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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

Essay

Comment

Economics

Sustainability

18 November 2024

8 min read

Raiding the fields, lessons from history

A tax raid on farmers is raising more trouble than revenue.

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.

A soot stained burnt-out harvester sits in a recently harvested field.

A burnt-out harvester, Lonesome Farm, Oxfordshire.

Nick Jones.

“Better red than expert.”

That was one of the slogans touted through the national propaganda channels in the early days of the People’s Republic of China shortly after Chairman Mao came to power. In other words, professionalism should be subordinated to politics.

It seems a pretty accurate description of the current UK government’s own attitude to farming in the light of their controversial inheritance tax raid on the nation’s farmers. Prior to last month’s budget, Agricultural Property Relief meant that farmers could expect to hand all qualifying agricultural assets on to the next generation without lobbing their children the simultaneous hospital pass of a whopping great tax bill. It was this inheritance tax relief and this alone that allowed every typical asset-rich/cash-poor farming business to survive as a going concern from one generation to the next.

Chancellor Rachel Reeves, perhaps applying her “better red than expert” thinking, identified this as a tax loophole that needed to be closed. She says it is costing taxpayers £1billion a year - which, when you think about it, is like a man who’s just cornered you in a dark alley saying you are costing him and his mates £100 by keeping those two shiny fifty pound notes in your own pocket.

Farmers will now be expected to cough up 20 per cent of the value of their agricultural property into the national coffers with every passing generation. It doesn’t take an expert mathematician to realise such an erosion of capital needed to pay these bills will render many farming businesses untenable, particularly given that farming relies heavily on economies of scale. This represents a torpedo strike on the farming industry which will sink a very large number of people, not just so-called Barley Barons.

No matter that the uptick of increased annual tax take from this measure will barely be enough to cover a day and a half of the NHS spend. Nor that while the government claims that, with a threshold of £1million before inheritance tax applies, 72 per cent of “farms” will not be affected (their definition including small parcels of land, and so-called toy farms which make no pretence to be food-producing businesses), the National Farmers Union says the true figure is closer to the inverse of that.

John McTernan, a former aide to Tony Blair and supporter of current PM Keir Starmer, didn’t help cool tempers with his revealing comment that farming was an industry which the UK could do without. “Labour can do to farmers what Margaret Thatcher did to the miners,” he said. Starmer was quick to distance himself from these incendiary remarks.

But as farmers would no doubt appreciate, what looks and smells like horse manure, probably is horse manure. And these measures are what they look like: an outright attack on the farming community, and more widely the ancillary rural economy which farming supports. The average farmer would be forgiven for thinking this feels far more ideological than fiscal in its aims.

That is why this week will see the largest rural protest in Westminster since the Countryside Alliance march in 2002. Farmers will converge on the Houses of Parliament to ask the government to reconsider such a direct attack on the food security of this country.

Given this fraught situation, are there any lessons to be learned from the past?

You have to wonder whether arguably the most left-wing government this country has ever seen is taking ideological plays out of the history book. Such tax raids on farmers' fields are nothing new. From ancient biblical times even to the last one hundred years, the consequences effect much more than the economy, they reach even to the soul of nations.

If farmers as a community stand in the way, what is the objective that lies beyond them, which the new utopians hope to attain?

In 1920s Russia, the Bolsheviks specifically targeted a class of landed smallholders known as the Kulaks.

The Kulaks were relatively prosperous, independent farmers, who faced severe repression during the 1920s and 1930s under Stalin's Soviet government. Originally benefiting from land reforms after the Russian Revolution, they were seen by Stalin as a threat to his goal of collectivizing agriculture. By labelling the Kulaks as "class enemies" of the working class, Stalin launched a campaign to liquidate them as a class around 1929, aimed at confiscating their land and redistributing it to state-owned collective farms.

The Soviet government seized Kulak farms, livestock, and tools, often forcibly relocating families to remote regions or sending them to labour camps where many perished due to harsh conditions. This campaign fuelled widespread suffering, triggering famine, especially in Ukraine, where it contributed to the devastating Holodomor. By the early 1930s, the Kulak class was effectively destroyed, resulting in millions of deaths and lasting trauma across the Soviet countryside.

Or how about China?

During China’s Cultural Revolution (1966–1976), smallholders and farmers faced severe disruption as the government under Mao Zedong sought to enforce collectivization and reshape rural life. Although China had already implemented collectivization during the 1950s, the Cultural Revolution intensified the suppression of individual farming and private land ownership, pushing for even greater alignment with socialist ideology. Farmers were forced into collective communes where land, equipment, and resources were shared, and individual autonomy was abolished.

Many were publicly humiliated, re-educated, or sent to labor camps. In addition, the chaos of the period meant that agricultural expertise was disregarded, as revolutionary fervour prioritized political ideology over practical farming knowledge. The mismanagement of agriculture, paired with forced collectivization, led to poor yields and food shortages, further destabilizing rural areas and causing hardship for millions of farmers and their families.

None of this is very encouraging for farmers in twenty-first century Britain. Especially when one considers how ideologically-driven Keir Starmer truly is, if his contributions to back issues of the magazine “Socialist Alternatives” in the early 1990s are any indication.

But if the socialist goals of the twentieth century were collectivisation and the social engineering of class warfare, what could they be today? If farmers as a community stand in the way, what is the objective that lies beyond them, which the new utopians hope to attain?

Again, it doesn’t take an “expert” to hazard a guess. Ambitious government plans to iron-clad the countryside in solar panels and wind turbine farms in a drive towards net zero will be made considerably easier once the current landowners are forced to flood the market with cheap land in order to service a hefty inheritance tax bill. All to save us from imminent environmental Armageddon.

As they listen to what farmers have to say this week, Keir Starmer and Rachel Reeves might do well to reflect on the fate of Jezebel and her king.

This is a narrative that some can at least imagine. But perhaps that is straying too far into what most would consider conspiracy theory at this point, so let’s back up a little.

All the same, when a wrong of this magnitude is done to a particular group of people - especially one made up of some of the most dependable, uncomplaining, and hard-working members of society, it seems reasonable to ask the question: Cui bono? Who benefits from this wrong?

For the answer to that, we shall have to wait and see how it unfolds.

But in the meantime, it is worth considering a perspective from even deeper in the past. A perspective on the “good” that comes from the ownership and stewardship of the land, especially land seen as a family or tribe or nation’s inheritance. With powerful stories set amid ancient fields the Bible has much to say on the matter.

In a sense the whole of the Old Testament is concerned with this question. God gives Adam and Eve land to steward and cultivate. And then expels them from it as a consequence of their sin. From Abraham until Israel’s exile, the story of God’s chosen people is profoundly linked to a promised land which is first placed in their hands as a blessing and means of sustenance and support - of life itself. An inheritance to be preciously held, stewarded, and passed on from generation to generation. And yet which is taken away again by the hand of God’s judgement when Israel turns away from its Lord and Sustainer.

But consider just one story for a moment: that of the humble farmer Naboth and his little vineyard, described in the first book of Kings. This provides an eerily close analogy to the UK government and its current land grab. It is both powerful and chilling.

One day the state, in the form of King Ahab, decides it would rather like Naboth’s vineyard for itself. Ahab offers Naboth money for it. Naboth refuses, saying, “The Lord forbid I should give you my inheritance.” Ahab - “vexed and sullen” - rages in frustration, until his wife Jezebel concocts a far more cunning scheme to get him that land, involving lies, slander and ultimately murder. There’s a twist in the tail, though. Once Ahab has what he wants, God sends his prophet Elijah to denounce his wrongdoing and warn him of his (rather grisly) coming fate.

For those with half an eye on the unseen as well as the seen in this country, the introduction of this family farm tax at this time may come as no surprise. Many in the church have perceived the “spirit of Jezebel” as ascendant on a number of cultural fronts at this moment in our history.

For Israel, the reign of Jezebel was a dark and uncertain time. And for farmers protesting on Tuesday, they may feel this is no less a dark and uncertain time.

As they listen to what farmers have to say this week, Keir Starmer and Rachel Reeves might do well to reflect on the fate of Jezebel and her king.

And for their part, farmers might reflect on the blessing of the inheritance they have received; and what, like Israel before them, they may have done - or not done - in the eyes of God, to jeopardize their chance to pass it on.

After all, at this point in the story, it’s not too late for either side in these farm wars to turn back.