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

Essay

Belief

Comment

24 May 2024

7 min read

Everyone comes from somewhere

Why young people need to understand the religious landscape.

Roger Standing

Roger is a Baptist minister, author and Senior Research Fellow at Spurgeon’s College in London.

A young person stands in front of railway station platfrorms and below a large informaton display.

Rostyslav Savchyn on Unsplash.

I had never been so self-conscious of being British. I had flown into Denver, Colorado and for the first time I realised that I had an accent. I had gone to study and a Canadian instantly knew I was a Brit. The locals were less clear. Some had me down as an Aussie, others guessed a South African.

But it wasn’t only accents. I quickly learned the differences between us went much deeper. Private health care, guns and the separation of church and state were a whole new cultural landscape. They felt very strange to my British sensibilities that were accustomed to the welfare state, the absence of guns and an established church.

My exposure to all things American began in the early 1990s. The sociologist James Davison Hunter had just published his prophetic commentary, Culture Wars: the struggle to define America. For those I was beginning to get to know, the campaigns to reverse Roe Vs Wade and ban abortion, along with active attempts to introduce prayer into the public school system highlighted the cultural differences between us.

Likewise, they found it hard to comprehend that in England Religious Education (RE) in state-funded schools was mandated by Act of Parliament. That I considered this a bad thing mystified them.

The world we are living in has changed. Issues around religion have become more critical than at any point in my lifetime.

Of course, RE itself had a chequered history. The 1902 Education Act provided state funding for denominational religious instruction, mostly benefiting the Church of England. Nonconformist churches were outraged at the thought of the established church indoctrinating their children. Methodists, Baptists and Congregationalists withheld their taxes and, by 1904, 37,000 summonses had been issued, thousands had their property seized and 80 had gone to prison in protest.

Thankfully things have moved on. During the twentieth century denominational instruction evolved through several stages to the present world religions curriculum.

Still, over the years I have consistently felt that our approach in the UK was in danger of proving ‘the inoculation hypothesis’ with regard to faith. That is, providing a small harmless dose of exposure to religion in childhood can effectively prevent the real thing developing in adults.

Of course, faith-based schools and RE remain hot topics. Only this month the government launched a public consultation on removing ‘… the 50 per cent cap on faith admissions’. Warmly welcomed by providers like the Catholic Schools Service, it was condemned by Humanists UK and others advocating a fully secular provision.

This line of contention has become a familiar one. On one side sit around a third of mainstream state schools that are church or faith-based, most affiliated with the Church of England. On the other are groups like the National Secular Society who correctly point out that the privileged position of church-sponsored education is not reflective of wider society.

These positions have become entrenched over the years. Arguments are laced with rhetorical hyperbole and are often either ill-informed or merely raise strawmen arguments to symbolically knock down. We can no longer afford to be so self-indulgent.

The world we are living in has changed. Issues around religion have become more critical than at any point in my lifetime. It is now more important than ever that we have a handle on it.

And then there’s the frequent stereotyping of religion in the media. Off-the-peg religious reporting ‘templates’ are easy to use but are ‘lazy’ journalism.

The invasion of Ukraine by Putin’s Russia is no mere materialist land-grab. To fail to take into account the theological dimension compromises any understanding of what is going on. The history of Eastern Orthodoxy and the Russian Orthodox Church help define the Russian identity that sits behind this conflict.

In Israel, the bloody atrocity enacted on Israeli citizens by Hamas, and the brutal devastation wrought in Gaza by Netanyahu’s Israeli Defence Force are beyond words. But this conflict is theologically as well as politically fueled. Hamas embraces a militant interpretation of extremist Sunni Islam, while Netanyahu’s religious-nationalist coalition sees his Likud party kept in power by ultra-Orthodox parties and far-right religious factions.

In India, the world’s biggest democracy, 970 million voters this year participate in an election stretching over six weeks. Yet this formally secular state has been travelling on a different trajectory. Yasmeen Serhan observed in The Atlantic that under Prime Minister Modi the ‘Hinduization of India is nearly complete’.

And then there’s the frequent stereotyping of religion in the media. Off-the-peg religious reporting ‘templates’ are easy to use but are ‘lazy’ journalism.

A leading newspaper recently carried instant opposition to the thought of Kate Forbes being a potential First Minister of Scotland because of her ‘traditionalist’ views. Somehow, her commitment in a BBC interview to defend the right to same-sex marriage even though it clashed with her personal views was insufficient.

Across one of my social media feeds as I was writing this piece came a plea, ‘I’m proud to be British. I’m proud to be a Muslim. I am not a terrorist. Why don’t they get it?’

Maybe the American approach to religion goes a long way to explain something of their culture wars.

But always there is America. And here’s where a penny unexpectedly dropped for me. If you keep religion out of schools, for many young people you deny them the tools, the ideas, and a framework with which to understand the religious dimension of life. This can have catastrophic implications.

As G.K. Chesterton is reputed to have observed, ‘when people stop believing in God they don't believe in nothing; they believe in anything.’

Then, for those living within a practising religious home, the absence of religion in school heightens the possibility that their thinking is siloed purely in their own rarefied tradition.

Maybe the American approach to religion goes a long way to explain something of their culture wars.

If it's true that whatever happens in America inevitably makes its home in Britain, we need to sit up and take notice. More than ever, we need our young people to be adept at understanding the religious landscape. With the ubiquity of social media, the unseen influence of echo-chamber algorithms and the nefarious activities of those bent on radicalising the vulnerable, we need them to have the tools and skills to be aware, see and understand.

This is what has caused me to think again and, surprisingly, change my mind. We need to draw a line in the sand on our historic arguments, disagreements and differences of conviction. The situation is more pressing. We need a reset.

If democracy is not a zero-sum game where the majority gets to impose its will tyrannically on the rest, this has to be a way forward.

The encouraging thing is that the groundwork for such a step change is already in place. In 2018 the Commission on Religious Education (CoRE) proposed a reconceiving of the subject as Religion and Worldviews. Their intention was to make it more appropriate and inclusive for the twenty-first century. For them, the ‘complex, diverse and plural’ landscapes of different religions and worldviews deserved both understanding and respect. Yet, students also needed to develop the ‘necessary critical facility to ask questions and challenge assumptions’.

Such an approach embraces the insights and philosophical commitments of non-religious worldviews too. ‘Everyone has a worldview’, said the report. Nobody stands nowhere was the title of an excellent animated short film on YouTube produced by the Theos think tank.

The truth is, ‘everyone comes from somewhere’. This is as true for secular humanists as it is for cradle-to-grave Anglicans, majority-world Pentecostalists and British-born Muslims. Helpfully CoRE defines a worldview as:

… a person’s way of understanding, experiencing and responding to the world.

The report maintained that it was vitally important that different worldviews were understood as ‘lived experience’. This was not just about abstract beliefs, doctrinal understandings and theoretical convictions. This was about real people, the lives they live and what is important and gives meaning to them.

If living in a genuine democracy is about learning how to rub along together. If it is about understanding and respecting those who have a different take on life than we do, no matter how ‘odd’ it seems. If democracy is not a zero-sum game where the majority gets to impose its will tyrannically on the rest, this has to be a way forward.

Given the challenges that face us, it seems to me that not to change our approach to RE would be negligent. Yet to remove all reference to religion from our schools risks our young people falling prey to manipulation, subversion and control by bad actors, misinformed activists and cranks.

These would be the seeds of our very own culture wars.

Personally speaking, I’d rather not go there.