness that other nations must quickly recover. 

Canada is historically a frontier nation of courage, reflected for instance in its contributions to WWI and WWII victories, as well as in the often-quiet contributions that Canadians make to peacekeeping efforts across the globe. But Canada can take bolder action, given its strategic Northern location and proximity to the Arctic, with its vast natural resources including critical minerals supply and its vast freshwater reserves. It can become a more influential global player amid trade wars, helping reduce dependence on Chinese resources.  

The United Kingdom’s combination of common law, property rights, financial markets and freedom of the press are important strengths. As Nigel Biggar finds in his Colonialism: A Moral Reckoning, the UK has historically championed free markets generating economic opportunities for diverse peoples; established peace where internal strife previously existed, protected the rural poor from wicked landlords, and provided civil service and judiciary systems to reduce corruption.  

Poland, as noted by Radoslaw Sikorski in a recent speech, shares with the United Kingdom “the same strategic vision. It is based on the fundamental assumption that international law is the guardian of peace and stability.” Poland also “consistently supports close, comprehensive cooperation between the UK and the EU’s security and defence frameworks” with continued focus on strengthening its military capabilities. And, of course, Poland is keenly aware of the threat of war which which is ever-present on its border. 

Australia has, over the last decade, demonstrated evident success in facing the threat of China on its doorstep, this ever-present threat producing a group of leaders across government, private and media sectors that are as sharp, worldly and realist in nature as any in the Commonwealth.  

Renewed partnership is necessary between these nations. There is a need for these nations to re-assert their historical courage, underpinned by vital modern capabilities. C.S. Lewis, in his famous Screwtape Letters, shows that “courage is not simply one of the virtues, but the form of every virtue at the testing point, which means, at the point of highest reality.” Each of these frontier nations has historically demonstrated success in the face of testing.  

Our focus cannot be narcissistic moralising – too often the case in today’s geopolitics – which is the product of the serpent’s advice in the Garden of Eden, in which our eyes will be opened as we “become as gods knowing good and evil.”  We must not allow others to twist our sense of history, such that we begin to exalt ourselves in the present moment rather than adopting attitudes of service, sacrifice and worship of that which is unfathomably greater and farther-reaching.

Instead, it must be – as we have seen with Churchill, and as described by Dietrich Bonhoeffer in his incredible commentary on the story of the Garden of Eden, to act. 

As Bonhoeffer writes, “If the Holy Scripture insists with such great urgency on doing, that is because it wishes to take away from man every possibility of self-justification before God on the basis of his own knowledge of good and evil… The error of the Pharisees, therefore, did not lie in their extremely strict insistence on the necessity for action, but rather in their failure to act. ‘They say, and do not do it.’”  

The frontier model we propose facilitates such action, prepared with the necessary capabilities and coordination for the considerable challenges before us. 

We must remember that to participate in the world with deep faith – courage – has been and always will be the basis for human freedom.  

Indeed, this is the task of the nations: united by the common heritage of English-Speaking Peoples, acting with faith in the good, always at the frontier.