Explainer

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

Belief

Climate

Comment

Sustainability

13 September 2024

7 min read

Living sustainably doesn’t have to be a burden, here’s the case for action

How not to get hot and bothered about climate change.

Barnabas Aspray

Barnabas Aspray is Assistant Professor of Systematic Theology at St Mary’s Seminary and University.

A protester holds up a green sign reading: 'It's hard to be green. Kermit'.

Markus Spiske on Unsplash.

The fundamental tenets of Christianity show why Christians are called to love not just one another but all created things.

1. God is love.

2. God created everything.

Therefore, God loves everything he created.

3. God appointed humanity as the guardians of creation.

Therefore, a fundamental part of our identity and calling as human beings is to protect and sustain all that God created.

This lies at the basis of everything Christians believe and do. But a case can be made that is more basic still because it appeals, not to anything distinctively Christian, but to natural human wisdom. The climate crisis is not a Christian crisis. It’s a crisis for everyone who cares about their future and that of our planet. The climate crisis may be something unprecedented in the history of humanity, but the principles that are needed to resolve it are not new at all. Sustainability is not a new or particularly abstruse idea. It is something everyone understands as basic common sense. If I cut down trees faster than they can grow, I won’t be able to do that forever. One day I will cut down the last tree and then there won’t be any more trees, ever again. If I catch fish faster than they can reproduce, then one day I will catch the last fish and then won’t be able to catch any more ever again.

But it’s not only about foresters and fishermen. Since the dawn of humanity, we have been living sustainably – wisely preserving resources and using only what we can replace, so that we and our descendants can continue to live. This applies to everyone regardless of their profession. All of us, if we spend more money than we earn, are living in a way that cannot last for long. If we use resources at a faster rate than we can replenish them, we will run into trouble at some point in the future. Every person possessed of reason and common sense knows this intuitively without having to be taught it. Only someone seriously deluded, foolish, or with some kind of mental health problem fails to understand the need for sustainability in order to have any kind of future at all, let alone a pleasant future.

The call to live sustainably can lead us to feel burdened by a permanent sense of guilt, a feeling that we ought to be doing more than we are...

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We are burning fossil fuels at hundreds of times the rate they can be produced. We are producing plastics that cannot be recycled, meaning we have to dump them in landfills that are growing all the time. We are pouring carbon dioxide into the air faster than anyone can take it out. All of these things mean that there is a time limit on the kind of lifestyles we are all leading now. If we carry on in this way, then one day we will cross a line from which there is no returning. As Mark Scarlata has pointed out, the solution cannot be technological. Even if we find a way to balance carbon outputs with inputs, we are only kicking the can further down the road. Our inability to live within our means will simply resurface somewhere else later on. The problem is spiritual, not technical.

Everyone understands this at some level even if it’s the kind of truth from which we prefer to avert our eyes. The harder problem is to understand why this basic common sense isn’t proving effective. Why are we living collectively in a way that only a foolish or insane person would live, when most of us taken by ourselves are neither foolish or insane?

The problem, at least in part, is that we are all entangled in systems that make it very hard for us to live sustainably. If I am an ordinary Brit living in an ordinary town or city, and I need to buy toothbrushes or nappies or cucumbers or strawberries, I go to the local supermarket: and the only options available are made of plastic or wrapped in plastic that will not decompose for 500 years, and often brought here from the other side of the world using huge amounts of carbon emissions. Most of us are busy people with limited financial resources. We don’t have the time to find sustainable alternatives and often they are too expensive even if we can find them. The societal structures that we live in limit the choices we have. The call to live sustainably can lead us to feel burdened by a permanent sense of guilt, a feeling that we ought to be doing more than we are, but also an inability to see how we could be doing more given all the pressures, needs and constraints on our time and money.

Christians do not naively believe that God will sweep in and fix everything if we just wait. That would be to deny our responsibility, and it is not what hope means.

We are all culprits in part, since we all contribute to non-sustainable living. But we are also partly victims of forces beyond our control, large cultural forces that shape and determine our actions more than we can imagine. We have very little power over those structural forces and currently things do not look good. Common sense principles aren’t working. The climate crisis is only getting worse. So, what do we do?

It is at this point that Christianity has something special to offer to the problem.

First, Christians are never called to be defeatist or to throw in the towel. This is because we are called to an enormous hope, a hope that surpasses understanding, a hope that the world cannot understand because it stands over against all the odds and all the possibilities. This hope is rooted in the conviction that our God is God Almighty, that he has not abandoned his creation, and that he has power to save. He is a saviour. He is the God of our salvation. This is the God we believe in. The climate crisis may look bleak right now, but Christians need never despair or become indifferent. If we do our small part, we can trust that God is in control of what is out of our control.

Secondly, Christians believe that every human being is a free agent with the capacity to choose how he or she will act. Our freedom may be limited by the societal structures that shape and constrain our choices, but it is not destroyed. We can still make choices within those limits to buy and live more sustainably – anything from choosing a holiday destination within driving distance, to giving up beef (by far the worst food for carbon emissions). There is something all of us can do.

Thirdly, Christians believe in a God who transforms hearts and lives, winning them to the power of the gospel and to a new way of living that is free of the shackles that this world – the structures of society – puts on us. This transformation is slow – slower than we would like it to be sometimes. We feel the shackles still gripping us at times. We are not expected to change everything all at once, to become holy overnight. Nevertheless, God gives us the power to change our lives, and to become part of the solution rather than part of the problem. The way towards sustainable living is not to try to change everything at once, but to ask: what one thing can I change in my daily lifestyle that would make it more sustainable? And then once we’ve mastered that and integrated it so we no longer even think about it and it’s just a default, then we can ask: what’s the next thing I can do? All of a sudden what looks like an unimaginable height of transformation, when it is broken down, becomes a series of manageable steps.

Even if we do everything in our power, we cannot by ourselves avert a possible catastrophe. We are small players in a big game. Christians do not naively believe that God will sweep in and fix everything if we just wait. That would be to deny our responsibility, and it is not what hope means. Hope means the opposite: that we continue to fight to avert climate disaster even when it seems hopeless. Christians are called to be part of the solution rather than part of the problem. We are called to live in such a way that, if catastrophe comes, it won’t be because of us – to live in hope that our actions are meaningful and worthwhile and that we are in the hands of a God who is far more powerful than the most powerful forces in this world.