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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

Column
Comment
General Election 24
Morality
Politics
4 min read

Make it a morally decisive election

This week we’re making more than a political decision.

George is a visiting fellow at the London School of Economics and an Anglican priest.

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The divide
Nick Jones/Midjourney.ai.

I still treasure my copy of the New Statesman from almost exactly 13 years ago, which was guest edited by the then Archbishop of Canterbury Rowan Williams. I’ve kept it partly because I organised the edition and deputy edited it on his behalf. And partly because it cost me my job as public affairs chief at Lambeth Palace after it provoked predictable Conservative backbench fury for his alleged meddling in politics. 

Digging it out now, there are some surprises from near that beginning of the 14 years of Conservative rule that’s expected to come to its end this week. The first is how mild mannered is the archbishop’s leader comment that cause so much trouble. In the years since, politics has become brasher and blunter, more facile and reductive. 

The second surprise is the fuss it caused at the time. Williams is politely critical of politics across the board and there’s a plus ca change moment when he wonders “what the left’s big idea currently is… we are still waiting for a full and robust account of what the left would do differently”.  

And he could be talking about now as he concludes by hoping for a “democracy going beyond populism and majoritarianism… capable of real argument about shared needs and hopes and real generosity; any takers?”

A magazine cover lists articles on one side and an image of half a face on the other.

 

That final question may get its answer this week. But at this distance, the furore that Williams caused in government takes on a different perspective. We can see, partly as a consequence of what’s happened latterly, that he wasn’t really mounting a political argument at all. His was a moral case, a prophetic voice calling out how the government, any government, “needs to hear just how much plain fear there is.” 

 That fear hasn’t abated 13 years after that article. It has built around a faltering economy, an island mentality inflamed by the perceived threat of migration and a sense that a political elite has abandoned its people.  

 Political policies alone aren’t going to salve this pain. The response to it needs to be as much a moral as political one, as caught by the headline I wrote above Williams’ piece all those years ago: “The government needs to know how afraid people are.” 

The government in power for the past 14 years has chosen not to address, or has ignored, or has been incapable of addressing the morality of our societal decay, favouring instead a search for eye-catching  policies and initiatives that it has hoped, admittedly with some success until now, would also be vote-catching.  

That it has now run out of road has as much to do with its moral as its political failure. When Williams published that piece, we were talking about the Big Society, the prime minister was on a mission to save the planet and urged us to “hug a hoodie.” Such moral imperatives seem very distant now and a moral degeneration in government has tracked the downward slide of the governing party in the opinion polls. 

So we’re not asked just to make a political decision this week. We’re making a profoundly moral one. 

We haven’t had a prime minister for whom morality was a governing principle since David Cameron laid claim to one (perhaps disingenuously) in his early days, before being led by his chancellor, George Osborne, into enforced economic “austerity” with surely one of the most cynical assurances of modern times that “we’re all in this together.” 

 Brexit did for Cameron and his successor Theresa May. She, I believe, is guided in public life by a personal morality, rooted in her Anglo-Catholic clergyman father, but by now there was no room for all that. Her “hostile environment” for illegal immigrants, with vans telling them to go home, was a moral low point which then found its hideous nadir in the Windrush scandal, with elderly people who had lived here all their lives threatened with deportation. 

Boris Johnson thought that he could make a political virtue of his immorality, a demonic possession that made him believe that he’d be loved for it. So he fiddled while Covid burned, partying in Number 10 while those who had voted for him were denied access by his rules to their dying relatives. 

I wrote in the Guardian that he wouldn’t be able to hide his immorality in Number 10 when he became leader and was sadly proved more right than I could have known. Liz Truss is said to be on an autistic spectrum, which is the kindest way to explain her mini-budget that offered tax-breaks for the wealthiest in the midst of a cost-of-living crisis for the rest of us. 

Rishi Sunak is widely said to be a decent man, but it's too late. This government had already rotted from the head – witness the spivs in its ranks hoping to make a fast buck out of the date of the general election. 

So we’re not asked just to make a political decision this week. We’re making a profoundly moral one. It’s time to turn the fear that the archbishop observed into moral indignation. 

It’s not really about who we want in government. It’s what we need, morally, to expel from it.