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Assisted dying
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9 min read

Assisted dying's language points to all our futures

Translating ‘lethal injection’ from Dutch releases the strange power of words.
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
Gaza
Israel
Middle East
Old Testament
Trauma
War & peace
10 min read

Two years on: the tragedy and the trauma of Gaza

As the anniversary of 7th October comes round again, an ancient story helps shed a new light on this conflict

Graham is the Director of the Centre for Cultural Witness and a former Bishop of Kensington.

Split-screen on TC shows many different news channels in English, Arabic and Hebrew.
Split-screen reporting.
Al Jazeera.

It is now two years since Hamas' vicious attack on Israeli citizens at the Nova music festival. Two years later, much of Gaza lies in ruins, nearly 70,000 of its people have died, and Israel continues its campaign to rid itself once and for all of Hamas, a hostile neighbour. The spectre of antisemitism has raised its ugly head again on the streets of Manchester. Meanwhile, the world waits to see if the Trump peace plan has a chance of working. 

The world is also deeply divided on the question of who is to blame here. Is it, as the Israelis say, firmly Hamas’ fault, the result of a fanatical Islamist group, sponsored by Iran, determined to extend militant Muslim control over the Middle East in general and Israel in particular? Or, as the pro-Palestinian crowds chant, are we watching a genocide which is the inevitable outcome of Israel’s ongoing occupation of the West Bank and Gaza? Everyone is pushed to decide. As a child of a friend asked his mum the other day: “Which side are we on?” 

Yet what if we try to see this conflict in a different light - not so much in terms of blame but pain?

Echoes of the past

Of course, this is not the first time there has been war between the people of Israel and their enemies on the coastline of Gaza.

The book of Judges in the Bible recounts a series of confrontations around 3,400 years ago between the Israelites and the Philistines, who harassed and taunted the Hebrew tribes as they struggled to establish themselves in the land of Canaan (NB - the Philistines are not the ethnic ancestors of modern Palestinians, despite the similarity in name. The Romans. partly to annoy the Jews, simply decided to change the name of the region from Judaea to Palestina.)

One of those ancient stories tells of Samson, an immensely strong Israelite warrior, who kills numerous Philistines in a spree of violence lasting several years. Samson eventually marries a Philistine woman, Delilah, who betrays him into the hands of his enemies. He is captured, and his eyes are gouged out. In a final act of violence, he brings down the roof of the Philistine Temple at the height of a religious feast, killing both himself and more of his enemies than he killed in his lifetime.

The story is both a tragedy and a trauma. John Milton’s great verse drama Samson Agonistes, written around 1650, presents Samson as a tragic figure, gifted and heroic, a hero of Israel brought low into his Gazan prison by a fatal character flaw of pride and lust, betrayed by his cunning wife, and in his famous phrase, ‘eyeless in Gaza at the mill with slaves, Himself in bonds under Philistian yoke’. The tragedy ends in his final act of destruction of both himself and his enemies.

Yet besides a tragedy, this is also trauma. The roots of the trauma lie deeply hidden in the history between Israel and the various tribes that surround them. Samson is one of many dragged into a history of tit-for-tat violence which ends in this scene of death and devastation. In the story of the Bible, he is caught up in the long history of human wrongdoing – as both victim and perpetrator - that stretches right back to Adam and Eve in the garden. The result is Samson and his enemies all lying dead in the rubble of a demolished building in the heart of Gaza.

In this one small strip of land today we find two peoples living out the trauma of what has happened to them in the past. And without a new approach, the result will be the same – destruction and devastation.  

On many trips to Israel/Palestine over the past 35 years, as I listened to Palestinians and Israelis look at the same issue with such different eyes, this conflict often struck me as both a tragedy and a trauma. That sounds bleak. Yet this perspective can, despite its apparent gloom, bring a glimmer of hope.

Tragedy and trauma don’t avoid the question of blame, but they don’t start there. They start with a posture of empathy. Tragedy makes us pause before making moral judgments and instead, simply to notice and enter into the sadness, the grief of it all. When we watch the final scenes of Hamlet or Macbeth, or even the Samson story, we are simply left in silence. We don’t rush to judgment, but simply acknowledge the heart-breaking sorrow experienced by the ordinary people caught up in this. Tragedy sits with the grief and darkness, and does not reach immediately to blame, realising that real life is usually more complex and the causes of conflict more opaque.

At the same time, understanding this as trauma forces us to enter into the pain underlying the conflict. Samson is born into traumatic times with his people under attack, and ends up living out the trauma he has experienced by brutal revenge on his enemies. In a similar way, in this one small strip of land today we find two peoples living out the trauma of what has happened to them in the past. And without a new approach, the result will be the same – destruction and devastation. 

The Jewish people of today, especially in Israel, remain deeply traumatised by the history of anti-Semitism which climaxed in the Holocaust of the 1930s and 40s. A determined attempt by a sophisticated, modern European nation to systematically exterminate every single one of the Jewish race is not just a historical event but one whose ripples or perhaps better, stormy waves, reach us today. Alongside this there is the expulsion of Jews during the C20th from Muslim countries such as Syria, Iraq, Yemen, Algeria, Tunisia and Libya. For those of us who are not Jewish it is hard to imagine the impact of such a reality, not just as a fact of history but as a real danger in the future. After all, if it happened once, it could happen again. It explains why Israel has always paid scant attention to international opinion and resolutions of the UN for a ceasefire, such as the one recently called for. As the Jewish writer Daniel Finkelstein put it:

“The origin of the state of Israel is not religion or nationalism, it is the experience of oppression and murder, the fear of total annihilation and the bitter conclusion that world opinion could not be relied upon to protect the Jews. So, when Israel is urged to respect world opinion and put its faith in the international community the point is rather being missed. The very idea of Israel is a rejection of this option. Israel only exists because Jews do not feel safe as the wards of world opinion. Zionism, that word that is so abused, so reviled, is founded on a determination that, at the end of the day, somehow the Jews will defend themselves and their fellow Jews from destruction. If world opinion was enough, there would be no Israel.”

So, with such a trauma behind them, it is not surprising that when a Muslim kills Jews in a British synagogue, when rockets rain down on Israeli towns, or Hamas militants swagger through kibbutzim, shooting people just because they are Jews, it triggers exactly the memory of the trauma that they have been through as a people. What Palestinians think of as resistance to an occupation of their land, is experienced by Israelis as an echo of the desire to exterminate the entire Jewish people, in a way that sends a shiver down the spine for anyone who has lived this story.

Just like Samson and his enemies. An eye for an eye leads both to end up eyeless in Gaza.

Yet the Palestinian people also have a trauma of their own. In 1948, at the time of the creation of the State of Israel, hundreds of thousands of Palestinians were made homeless and stateless, deprived of their homes and their land, often at gunpoint, and many killed by Zionist fighters. The Arab nations did little to help, only interested in their own interests. The European nations stood by. America continue to fund Israel so that their army vastly outweighs any other army in the region, and certainly enough to crush the stones, knives and bombs of various intifadas. Their deep sense of injustice also leaves a scar, one that can continue to be used by groups like Hamas for their own purposes.

And so today when Gazans watch their cities pummelled to dust, when Palestinians are made to queue at checkpoints simply to travel from one place to another,  when land is taken through the building of a security wall, and Israeli settlements continue to get permits to build on Arab land, while it is much harder for Palestinians to get planning permission to build a new home, all this triggers the memory of what Palestinians call the Nakhba or the disaster. What Israelis see as legitimate self-defence, security measures to keep terrorists at bay and to keep their people safe, is experienced by Palestinians as an echo of their own past trauma of dispossession.

The result is that both sides end up caught yet again in a cycle of violence, just like Samson and his enemies. An eye for an eye leads both to end up eyeless in Gaza.

Yet this approach perhaps places upon us who look on, the responsibility to try to enter into the pain of the other side.

Now of course, we can argue about which trauma is the greater. We can debate the merits of each moral case, or where real blame lies. But trauma doesn't work like that. Trauma sits within the mind and the body, and spreads, overwhelming any ability to cope normally and react with a sense of proportion and balance. The effects of trauma are not deliberate or logical but involuntary. Reactions to trauma are notoriously complex and differ according to individuals. Trauma stays with individuals for years and with communities for generations.

Understanding this conflict not so much as through the lens of blame but of pain may help us understand this conflict differently. Of course, it doesn't avoid the question of blame, because terrible things have been done here. It also doesn’t deny Israel’s right to defend itself against Hamas’s attack with legitimate force. Most of us tend to lean towards one side or the other of the conflict. Yet this approach perhaps places upon us who look on, the responsibility to try to enter into the pain of the other side. And when the dust of battle settles, it perhaps promises a better way to cut the cycle of violence in the future.

Understanding this conflict as both tragedy and trauma helps us see it in a new light. And perhaps it gives us the glimmer of a hope of a way forward. The memory never goes away, but trauma victims can find ways to approach the memory of what happened to them in different ways.

The story of Samson ends with destruction and his burial in the family tomb. It ends in death. Within the long story of the Bible, however, the chaotic period of the Judges is superseded by the monarchy – the kings of Israel, the best of whom is King David – a ruler with flaws, but described as ‘a man after God’s own heart’. Beyond that, the story of David points to a later ruler also born in Bethlehem, whose rule meant not hating and killing his enemies, but loving them to the point of dying for them, thus, finally, bringing peace. It is that kind of Jesus-shaped, self-sacrificial, radical, counterintuitive leadership on both sides that can show a way out of the cycle of violence and hatred that was there in the period of Samson, and is there today.

Only leaders who are not concerned with doing whatever it takes to stay in power, nor willing to sacrifice others for their own purposes, who don’t care about personal reputation, but are willing to take the risky path of reconciliation, as I have argued elsewhere on Seen and Unseen - only this kind of leadership can lead us beyond the tragedy and trauma of the past into a more hopeful future.

The last word might come from Audeh Rantisi, a Palestinian evicted from his home in Lydda in 1948. He went on to become an Anglican priest and an activist for reconciliation between Jews and Arabs and the need for both to recognise the scars and humanity of the other:

I still bear the emotional scars of the Zionist invasion. Yet, as an adult, I see what I did not fully understand then: that the Jews are also human beings, themselves driven by fear, victims of history's worst outrages, rabidly, sometimes almost mindlessly searching for security.

Four years after our flight from Lydda I dedicated my life to the service of Jesus Christ. Like me and my fellow refugees, Jesus had lived in adverse circumstances, often with only a stone for a pillow. As with his fellow Jews two thousand years ago and the Palestinians today, an outside power controlled his homeland - my homeland. They tortured and killed him in Jerusalem, only ten miles from Ramallah, and my new home. He was the victim of terrible indignities. Nevertheless, Jesus prayed on behalf of those who engineered his death, "Father, forgive them..."

Can I do less?

 

This article is an updated version of one first published on 7 November 2023