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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

Explainer

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Holidays/vacations

Paganism

28 October 2024

6 min read

A brief history of Halloween

Our obsession with pumpkins and ghosts reveals a lot about us

Theodore Brun

Theodore is author of the historical fiction series The Wanderer Chronicles. He previously studied Dark Age archaeology at Cambridge, and afterwards worked in international law.

As summer withers into autumn, these days you can’t escape the impression that Halloween is taking over.

Like Christmas or Mother’s Day, the run-in to Halloween seems to project further backwards from the actual date of its celebration - 31st October - with each passing year.

I am especially conscious of this as a parent. Weeks before the actual “event”, the kids start coming home from school with all manner of Halloween arts and craft detritus, poems, storybooks and spelling tests (no pun intended). Costumes are dug out for special Halloween dress-up days. The kitchen is covered in pumpkin pulp and paint – which is fine. (I’m less keen on the vampire blood dripping off my eight-year-old’s chin.)

In the supermarkets and department stores, the black and orange decking appears. Cobwebs materialise in the shop windows with a speed and intensity which any arachnid would envy. Movie billboards on passing buses take a turn for the infernal; Netflix algorithms become decidedly witchy. Everywhere you look, your eye is met with devil horns and the baleful glare of demons.

No doubt commercially it’s a great money-spinner. But what does it say about the prevailing currents of our culture?

Our obsession with this holiday - or at least someone’s obsession with this holiday - apparently knows no end. But why?

No doubt commercially it’s a great money-spinner. But can we read anything more into this growing obsession with Halloween? What does it say about the prevailing currents of our culture?

In the British Isles, at least, the tradition of a celebration marking the end of the harvest season finds its origin in the ancient Celtic festival of Samhain (pronounced ‘Sow-in’). The Celts, who populated what is now Ireland, Great Britain, and parts of Northern France, celebrated their new year from sunset on October 31st to sunset on November 1st. (Would that ours were so neatly packaged.)

Samhain marked the end of harvest and the start of winter, a time when the days grew shorter and colder. It was viewed as the transition from the light, fertile half of the year to the dark, barren half. But more than this, Samhain was believed to be a time when the boundary between the physical world and the spirit world was thinnest, allowing spirits (both good and bad) to pass through. Thus, it was a time for honouring ancestors and the dead, who were thought to return to their homes seeking hospitality. This ‘thinning of the veil’ also meant the increased presence of otherworldly beings like faeries (or worse), which could cause harm if not appeased. Offerings of food and drink were left out to ensure peace with them, too.

Some of the ways in which the festival of Samhain were held will be familiar to us today: large communal bonfires were lit (long before Guy Fawkes appeared on the scene); feasts were held in honour of ancestors; fortune-telling and divination were considered especially effective at this time; some traditions involved donning disguises and costumes in order to ward off and confuse harmful spirits; small food offerings were left out to placate wandering spirits. Livestock were often slaughtered ahead of the coming winter.

With the slow but inexorable conversion and Christianisation of the peoples of Britain from the late Roman period of the third and fourth centuries on into the early medieval period, this pagan festival marking the transition in the year from light to darkness evolved. Like many aspects of a pre-existing pagan culture, the festival of Samhain, under the influence of the Christian faith, was not expunged but rather, in the church’s eyes anyway, redeemed. In other words, the paganism of the British Isles was not so much swept away as swallowed up, and then re-constituted into something more overtly Christian, but with pre-existing cultural undertones still there.

So, Samhain became All Hallows’ Day or All Saints’ Day, celebrated on November 1st, which honours all the saints, both known and unknown, who have attained heaven. The first recorded evidence of its celebration in the West was in Rome in the early seventh century. By the mid-eighth century, it had spread to most of the Western Christian tradition. It provided a kind of catch-all celebration for the sainted dead, marked by special readings and prayers, and often the lighting of candles at gravesites or in churches, honouring deceased loved ones and saints. In terms of teaching, All Hallows’ Day emphasises the Christian belief in the communion of saints – the spiritual union of the living and the dead in Christ. You can see, perhaps, the same “thinness” of the veil between their otherwise separate worlds marked there.

G.K. Chesterton used to argue that, paradoxically, the most pagan thing still in the world is the Christian church. He understood that in the West at least, all of paganism - the awe and mystery which pagans once held towards the natural world - has been rolled up and retained in the traditions and rituals of the church. The festival of Halloween, for a long time anyway, seemed a particularly obvious case in point.

However, there is no doubt that in more recent decades, with the general waning of Christian faith and advance of secularism - at least in our outward expressions of culture, if not necessarily the inner convictions of our hearts – the surface veneer of Christian faith has rather sloughed off this festival of Halloween. And what we are left with is something more overtly pagan, and certainly more sinister.

Could it be the apparently ceaseless proliferation of this ancient festival has something altogether more chilling to say about our culture?

In his book Heretics, Chesterton had already envisaged what we are now seeing in our culture a hundred years after he wrote it. He wasn’t too worried. “If we revive and pursue the pagan ideal of a simple and rational self-completion, we shall end where Paganism ended. I do not mean that we shall end in destruction. I mean that we shall end in Christianity." In other words, if society returns to pagan ideals, he was sure it will eventually lead back to Christianity because of the deep moral discoveries and spiritual truths that Christianity offers.

On the other hand, I am not so sure. Historically, what has once been a pagan culture that is rolled up into a Christian one does not revert to that same naïve, even “innocent” form of paganism when Christianity is discarded later on. Rather, the spiritual mood becomes post-Christian. Even Anti-Christian, re-creating a form of paganism as appropriated and adapted by the spirit of anti-Christ. That seems closer to the mark, especially when you notice the number of inverted crosses appearing on the doors of the more enthusiastic Halloween celebrants on the street.

So could it be the apparently ceaseless proliferation of this ancient festival has something altogether more chilling to say about our culture? In Jesus’ own words: “And this is the judgement of the world: the light has come into the world, and people loved the darkness rather than the light because their works were evil.”

Even if this might be nearer to the truth, the claim of Christ has always been one of hope: where there is death and darkness, so must follow resurrection and light. And at this time of year, it is perhaps to our profit to remember one of the most beautiful passages about light and darkness ever penned: “In him was life, and that life was the light of all mankind. The light shines in the darkness, and the darkness has not overcome it.”

Worth remembering, too, however scary we make our pumpkin, we are still moved to fill it with light.

So, let’s not be too gloomy.

After all, Christmas is coming.