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

Interview

Assisted dying

Culture

Politics

S&U interviews

13 February 2025

5 min read

Marsha de Cordova: the personal experiences driving her passionate politics

“What disabled people need is assistance to live, not to die.”

Robert Wright

Robert is a journalist at the Financial Times.

A woman wearing a red jacket stands formally beside an office stair case.

When Marsha de Cordova talks about most issues relating to her work as the Member of Parliament for Battersea, in south London, she sticks to the standard position of her Labour party. Meeting at her constituency office by the busy Clapham Junction railway station, she dutifully defends her party’s government, elected last July. She points to ministers’ work to reform planning and improve renters’ rights as evidence they are making progress.

But when conversation turns to the Assisted Dying Bill currently going through parliament, her tone becomes unmistakeably more urgent and her passion more obviously personal.

The strong feelings mark de Cordova out as one of a group of Labour MPs who have been spurred by personal experience and, in many cases, religious conviction to oppose the Assisted Dying Bill introduced by a colleague, Spen Valley MP Kim Leadbeater. While the legislation is a private member’s bill without official government support, it has been widely seen as reflecting the views of Prime Minister Keir Starmer.

De Cordova, who is Black, expresses similarly trenchant views about the government’s rhetoric on immigration. She is also a strong supporter of rapprochement with the European Union.

However, her views on assisted dying – informed partly by being a committed Christian – are particularly forcefully expressed. She answers tersely, “No, I’m not”, when asked if she is happy about the political capital the new government has expended on the Assisted Dying Bill. She adds that she voted against it at second reading, the first parliamentary vote on a bill. She intends to oppose it again at third reading, before it passes to the House of Lords.

“We didn’t need to expend so much capital on it,” de Cordova says. “The aim now has to be to ensure the bill doesn’t pass third reading.”

Many of the Labour MPs who have opposed the legislation have cited religious objections. In the Cabinet, they include health secretary Wes Streeting and foreign secretary David Lammy, both Christians, and justice secretary Shabana Mahmood, a Muslim.

De Cordova also links her opposition to her disability. De Cordova is registered blind because of nystagmus, in which the eyes repeatedly move involuntarily, disrupting vision. There have been fears assisted people could come under greater pressure than others to seek assisted death.

“As a disabled woman, I’m incredibly concerned,” de Cordova says. “What disabled people need is assistance to live, not to die. That should be our government’s priority.”

“My faith is an integral part of who I am. It really is part of my values, my beliefs, my politics.”

The assisted dying fight has garnered unusual levels of publicity for the Battersea MP, who entered parliament seven years ago when barely expecting to do so. De Cordova, now 49, was serving as a Lambeth borough councillor when the 2017 snap general election was called and decided to seek the Labour nomination for Battersea, then held by the Conservatives.

The seat was one of several Conservative seats in pro-Remain areas that fell to Labour’s surprisingly strong showing in the election in the wake of the 2016 Brexit referendum.

“No one really thought I could win here,” de Cordova says. “Obviously, Brexit I would say played a role in that I’m a strong Remainer.”

De Cordova increased her majority in 2019 and last year’s general election. She sees strong continuities between serving as an MP and her previous role in the charity sector. She had been working when elected as the engagement and advocacy director for the Thomas Pocklington Trust, which supports blind and partially sighted people.

“I didn’t grow up wanting to be a politician,” de Cordova says, of her upbringing in Bristol. “I’ve always had the desire to be making a difference. All of my work before becoming a politician centred around that – being that voice for the voiceless.”

She links her work to her faith. She became a Christian in her late 20s and now attends Holy Trinity Clapham. The church is famous as the spiritual home of William Wilberforce and the “Clapham Sect” of early 19th century campaigners against the slave trade and other social evils.

Her faith has led to her appointment as second church estates commissioner – the liaison between parliament and England’s established church, who answers questions in the Commons on behalf of the church.

“My faith is an integral part of who I am,” de Cordova says. “It really is part of my values, my beliefs, my politics.”

It becomes clear speaking to her that her objections to the policies of the government – and the Assisted Dying Bill, which many of her party colleagues support – are clustered around areas involving challenges to fundamental rights.

She objects to the Assisted Dying Bill because she sees it as part of a steady erosion of disabled people’s rights.

“The issue will have a hugely, hugely disproportionate impact on disabled people,” she says. “That, for me, is a no-no.”

Provision for disabled people was “hollowed out” under the last Conservative government, she says.

“That, for me, will always be the issue,” de Cordova says. “I want to campaign and fight for full equality for us.”

She also views immigration issues through the prism of immigrants’ rights.

Asked if she wishes the government took a less hostile tone on the issue, she replies: “From my perspective, when I think about immigration, I tend to think about it in a compassionate way.”

She calls for the establishment of “safe routes” to ensure people fleeing persecution can claim asylum from outside the UK, without making dangerous Channel crossings. The government has shown no signs of introducing such rights.

“Let’s think about immigration in a positive way,” de Cordova says, adding that her grandparents were immigrants to the UK from the Caribbean. “The Tories and the right have always tried to portray it as a negative. It’s not always a negative.”

For de Cordova, the unglamorous role of church estates commissioner forms part of that pattern of advocating for the voiceless.

The job entails dealing with every aspect of MPs’ questions about church life, including the status of historic buildings and other less obviously morally important questions.

However, de Cordova, who was appointed a month before publication of the Makin Report on the church’s handling of abuse by John Smyth, is clear the church has urgent problems to resolve.

The Makin Report has to be a “turning point”, she says.

“I understand steps are being taken to address the challenges,” de Cordova says. “They need to set out over time how they’ll ensure such abuse never happens again.”

The campaigning approach is part of de Cordova’s wider philosophy. She says she has faced many challenges as a result of her disability and tried to overcome them.

“I want to ensure that I can break down the barriers for people coming after me, so that people don’t have to face those same experiences,” she says.

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