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

Paganism

Sport

28 July 2024

8 min read

Paris 2024 and Christianity’s opening ceremony

A subversive Olympic opening relies on Christianity’s own beginnings.

Tim May

Tim is an associate vicar of King’s Cross Church (KXC), a London-based Anglican church.

A painting of the Last supper showing Christ and the disciples at a table.

da Vinci's Last Supper.

Public domain, via Wikimedia Commons.

The opening ceremony of the 2024 Paris Olympic Games, held on the River Seine, has unsurprisingly caused controversy. Such moments, where one nation through pageantry and spectacle performs itself to all others, never fail to draw comment. The 2024 ceremony has drawn various detractors, not least those claiming the ceremony was an “attack on Christianity.”

You might remember the masterful opening to the London 2012 games. Director Danny Boyle’s theatrical spectacle told a symbolic story of nationhood. By depicting the bucolic, the industrial, and the NHS, he considered the UK in both dark moments and at its brightest. With a great exhibition of British humour, James Bond appeared to parachute out of a helicopter with HRH Queen Elizabeth II, while Mr Bean entertained the whole wordlessly through sardonic single-finger piano playing.

Widely held to be a creative triumph, Boyle was preceded by the Beijing Olympics where its opening ceremony, CGI fireworks put to one side, wowed the world with unprecedented size and scale, reminding us that we live in an era of Chinese power.

Tokyo 2021, delayed by a year due to the Covid-19 pandemic, involved 1,800 drones filling the skies – a faultless demonstration of a technological age where Japanese engineering has been indispensable.

The sporting side of things was easily forgotten as we witnessed an emphatically kitsch depiction of French history and culture.

In 2024 Paris, the weather was perhaps the greatest focus of attention, which suited the British commentary perfectly. We Brits surely are the world experts in making light-entrainment out of describing rain. Soggy athletes sailed the Seine on a variety of uninspiring looking barges. Sanguine but soaked, the athletes dutifully waved and smiled; adorned not in gold, silver or bronze but flimsy ill-fitting plastic ponchos.

Overshadowing this athletes’ parade were the creations of theatre director Thomas Jolly, mastermind of the whole ceremony. Boldly deciding to choose the city as a stage, rather than make use of the conventional choice of a stadium, the sporting side of things was easily forgotten as we witnessed an emphatically kitsch depiction of French history and culture.

Although the weather somewhat thwarted proceedings, it was the content of the performance that drew criticism.

Far-right politicians decried Jolly’s offering as a violation of French nationhood. Conservative pundits focused their criticism on Jolly’s elevation of LGBTQIA+ culture.

Christian commentators have, with various degrees of rancour, condemned a strange scene where Leonardo da Vinci’s famous painting of the Last Supper was subverted by a pastiche of ostentatiously queer characters. At the centre of which was not Jesus Christ but a robust-looking figure resembling Lady Liberty.

Elon Musk spoke up in protest too, posting that it was ‘extremely disrespectful to Christians.’ Full-throttled cries of blasphemy resound, and probably for good reason. What we witnessed was Christ being usurped and replaced by the insurgency of self-expression and the currently sacred idea of diversity and inclusion.

Ahead of the ceremony, Jolly told British Vogue about the heart behind his creation: “there is room for everyone in Paris. Maybe it’s a little chaotic, it’s true, but that allows everyone to find a place for themselves.” The opening ceremony will be a success, Jolly says, “if everyone feels represented in it.”

I guess this isn’t the case for the thirty per cent of the world who would identify as Christian. That’s because every family and flavour of Christianity would recognise that Holy Communion, the central act of Christian Worship for 2000 years, the institution of which is depicted in da Vinci painting, was being publicly and globally vandalised.

When Christianity becomes moral wallpaper to an entire civilisation and its culture, it unsurprisingly becomes a target for satire.

How can we make sense of this moment? Is there anything more for the Christian to contribute other than indignation or outrage?

Whenever something like this occurs it reminds me of the central role Christianity has played in Western culture. The intelligibility of the ceremony’s controversial scene rests on the idea that da Vinci’s painting is a globally recognised symbol. Otherwise, we would have just been watching a really strange dinner party with no food. But with Da Vinci’s famous painting in our mind the subversive power of Jolly’s scene hits hard.

The view, popularised by the historian Tom Holland among others, would go as far as to suggest that Christianity’s effect on Western culture is so pervasive that even moments of protest and subversion, as we saw in the Paris ceremony, are cultural phenomena inherited from the Protestant Reformation. Regardless of how far you agree with Holland’s thesis, Jolly's subversion only makes sense because of the dominant role Christianity has played in shaping the western imagination, and that is a position of latent power that should cause pause for reflection.

I’ve read half a dozen articles from a certain sort of right-wing journalist who parrot thoughts like, “they wouldn’t do that with the Quran”. That might be right, but it fundamentally misses the point. Blasphemy, let’s say, in Iran, would certainly not involve the Last Supper.

The scene made sense only because of Christianity’s now diminishing position of power but it's a position of power, nonetheless. When you align Jesus Christ with the status quo, with the corridors of power, when Christianity becomes moral wallpaper to an entire civilisation and its culture, it unsurprisingly becomes a target for satire. Especially for anyone or any group that feels persecuted or marginalised. I’m not for a moment defending what Jolly did but trying to understand why it happened.

The last supper, the meal Jesus shared with his friends the night before his crucifixion, was the opening ceremony of Christianity.

The kind of cultural power Christianity has had in the West comes at the cost of clarity because Christianity was itself originally a counterculture. Crucifixion, a supreme act of imperial domination, became the foundation of Christian thought and ultimately its greatest symbol. The original Christian movement was seen itself to be blasphemous for contradictory reasons by both the Jewish and Roman religious leaders of the time.

The fundamental difference between Christianity and merely holding conservative values that should not be transgressed, is God. It was genuine belief in Jesus Christ as the long-awaited messiah of the Jewish people and the Saviour of the whole world - a belief that led his first bedraggled and bewildered disciples to live in such radical and counter-cultural ways that many were killed by the Roman Empire.

It is right for his followers today to speak up and say how wrong it is when the special and sacred things he did for them are yet again trampled on in public, but it's also worth remembering that’s how the story started - with Jesus’ body brutalised and broken. That somehow, in moments like this, we miss the power of Jesus when we simply defend him on grounds of “decency” and “respect.” Instead, if we return to the original events themselves, Jolly’s depiction, in its mockery and subversion, actually reveals the power of The Last Supper.

Da Vinci’s painting was not intended for a gallery but was originally painted on the wall of a fairly obscure monastery, transported to a gallery years later to become primarily art, it is more a foundational aid to the faithful to remember the original events Da Vinci is depicting.

The last supper, the meal Jesus shared with his friends the night before his crucifixion, was the opening ceremony of Christianity. Every time a Christian takes Holy Communion - the central act of Christian worship for over 2,000 years - they remember the opening ceremony where:

“Jesus took bread, and when he had given thanks, he broke it and gave it to his disciples, saying, “Take and eat; this is my body.” Then he took a cup, and when he had given thanks, he gave it to them, saying, “Drink from it, all of you. This is my blood of the covenant, which is poured out for many for the forgiveness of sins”

The most peculiar part of the opening ceremony of Christianity - more peculiar than any sight we saw last night - is the presence of Judas. The biblical accounts describe Jesus’ knowledge of Judas’ intentions to betray him to the Romans, and yet Judas is still welcome to the table. If there’s space for Judas, then there is space for all of us. The opening ceremony Christianity cannot be remembered without the presence of Judas the betrayer, and Peter the coward or Thomas the doubter. The great irony and the big mystery of the Christian Faith is that you can’t out-sin grace. You can mock it and subvert it, but Christ died for the ungodly.

Last night’s scene doesn’t come close to the original events. Not only was Jesus betrayed by his friends, he was then tortured, humiliated and executed publicly in just about the most excruciating way humans have devised. That was blasphemy of another level, but it was also victory because God was choosing to love inclusively beyond any human metric.

Tom Holland may be right that no part of western culture has escaped Christian influence, but I want more than a little downstream influence.

This means that there’s nothing more inclusive than the opening ceremony of Christianity and yet, at the same time, nothing more exclusive. It is not us who provide the food but God. In Jolly’s performance, the Last Supper scene was concluded by the French actor Philippe Katerine, emerging painted head to toe in blue. Whilst this bearded smurf caused baffled sniggers across the planet, Katherine was apparently representing Dionysius, The Greek god associated with wild drunken parties. The food on offer by Jolly is wild desire and self-expression. In Christianity the food is God himself, his body and his blood. God’s love is given not simply expressed, even to those who will betray him.

Moments like this will become harder for Christians to navigate. It feels like just as a wave of secular liberalism wants to finally vanquish the power position Christianity has painted for centuries, a new conservative vanguard of resistance is rising to protect or enrol it for its own means. From the mouth of Modi or in Trump’s tirades, a new religiously armed populism is raging. Tom Holland may be right that no part of western culture has escaped Christian influence, but I want more than a little downstream influence.

Take us back to the opening ceremony, to the foundation of Christian faith. Take us to the waterfall, where the torrent flows straight down from the mountain, and save us from the slow-moving sludge of the wide river downstream. Take me back to the opening ceremony of Christianity. To the table where God welcomes a Judas like me, to the meal where the master became a servant and washed his followers' feet. Take me back to eat food I could never afford and wine I could not create.