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War & peace
6 min read

How Ukraine reckons with its reality

From Kyiv's coffee shops to the front line.
A woman squats and touches a war memorial
War memorial in Bucha.

How on earth it came up I have no idea, but I vividly remember chatting with my grandmother about the ‘Phoney War’ of 1939. I can’t have been much older than 10. It’s not that I was especially inquisitive about history, nor that I had the presence of mind to ask for stories from her extraordinary life. How I wish I’d done that with all four of my grandparents. But my hunch is that it was prompted by sitting in the garden on a glorious summer’s day. We were probably shelling peas or peeling potatoes or something—she always got people staying to do jobs. 

She was reminiscing about how weird those months in mid-1939 were, in particular remembering how lovely the summer had been, far brighter and drier than normal. Even after the Nazi invasion of Poland on 1st September (thus triggering Britain and France to declare war two days later), the weather remained good. A sense of war’s inevitability had hovered throughout 1939, so even after Chamberlain’s famous ‘final note’ was rejected, nothing much changed. At least, not for ordinary Britons. Life went on. It would take many months before the conflict came all too close to home. 

I couldn’t help but think about this during my visit to Kyiv and Lviv earlier this month. The difference, of course, is that there was nothing phoney about Russia’s 2022 invasion or the horrors inflicted on eastern Ukraine since the 2014 annexation of Crimea. But for the majority, routines continued uninterrupted. As they must.  

For example, assuming the worst, I had contacted several Ukrainian friends offering to bring any scarce or unavailable items from Britain. No one took me up on it; it was unnecessary, they all said. After wandering through both cities, it was obvious why. Although trade will undoubtedly have been slower than before the war, shops seemed well stocked with all the necessities and not a few luxuries.  

Then on my final morning, I was quietly sipping a cappuccino in Lviv’s historic Rynok Square when the air-raid sirens suddenly cranked up into their now familiar whine. Being kept awake by Kyiv’s sirens had been a new experience for me (a mark of our Western privilege that we have avoided all-out war on our soil for decades). But this was my first daytime alert. It was even accompanied by booming Ukrainian announcements, although the advice was inevitably lost on me. As it was on all around me, who seemed assiduously to ignore it. The few mid-morning pedestrians—few tourists come here— maintained their ambling pace unchanged; the taciturn waiter patiently took orders at the next table; a middle-aged businessman on the square continued his negotiations on the phone while gesticulating with his briefcase. So naturally, I kept sipping. 

This was not because the sirens cried wolf. Just 10 days before my visit, Lviv had suffered one of the worst air attacks of the war, with 7 killed, over 60 injured, as well as the destruction of schools and historic buildings. Moreover, I met a friend for lunch an hour later who told me that some man-sized drones had attacked his side of Lviv and he saw one or two shot down. So it was all real enough. What was everyone thinking? 

Those who keep going amid a siren’s whine are not perhaps ignoring it but taking calculated risks in their perseverance.

Ignoring reality 

T. S. Eliot famously observed that "Humankind cannot bear very much reality." So perhaps that was what was going on here. After two and a half years of war, I can quite imagine exhaustion and resignation to what was going on. So it just gets ignored. Ordinary life must go on. After all, only a small proportion of the population is actively engaged in the war; the rest, if they haven’t already left, must try to keep calm and carry on. In fact, men aged between 18-60 are unable to leave at all without the necessary papers and these are hard to come by. Perhaps the only way, then, is to avoid thinking altogether. On a beautiful day, once autumn has begun to temper Ukraine’s oppressive summer heat, sustaining the illusion is simple. Life carries on. 

Of course, it can’t last. Every single person I spoke to had family or friends at the front; some had already been killed. The destruction caused by air raids brought a distant conflict onto people’s doorsteps. However, it was driving through the pleasant Kyiv suburbs of Bucha and Irpin, both of which I had previously visited several times, that reinforced the impossibility of ignoring reality. Bucha is now emblematic of the invasions very worst atrocities, from when Russian forces had Kyiv almost entirely surrounded before being pushed east. Locals were rounded up and slaughtered, with the bodies of several hundred civilians later found to have died from bullet wounds rather than shrapnel. But as we drove through, it was impossible to conceive of those horrors. Apart from anything, the weather was so lovely. Atrocities don’t occur on beautiful days… or in lovely places… surely? 

Persevering amid reality 

What impressed me most in those areas was the speed of the rebuilding work. Entire shopping malls and neighbourhoods had been razed. But after only twelve months or so, a memorial to Bucha’s 500 dead had already been erected. As we drove through, major construction projects were underway, with multiple cranes towering over rapidly rising apartment blocks and retail parks. 

These are not signs of reality ignored but faced. These are signs of gritted hope. So it struck me that those who keep going amid a siren’s whine are not perhaps ignoring it but taking calculated risks in their perseverance. Just as it is unwise, if not impossible, to live on a permanent adrenaline rush, so one cannot always exist in flight or fight mode indefinitely. It is simply that in wartime, risk thresholds change. Human beings are resilient and adaptable. They endure the most extraordinary setbacks and conditions. 

So, to be with Ukrainian friends in my limited, deficient expression of solidarity, has been inspiring. No one I met had any illusions about the realities of Ukraine’s current plight (especially with a harsh winter looming as Russia systematically destroys power stations). But still they persevere. 

Seeking deeper perspectives of reality 

However, Eliot did not primarily refer to bearing the reality of the mundane. As the novelist Jeanette Winterson explained, Eliot was identifying how little twentieth century society (that of his Waste Land in particular) could bear of spiritual reality. He meant the phenomenon of resistance to a journey towards God or of facing themselves as they stand before God. 

However, the horrors of invasion and the nightly anxieties of air raids have put paid to all that. One friend I was glad to see again is Andriy, previously a fairly well-known Ukrainian journalist and now a church pastor. He regularly goes to the frontline as an unofficial chaplain, visiting troops in their camps and the injured in hospital. He was unequivocal. Before the war they would undoubtedly have been shrugged off. But now, he has not met a single soldier who is uninterested in the things of God and eternity. War has forced them to face their mortality and Andriy has found that most are desperate to talk about little else. These things matter. Even on a beautiful, bright, early autumnal day.

Explainer
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