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

Leading

19 August 2024

9 min read

Canada’s long hot summer of decline

Courage is needed when a country starts to fall apart.

Emerson Csorba

Emerson writes on geopolitics. He is also a business executive and holds a doctorate in theology.

An aerial photography of a huge plume of smoke from a forest fire.

Jasper National Park on fire.

National Parks Canada.

In July 2024, wildfires blazed across large swathes of Alberta, engulfing much of the town of Jasper. As the smoke drifted to the City of Edmonton, air quality worsened considerably, reaching 10+ out of 10, or “very high risk,” on the air quality health index.

The smoke confined much of the city of one million inhabitants to their homes – keeping stoves, television sets and other electrical appliances off to deal with the mid-thirties Celsius heat. Many wore masks when daring to venture outside. Scenes were, as in the past, apocalyptic – imagine the movie Bladerunner 2049.

In 2016, the first major fire occurred in Fort McMurray, which led to a successful evacuation of 90,000 residents with photographs depicting what looked like hell on earth. This fire, covered by the international press, was at the time a one-off. It has since become the norm during Canadian summers.

The fires are emblematic of the state of Canada.

Now, metaphorical fires of all sorts – breaking of the healthcare system, surging housing costs, immigration without a plan, and decreasing civility in political debate – are spreading across Canada.

It is noteworthy to witness just how rapidly Canada’s situation has degraded. It is a testament to the quickness – not unlike the spreading of a forest fire, ignited by an errant cigarette – with which a small group of individuals within a government can inflict lasting damage on a country.

Indeed, the last decade for Canada has represented a backward turn. It is a regression from earlier domestic and international success, in which many across the world looked to Canada as a beacon of hope. Our international standing has diminished noticeably.

This unexpected looking back to better times is well captured in the song “The Boys of Summer.” I often listened to The Ataris cover of the Don Henley classic when playing travel baseball across Canada and the US in my teens.

The narrator reflects nostalgically on a summer romance. What was once present is now gone:

“Don’t look back, you can never look back/I thought I knew what love was, what did I know?/ Those days are gone forever/I should just let them go but…”.

The story is much the same for Canada. What appeared so promising as recently as the early 2010s – the country on the rise economically and with a solid reputation internationally – has given way to decline and crumbling of vital social services. For example, healthcare median appointment waiting times now average 27.7 weeks (about 6 and a half months), though higher in the provinces of the Maritimes and Alberta.

Internationally, Canada no longer enjoys a privileged relationship with the United States. The relationship will become even more fraught should former President Trump re-assume the role of President while Prime Minister Justin Trudeau is in power.

Looking to China, Canada suggests the need for “dialogue,” a foreign policy nevertheless ten years out-of-date, and despite Canada serving as China’s international punching-bag.

We have become afraid to not be invited, rather than to step forward with courage.

We are, of course, in a darkening period in world history. Evil appears to be more strongly at work in the world now than in recent memory.

The coronavirus pandemic was a turning-point, in which American and Chinese relations began to fracture. This was followed two years later by the Russian invasion of Ukraine and close to two years after this, the 7 October massacre of Jews by the terrorist group Hamas.

In the United Kingdom, the murder of three girls in Southport has given way to nationwide riots, spreading through social media and its network effects.

The dividing lines between identity-based groups domestically, and alliances internationally, are becoming clearer and more rigid. This is the trend since the pandemic crisis. Earlier tolerance of “grey” areas of difference is giving way to “black and white” division between nations and groups within them.

Canada is therefore no exception to the crises facing democracies in the political West. Yet Canada’s failures are notable, given the shining light of political moderation, of government effectiveness, and of international collaboration that Canada historically is.

Most notable and concerning within Canada is the lack of courage among political leadership. Canadian leadership fails to speak and act boldly domestically or internationally. Prime Minister Trudeau reportedly avoids cabinet meetings and one-on-one meetings with ministers, hiding whenever problems emerge. This is the opposite of courage.

Courage, a distinctive Canadian virtue so well proven in WWI Battles of Vimy Ridge, Passchendaele and The Somme, or the Battle of the Atlantic in WWII, is in short supply. Yet, if there was ever a distinctive Canadian quality, it is courage, often in times of crisis.

In my time abroad, I have been struck by an increasing Canadian refrain on just wanting to “be at the table,” but without considering what our contributions at the table will be. We have become afraid to not be invited, rather than to step forward with courage.

What are individuals to do when they see their country falling apart? And what are they to do when looking at their country’s regression from some distance, as members of the global Canadian diaspora?

A compelling example is given by the philosopher Robert Adams in his retelling of the story of Dietrich Bonhoeffer. Bonhoeffer, a German theologian, left for New York on 7 July 1939, where he was received by American friends providing safety from Nazism.

Yet, within days Bonhoeffer found his time in New York “almost unbearable,” noting that “If trouble comes now, I shall go right back to Germany. I cannot stay out here alone; I am quite clear about this, for after all, over there is where I live.”

Bonhoeffer later reflects “I have made a mistake in coming to America. I must live through this difficult period of our national history with the Christian people of Germany. I will have no right to participate in the reconstruction of Christian life in Germany after the war if I do not share the trials of this time with my people.”

Adams uses Bonhoeffer as an example of vocation, highlighting belonging, caring and participation in social processes as key elements of a vocation. Returning to Germany was not necessarily what was best for Bonhoeffer (he would later die in the waning period of the war in Germany, while he would have carved out a prestigious academic career in America). But Adams notes that Bonhoeffer would have felt it wrong had he not returned.

In short, Bonhoeffer belonged with his democratically minded neighbours in Germany. He cared about the restoration of his country. And he knew that he must participate in the fight against evil enveloping Europe.

It often takes leaving your own country to understand it more clearly. I have learned during my time abroad that Canadians are understated and yet highly competent, open-minded and hopeful.

Canada has a powerful diaspora, whose global influence is well captured by former Globe & Mail newspaper editor John Stackhouse in his book Planet Canada. Years ago, the “Canadian Mafia” was the tongue-in-cheek name given to Canadians who simultaneously led multiple major British institutions such as the Bank of England, University of Cambridge, Royal Mail, Wimbledon, Associated British Ports, UK National Lottery, Heathrow Airport, and Canary Wharf, not to mention leading the BBC’s International reporting.

In recent years, many age-mates and friends served in leading roles in top think tanks and UK institutions such as No 10 Downing Street, helping to design and implement UK technology innovation policy, or crafting health and social care policy while helping spearhead the UK vaccination campaign to hard-to-reach minority groups.

The senior-level of Canadian leadership in the UK was followed by many early or mid-career Canadians serving in influential UK leadership roles.

But just as Bonhoeffer returned to Germany, or as Israelis returned immediately from jobs in technology, finance, academia and other sectors in America and the UK to serve their country in the fight against terrorism, now is the time for many within the Canadian diaspora to return to Canada.

Such is the damage that has been inflicted on the country over the last decade, and the future plight, should Canada’s brightest not dedicate themselves fully to the Canadian cause as part of defending the long-term good in the wider world.

It often takes leaving your own country to understand it more clearly. I have learned during my time abroad that Canadians are understated and yet highly competent, open-minded and hopeful. There is a palpable energy and desire to contribute meaningfully – not apathetically – among Canada’s Gen Zers.

Canada’s young people balance their own diverse ethnic origins with an abiding love of Canada. They want to make Canada better.

Canadians must not only show up at the table but contribute – with confidence – when at the table. The focus must be to participate, and then win the prize.

Just as the narrator ends on a high in “The Boys of Summer” – saying “I can tell you, my love for you will still be strong/After the boys of summer have gone” – there remains considerable hope for Canada.

But this hope must translate into critically minded participation in Canadian life. This critical spirit toward leadership and institutions is one part of courageous, confident and sometimes even assertive action in the world.

On assertiveness, Canada can learn from its ally Israel. In his recent speech to U.S. Congress, Israeli Prime Minister Benjamin Netanyahu spoke boldly on behalf of the rising scourge of antisemitism facing the Jewish people. He highlighted the nefarious influence of totalitarianism.

Most importantly, he highlighted our shared democratic struggle. Indeed, Israel’s success in the fight against evil in the form of totalitarianism is a precursor to the success of other democracies such as the United States, Canada and the UK in the same fight: “Our enemies are your enemy, our fight is your fight, and our victory will be your victory.”

Whatever one thinks of Netanyahu, he stood up forcefully for his nation and for the Jewish people in the face of evil seeking to undo the values underpinning our democracies.

While likely to be more moderate in tone, Canadians must nevertheless participate boldly in the world, regaining our characteristic courage.

In reflecting on his tenacious service, St Paul asks “Do you know that in a race the runners all compete, but only one receives the prize? Run in such a way that you may win it.”

Canadians must not only show up at the table but contribute – with confidence – when at the table. The focus must be to participate, and then win the prize.

Canadian renewal is possible, but this demands that Canadians abroad return home – like Bonhoeffer – bringing their experiences, learnings and networks acquired as members of the Canadian diaspora with them. Indeed, these help form the basis for courage.

This return is one key step in Canadians contributing to victory – along with British, American, French, German, Israeli and other allies – in the fight against darkness. We must light our lamps within the darkness, keeping awake at home in readiness to put out the fires coming our way from over the foothills.