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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

Article

America

Conspiracy theory

Culture

Politics

9 July 2024

6 min read

When America presses in on you

A returning American feels the heat generated by contesting ‘realities'.

Jared Stacy

Jared Stacy holds a Theological Ethics PhD from the University of Aberdeen. His research focuses conspiracy theory, politics, and evangelicalism.

A runner passes a church and a flag in an America suburb, under billowing clouds.

Nick Jones/Midjourney.ai.

There’s a man. Running. My eyes snap into focus. Time slows - I catch his pace. Then, my eyes start widening. An odd feeling. Being forced into it. Seconds stretched out into minutes. Taking in more, looking for more, looking down that sidewalk, on a street corner in New Jersey.

Before? I was sitting there. In the backseat of my Uber. Winding our way through New Jersey. And I’m sitting there, tired, mindlessly scrolling my phone until that moment. He’s there running.

And I see him. T-shirt. Running shorts. And I’m sitting. And—a nervous flash—he’s running. Why?

And my eyes adjust, widening, scanning, checking detail, and I’m almost seized. My mind shaking itself, coming online, no more automation. My consciousness catches up: “you’re in America,” I tell myself.

Right. I’m not in Scotland. And that man is running. Here in New Jersey. In America. And I’m talking back to myself in this silent car. I’m watching him run. I’m asking why am I slowing this down? And—it flashes—“running from what?”

And I catch up to myself. To what I was trying to say, that people in America run from shooters, too. A wave crashing, sitting in the back of the Uber, and look. Now I’m really looking. Not forced. But naming. There’s other pedestrians passing him, walking. Slowing. On the other side of the street— no fast movement. No screaming. No pops.

I start breathing. I didn’t know I stopped. He’s out jogging. The automated safety check ends. The tranquility of tyranny resumes. I’m sitting in the back of an Uber. I make a note. Be more alert at the train station.

—

People ask me how the relocation back to America has been. And I don’t know what to tell them. There’s a wide gap between the visceral sense of it all pressing in on you, and more common—but also abstract—analysis.

The experience of coming back has been oddly particular. I lived in Scotland for three years, and most of it was spent studying America. From that distance, the broad strokes of American life, the larger trajectories and dangers of our shared political decisions and religious extremism, well, they’re a bit clearer.

But coming back, America presses in on you. And the only way of talking about that, maybe, is specificity. Kerouac was always good at articulating this. His America wasn’t the rise of the military industrial complex in the 50s. It was the road, the gas station on the way from Denver, it was jazz, the dim doorways of San Francisco bars. I’m thinking of Kerouac, but also Langston Hughes. Poets and artists who in their own time, held a mirror up to America, helped us move from the “I” to the “we” as Steinbeck said.

We’re all asking a version of “what’s wrong in America?” (And, do keep asking.) But to ask that question often assumes the broadest strokes, the ones that are most clear from a distance. Which means they are, in one at the same time, the most abstract.

These realities are everywhere, and no where. They are the air we breathe. They appear to the privileged as “logical” and to the powerless as “inevitable.”

Asking after democracy, after the election, and the increasingly nebulous “the church” — I’m convinced that answering “what’s wrong in America?” in the biggest of terms is leading me to (wrongly) believe that responsibility lies among the gargantuan free-floating concepts which we use to narrate our world. As if solving the “crisis of democracy” is a conceptual problem. When in reality, it is concrete, and involves more than coalition building or political activism.

Why more? Because the choices Americans have made over the last 10 years originate from imaginations which limits the scope and scale of what is possible. This is what I mean by “America presses in on you.”

Coming back to America has made this clear. I’m more aware than ever that we can produce good answers and generate compelling analysis about America without ever asking in what way these answers or analysis are sharp enough, concrete enough to puncture the bubbles of social reality in which people choose to live and in some cases are forced to live.

These realities are everywhere, and no where. They are the air we breathe. They appear to the privileged as “logical” and to the powerless as “inevitable.” They press in on us all in their own way.

In some cases, they dull our senses. We say, “as long as our Amazon deliveries continue, as long as the streaming services work.” In some cases, they don’t just press in on us, but press down and perpetuate injustice. As Dietrich Bonhoeffer asked, “where are the responsible ones?”

The visceral shock of return is ongoing. And it hits me in strange ways, on Uber rides and in worship. American life is everywhere and I’m seeing it with different eyes.

Do I care about democratic machinery? Yes. Am I concerned about whether or not the church is, in fact, the church, and not a gear in a partisan machine? Yes. But I’m increasingly convinced that responsible living in the American situation becomes most clear, most evident as we consider the large in terms of the small.

Responsibility emerges with attention paid to the concrete and intimate. January 6 is the subject of my dissertation. But before that, in the months leading up to January 6, I was a pastor just 40 miles from DC. For me, January 6 was a local event. That particularity, that specificity, is a window into a concrete responsibility.

And now, back in this same community, I found myself distracted in a church this weekend. The man in front of me raised his hands in worship, revealing a revolver hanging on his belt. What America is this? But also, what Christianity is this?

The visceral shock of return is ongoing. And it hits me in strange ways, on Uber rides and in worship. American life is everywhere and I’m seeing it with different eyes. And I wonder what it will take to break the spell of our most cherished illusions, of a certain type of freedom — one that tells us it is Christian to raise our hand in surrender to a god who we say is loving enough to save the world, but seemingly not strong enough to deliver us from our evil.

In the end, perhaps it’s best to say that it’s been proof of a good ruining. After all, we’ve experienced nothing short of a conversion, a move closer towards peace, towards hope, that unsettles all our strategies of security and comfort underwritten by violence and oppression. This is the kingdom of Heaven. Something Jesus announced that continues to unsettle and disrupt the likes of T.S. Eliot who put it well in Journey of the Magi:

We returned to our places, these

Kingdoms,

But no longer at ease here, in the old

dispensation,

With an alien people clutching their gods

I should be glad of another death.