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Assisted dying
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9 min read

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

Essay
America
Comment
Politics
Race
13 min read

A raging election and the haunting of American memory

Civil War lessons on what ‘we the People’ choose to remember or forget.

Jared Stacy holds a Theological Ethics PhD from the University of Aberdeen. His research focuses conspiracy theory, politics, and evangelicalism.

A US flag flutters under a dark brooding cloudy sky.
Roger Hoover on Unsplash.

Foreboding. That’s how my friend described the time between now and the election in America. It’s everywhere, and nowhere. It’s felt, it’s lived, it’s immediate. And it’s true, there is little reason to carry ourselves as though this election will be anything other than consequential—immediately so—for at-risk communities across the United States, from hurricane survivors to Haitian-Americans.   

We would do well to pay attention to this. And for me, as an American citizen, I plan on casting my vote against Trump, for what I wager to be a better path towards provisional freedom. But there’s a part of me that remains attentive to the stakes and the perils that lie beneath the immediate. 

As you survey the landscape of the American experiment, you will find it marred not just by scars of racial hatred and violence, but the shadows of things forgotten and repressed. Looking over it long enough will reveal the chasm between America’s living memory and its history. It’s here, surveying that great landscape, the gap emerges between what “We the People” choose to remember and what we’ve deigned to forget. And this memory—as much as the polls and the data predict—will influence what is to transpire these next few months. 

As we bear witness to the events unfolding before us, we would do well to remember how “We the People” have never truly resolved our Civil War. Our memory of the war is both hallowed and haunted.  

If onlookers and participants alike want to understand—really and truly—the crucible of this American election you have to descend to the depths of American memory, into its distortions and attempted preservations. You have to understand not just the Civil War itself, but its ongoing aftermath, from a period called Reconstruction to the century later Civil Rights struggle, and on to today. Recently I heard historian Jemar Tisby share an anecdote of something uttered by a Gettysburg battlefield tour guide, “The north won the war,” he said, “but the south won the memory.” 

Who has time for a history lesson? I would submit the stakes are too great, and the need too earnest, to ignore. 

Memory is a fickle thing. But it is also a moral thing. Memory gathers the resources from which individuals become a “we.” That is the point where everything begins to change, observes John Steinbeck. That move from “I” to “We,” he called it. Memory can create a people. From it, a “we” can draw strength, clarity, and courage for the present, it can also reap the whirlwind.  

Theologian Stanley Hauerwas captured the stakes when he observed, “memory is a moral exercise.” And in a moment where the American social fabric seems to be rending at the seams (not at all an unprecedented event), I think part of staying the course involves turning again to the moral power of memory. To remember what we’ve forgotten, to surface what has been buried.  

But in the middle of an election cycle endlessly bombarding Americans with hate, disinformation, and propaganda, the turn to memory might seem little more than idealism. Who has time for a history lesson? I would submit the stakes are too great, and the need too earnest, to ignore. The problem is: the American memory is distorted and divided. 

Ruby Bridges visits Barack Obama at the White House to view 'The Problem We Have To Live With' on its walls, 2011.

Barack Obama and a middle aged black woman look at a picture of her when she was a child walking between guards protecting her.

In 1960, a six-year-old girl by the name of Ruby Bridges became the first African American to attend William Franz Elementary School in New Orleans. She walked into the school that day surrounded by armed guards, assigned to protect her from public fury in the wake of a federal court order enforcing integration across New Orleans Public Schools. 

Ruby became an icon of the Civil Rights struggle of the Sixties. She was canonized by artist Norman Rockwell in a piece aptly titled, “The Problem We All Live With.” Between that painting and hundreds of photographs that captured her bold yet innocent stride up those school steps with books in hand, Ruby Bridges was impressed into American memory.  

Consigned to these mists of memory, Ruby Bridges appears as perpetually six years old to many white Americans. But one fact pierces the mists of memory: Ruby Bridges has an Instagram. Though her memory in white America reduces her to an image frozen in time, she is a woman alive today in her sixties with an incredible ongoing career in advocacy and activism. The cries of “woke!” that emerge in every conversation about justice and equity in America cannot silence the reality of time: the Civil Rights struggle is not so distant as white Americans often insist it was. What we remember is tragically the result of what we’ve tried to forget. 

But whenever the church settles to serve as a chaplain of empire, it soon confuses the privilege and luxury it secures with its own freedom.  

We tend to think of history as objective, as a set of facts. And this obscures how our own memory of history can be distorted and warped. Consider this past month that former US President Jimmy Carter turned 100 while in hospice care. His birthday made mainstream news. An impressive lifespan to go with an incredible legacy as a husband, father, and public servant. But the American memory is strange. Strange because Carter, the oldest living US President, is still with us. Making it all the more startling to remember that the Rev. Dr. Martin Luther King was born 5 years after President Carter. That, if not for an assassin's bullet at a Memphis hotel balcony in 1968, Dr. King could have been celebrating his 96th birthday this coming January. Memory can be distorted, warped, and pressed into service of propaganda. 

Too often, the white church in America has made itself fit for service as a chaplain of empire. Willingly producing, baptizing, or consuming memories which obscure the truth that brings about reconciliation. In so many words, we have in America today a more reactionary and partisan element of the church. One that cannot take the moral responsibility of memory seriously because it finds itself too invested in its role of reifying and deifying America. And whenever the church settles to serve as a chaplain of empire, it soon confuses the privilege and luxury it secures with its own freedom. Because many white churches confuse this power with freedom, the memory of America is captive to its own ends. It is not free. It does not know the freedom which liberates the church to the moral task of memory. 

I think here of Dietrich Bonhoeffer’s claim that the church can never take immediate or “direct” political action as church because, as the community of God’s people it “does not know the necessary course of history.” The church does not possess special access to the ideas of the future, nor does it consign the world to fate. What the church is, it is as witness. It testifies in the bread, the wine, the water of the liberating presence of God. But when the church acts apart from this vocation it risks becoming what Ernst Kasemann called the “anti-church” which replaces the cross with power. 

I find this a broadly accurate depiction of what the white American church presently offers to the American public. It is not the beloved community and conscience of the nation to which Martin Luther King Jr. spoke, rather it is a chaplain of empire. And in this role, the church finds itself both a producer and consumer of a distorted memory, filled with a mixture of sentiment, propaganda, and raw fact. A story of America in service of a particular vision of America which never existed. 

Is this not too political for the church? Mustn’t we keep religion and politics separate? All theology is political. That is, all human talk about God involves consequences—for good or ill—concerning fellow human beings. James Cone puts it more directly: “Any talk about God that fails to make God's liberation of the oppressed its starting point is not Christian.” The difference then is not whether the church is political, but rather whether its talk about God is indeed talk which remembers in a living way the God of Jesus Christ, and whether or not it opens itself up to the critical examination of its own god talk. And this is where we find a good deal of the white American church today. 

Even the mention of the “white church” in America should stir up the paradoxes and contradictions which persist in the field of American memory. But perhaps we too easily confuse “history” with “memory.” Memory is living, fluid, and potent. I like how Robert Jenson puts it, “so long as a people is alive, there will be an exchange between how it remembers its history at any given time and its needs, concerns, and goings-on in the present. There is thus usually a difference between a people’s own living memory…and the accounts constructed by historians…” Jenson was talking about the Old Testament. Here, we reflect a bit on the American experiment.  

I remember in 2020, as a pastor, I sat in a prayer night at the church where I served on staff. But there was not much praying. Instead, we were shown a video selected by our senior pastor. The video was a tour of Washington D.C. highlighting all the Christian imagery and inscriptions scattered across the American capital. I’ll never forget the words that came from my pastor: “The next time,” he said, “anyone tells you America isn’t a Christian nation, you tell them about what you learned here tonight.” And that was it. The video never mentioned many of the buildings were built by the hands of people enslaved in an institution justified by a most bankrupt faith. 

I’ve come to understand that every church in America, even with the Christian story on its lips, tells a story about America, too. And the memory of that story carries with it theological consequences. After all, there can be no quicker way to discredit human words about the God of Jesus Christ than to attach those words to a false memory of America masquerading as dogma.  

The statute of General Longstreet, Gettysburg battlefield.

An equestrian statue of an American Civil War general wheeling his horse.

Stranger still was realizing the church I served was constructed on a piece of land in Virginia’s Spotsylvania County lined with historical markers. One identifies the land as the camp site of Confederate General James Longstreet during the Fredericksburg Campaign of the Civil War. Tellingly, Longstreet’s own life and legacy gives witness to the enigma of memory and also the possibility of change that arises from the wedding of truth and reconciliation. 

Longstreet was long known as General Robert E. Lee’s right-hand man. He devoted himself to the Confederate cause in defense of slavery. And stood by Lee till the end of the war, joining him at Appomattox, Virginia, where he was reunited with his foe and friend, Union General Ulysses S. Grant. Instead of imposing harsh penalties on the Confederates, Grant proved reconciliatory in ways that Longstreet never forgot, according to his biographer, Elizabeth Varnon.  

In fact, Longstreet became an ardent supporter of Reconstruction policies and Civil Rights, including the vote, for formerly enslaved people. His transformation made him an enigmatic figure that attracted the bitter hatred of fellow former Confederates seeking a scapegoat for the South’s defeat. They found their sacrifice in Longstreet. 

After the war, Longstreet settled in New Orleans for business. In 1872, there was a disputed election between pro-Reconstruction Republican governor and the Democrats. Longstreet answered the call from the Republican governor to lead a “mixed” regiment of African Americans and white Americans against a renegade paramilitary force comprised mainly of disgruntled Confederate veterans. These paramilitary groups opposed the African American vote and Reconstruction policies in general to the point of violence. 

In a historical episode that echoes January 6, 2021, Longstreet, a former Confederate General, led this Reconstruction regiment against white paramilitary insurrectionists seeking to subvert the election and install their own governor. The clash became known as the Battle of Canal Street. But its original name was given by the nearly successful Confederate paramilitary: “The Battle of Liberty Place.” This was the name affixed to a monument erected in 1891, which stood in New Orleans until it was removed under cover of darkness for fear of political violence in 2017. 

The stark transformation of Longstreet’s life and career does not make the man a saint. He clung to racist ideologies until his death. To emphasize his support of Reconstruction is not to canonize him as much as it is to highlight the enigma of American memory. That, in the wake of the Civil War, the conflict over Reconstruction proved so destructive that eventually whites from the North and the South opted to reconcile at the expense of Civil Rights. In the contested Presidential Election of 1877, Republicans accepted the Presidency in exchanged for the Democrat’s demand for an end to Reconstruction and a withdrawal of Federal troops. The dealings of 1877 made Jim Crow America possible, and forestalled gains of the Civil Rights movement for nearly another century. And the question remains open: will America ever deliver on its promises? This is the appeal made by MLK and others. 

And our failure to remember as Americans is, surely, part of the task of the church in America. For a witness to the Christian story surely involves a freedom to speak truths of our common life and history which make for reconciliation. For me, as the election nears, I’m thinking of the enigma of Longstreet and the distortion of American memory. 

For in the very church that claimed America was a “Christian nation” merely by virtue of slogans fixed atop our public buildings, there was along with it a willed ignorance to matters of race in our own community. I experienced enforced silence on just how far a pastor might talk about race before being “too political” or “divisive.” I found there is a tragic irony of failed memory in gathering to worship on land once occupied by Longstreet’s camp, the man who supported Civil Rights and resisted an insurrection. After I left, I learned the church’s parking lot was made available for busses attending the event that metastasized into the January 6 insurrection. And just this past month, thousands of evangelicals descended once again into Washington DC, praying and declaring Trump’s victory against Harris. Here too, the whitewashing of January 6 has its own consequences. 

Amid the raging fury of an American election cycle, memory can help provide perspective, so long as we are willing to incriminate ourselves with the sins of forgetfulness and short-sightedness. There are events forever etched into our collective memory, to be sure. We have slogans for them. Like “Remember Pearl Harbor” and “Never Forget” for 9/11. But even here, amidst cries to remember, our memory persists in a state of perpeutal division and distortion. The slogans we create to remember the tragic dead too easily become transformed into a license for our unflinching commitment to the myth of redemptive violence. 
Again and again we see, memory carries moral power. And without truth in our memory, there can be no reconciliation. But I remain hopeful precisely because I do not worship fate. The confession which binds Christian community speaks of the God who reconciles. This reconciliation is received as a grace by the truth of Jesus Christ.  

Whether or not “We The People” renew our capacity to speak the necessary truths, to live in that light, and so prove reconciliation to be a lived reality not mere sentiment, depends in no small part on the willingness of Christian community in America to take up the fuller and deeper ministry of reconciliation bound up in our confession. Such a ministry cannot be one of external compulsion, of endorsing authoritarian politics and programs in the name of another crusade. Rather, it is one that begins and ends with the question of whether the church will be the church. Whether or not America continues as America does not rest on the church. And freed from this strange, alien imposition, the church may find itself all the more fit to help America remember and so tell the truth and reconcile together. 

So long as we Americans allows ourselves the freedom to recognize the inherent relationship between truth and reconciliation, perhaps we can carve out a higher vantage point from which the stakes and perils of this election become a bit clearer and stir in us a bit more courage to persevere in what Lincoln spelled out over a century ago, a new birth of freedom and government of, by, and for the people…all the people. And may the church stand to testify that this temporal freedom is only a fleeting harbringer of a freedom which comes to all humanity through the scandal of a cross and empty grave.