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

Article

Comment

Feminism

Leading

23 October 2024

5 min read

Can Kemi really have it all?

For female experiences to mean something, we need to be part of something bigger.

Sian Brookes

Sian Brookes is studying for a Doctorate at Aberdeen University. Her research focuses on developing a theological understanding of old age. She studied English and Theology at Cambridge University.

A woman works at a laptop on a desk surrounded by picture frame.

Kemi Badenoch campaigning.

Kemibadenoch.org.uk

Apparently Kemi Badenoch is unfit for leadership due to a ‘preoccupation’ with her children. Such comments are hardly a surprise. After all, she is both a mother and a woman vying to be in a position of power. Since the beginning of time women have been mothers, but women haven’t always been in positions of power. So it is not surprising that some people have problems adjusting to the change. But it isn’t just Robert Jenrick who finds this adjustment difficult. In my experience, most women find it hard too. Becoming a mother is a beautiful but body-breaking, exhaustion-inducing and identity-questioning process. And that is just in the first few months. Add to that the expectations of also having successful careers as well, and it is no wonder we find it hard.

Kemi Badenoch’s response, naturally and rightly, was to show how capable she is to lead the Tory party alongside her maternal responsibilities, whilst challenging the view that just because she is a woman she is more responsible for her kids than a man with similar age kids would be. But her lack of acknowledgement of the hardship involved in being a mother and having a successful career does leave an awkward silence around what is an ongoing imbalance in many relationships when it comes to holding the fair share of parental, household and professional responsibilities.

This relentless pursuit of the ability of mothers to do everything else as well as being a mother says something about what we expect from women in our society. We need to prove that it is possible to be a woman and do all the things men have traditionally done. Yet sometimes I do wonder if we make it harder for ourselves. Is it our own expectations which make this thing called being a woman much harder than it needs to be?

Perhaps she is valuable not because of what she does or the choices she makes and what that says about the feminist cause, but because her worth lies elsewhere.

I’ve been blessed with the task of raising three boys, but I think about my friends who are raising little girls and the hopes they have for them. The hopes that they will grow to defy the expectations placed on them because they are female; to counter the oppression put upon them by breaking through the ceilings that may be built over them by others, to become whatever they want to be; engineers, consultant doctors, CEOs, even builders or plumbers if they so desire.

At the same time, (if the girls want them), they are expected to build families and loving safe homes. All of the things our mothers hoped for us and their mothers before them hoped for their own daughters.

Yet now, alongside those hopes for domestic fulfilment, so many other expectations have been added. Of course, the obvious solution to this, as Kemi has argued, is for men and women to share the load on both sides – to build the home and work life in a way that benefits both in the partnership. But the fact remains that relatively speedily in the course of historical development, we have come to a position where we are all expecting to have it all, all the time. And especially for our girls – we want them to be strong, powerful, successful, fruitful and productive all at once.

Now, this is not to say that we should revert to a time when only women ran the household and only men inhabited the professional domain. But sometimes perhaps it’s OK for a woman just to be a mum, if that is what she wants. She doesn’t have to also show the world she can be everything else as well. Some would criticise that decision as selling out on the relentless need to fight for equality with men. But not everything a woman does has to demonstrate some ideological end in fighting for equality, as though that is what gives her value as a woman. Perhaps she is valuable not because of what she does or the choices she makes and what that says about the feminist cause, but because her worth lies elsewhere.

Whatever we do, we do it to witness to a love, a truth which goes beyond whatever we can give to the world.

Many of the friends I spoke of earlier who have those little girls chose to have their daughters baptised as babies. This act of infant baptism puts the stake in the ground for the belief that before they could do anything, before they could prove their worth as a female member of society demonstrating all that power, strength, purpose and ability to right all the wrongs of the past, they were loved and valued beyond measure, without condition.

As a girl, and before they grow to be a woman, maybe a mother, and then potentially the leader of a political party, they are a child of a God who values them not because of what they have done or will do, but because they are His child. At the same time, this doesn’t mean we sit back and do nothing – it’s central to the Christian faith to fight injustice and overturn oppressive powers, but this is never achieved by human action alone as though the weight of the world falls on our shoulders, it is done by bearing witness to a God who has a better plan for the world and for society than we could ever dream or imagine. It is only when we realise this that the burden might be lifted from all the women fighting for all the things we are supposed to fight for.

Of my three closest friends in the church, one is (currently) a stay-at-home mum, one a doctor, one a vicar. As for myself, I am studying for a PhD in theology. We also all spend a lot of time looking after children, cooking and doing the dishes (as do our husbands). And yet, when we reflect together, these choices feel less statements of how we might be empowered or not as women, but more the result of a belief that whatever we do, we do it to witness to a love, a truth which goes beyond whatever we can give to the world. And so, we can each celebrate what we “do” because in each offering of ours can be found meaning, purpose and life beyond our own abilities, even our own individual actions. Perhaps, this is better than any kind of feminism you find around these days, because it allows us each to do the small thing in front of us without loading more on ourselves than we can bear alone. Only together, and only in knowing we are part of something bigger than ourselves, can our variety of female experiences mean something. In this way of living, being a woman feels very free indeed.