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

Comment

Gaza

Israel

Middle East

War & peace

18 December 2023

8 min read

A peacemaker’s guide to keeping hope alive

Amid continuing despair around the Israel-Hamas war, former diplomat Todd Deatherage shares the practices of the peacemaker.

Todd Deatherage

Todd is the Executive Director and Co-Founder of Telos Group. It forms communities of American peacemakers across lines of difference and conflict, including Israel/Palestine.

Two people down a table turn and listen to someone closer talk, against a wall mural.

Reconciliation event, Northern Ireland.

Telos Group.

The world seems enveloped in darkness right now. The list of things that hide and extinguish the light is long, but for many of us it is the ongoing war in the Middle East that casts shadows of gloom and foreboding over our days and sometimes our sleepless nights.

As I write, Palestinian men, women and children in Gaza continue to die daily from unrelenting bombardment. Treatable injuries and illnesses are now fatal. Many lack access to food and clean water. About 134 Israelis remain in captivity. The West Bank teeters on the brink as ideological settlers pursue an agenda of harassment and displacement of Palestinian villagers.

Israelis and Palestinians remain deeply traumatized people and are transferring their untransformed traumas onto each other in endless cycles of conflict that are brutal to both, though glaringly asymmetrical. The rest of the world cheers and rationalizes and mourns and protests and marches and divides itself as the body count in Gaza soars.

‘Hope is not the same thing as optimism, hope is not a feeling. Hope is what you do.’

Mitri Raheb

Even for those of us watching from a distance, despair is unavoidable, and in many ways, the only rational response. Who dares speak of hope amidst such horror? And yet, without hope we are all lost. Hope is essential for life and flourishing--a life devoid of it is only existence. But how do we face such a brutal reality and look to the future with any sense of a better one? Is it even possible?

Hope is possible, even in such a time as this, but only if we define it correctly. The Palestinian theologian Mitri Raheb says that hope is not the same thing as optimism, hope is not a feeling. Hope is what you do. We push back against violence, hatred and fear by living and acting in hopeful ways. Daily acts of resistance against injustice and brutality protect and nurture our humanity and open up space for our own transformation. As we allow ourselves to be transformed we can be better agents of healing in the world around us. Hope is what you do. It is an active, intentional, clear-eyed yet generous way of living in the world.

The physicist Niels Bohr said the opposite of a fact is a falsehood but the opposite of a truth may be another profound truth.

And it’s important to connect hope and action in a moment like this in particular because the horror we’re witnessing has a context. This is not a natural disaster. We're not where we are simply because bad things happen, but because we brought ourselves here. Because too many have believed the lie that freedom and security come through violence, and that equality and peace can come via ideologies of exclusion and religious or ethnic superiority. We have accepted the fiction that our lives are not interrelated with those of our neighbors. And we have imagined that inequitable systems of subjugation and control can be sustained forever.

And so we keep hope alive by embracing the truth and grounding ourselves in the conviction that the death and destruction of this war will only lead to more of the same. Our words and our actions in this moment can be demonstrations of hope when they are rooted in a steely conviction that the horror of October 7th did not make Palestinians freer, and nothing that’s happened since is making Israel, or any of us, safer. This is how we got into this, not how we get out of it. Violence begets violence begets violence. We act in hope by calling for a ceasefire and the release of hostages. And ultimately we set our sights on a new reality in which Palestinians and Israelis can enjoy freedom, dignity and security in equal measure.

Here are some practices of the peacemaker that not only represent acts of hope but that open the possibility to bring about change in us and change in the world.

Listen to understand. Many of us live within the sound of only one narrative of the shared reality of Israelis and Palestinians. Listening to understand those whose stories are new to us is a first step in nurturing the empathy that will allow us to see the humanity of all.

Listening to those with whom we disagree, not to combat or argue, but to truly understand has the potential to sharpen what we know and believe even as it holds open the possibility of lowering the temperature between us and the person being seen and heard. And this may expose that behind our disagreement may be something deeper. (Hint: It’s often fear.)

Learn to hold experiences in tension. The physicist Niels Bohr said the opposite of a fact is a falsehood but the opposite of a truth may be another profound truth. Palestinians and Israelis each have their own connections to the same piece of land, their unique histories and experiences, and any honest peacemaking effort great or small has to hold these experiences in tension, not as equally true, but as the things that must be understood and dealt with in any effort at conflict resolution.

Peacemakers know the importance of centering the voices of those most vulnerable. In this case, that has to begin today with the millions of displaced Palestinian civilians in Gaza, the families of the hostages, the Israelis who’ve fled their homes in the south and north of their country, and the Palestinians trapped and apprehensive in the West Bank fearing all this is coming their way.

Peacemakers also acknowledge that each of us has agency. We may think our influence is small, but we have communities and circles of friends, we have elected leaders who are meant to be responsive to our concerns. There are always things we can do, and the cumulative effect of many small actions can bring change.

At a time of such horror and atrocity, casting blame is an easy and natural response. But what can’t be overlooked for those who want to create hope is the necessity of doing the honest work of self-interrogation. The persistence of antisemitism for centuries and its alarming rise in the present, coupled with the growth of anti-Arab and Islamophobic sentiments, force us each not only to examine our internal biases and those that exist within our own communities, but also to confront them. Credible voices from within our communities are needed, to borrow from Jesus of Nazareth, to point out the proverbial logs in our own eyes so that we might see more clearly to help our neighbor remove the splinters from theirs.

Part of the work of self-interrogation is also to own our complicity in creating the conditions we see today. For too long our governments in the West have acted as if the blockade of Gaza was somehow sustainable, and that Israel can perpetually occupy the West Bank with no political horizon for a better reality. And in recent years, the Americans have pursued a fiction that Arab-Israeli normalization could proceed with abandon while the Palestinians fall ever deeper into Israeli control and their own internal political dysfunction.

The fact that we are a party to this conflict---our implication in it--- also creates the opportunity and the imperative to transform our involvement into morally grounded policies and interventions that create greater space for the work of peacemaking and conflict resolution. Which leads us to advocacy as an essential practice of peacemaking

He told us the peacemakers are blessed. His universal invitation to live as his ambassadors of reconciliation and healing still echoes down through the centuries as a calling the world so desperately needs.

In the West, as an atrocity of historic proportions is being perpetrated right now, in real time, in our lifetime, we have to call on our leaders to end the ruination of Gaza. To work to return the hostages. To truly commit our governments to cease being peacetalkers and to become peacemakers. To use our influence to create the conditions for true security, honored dignity and freedom for Palestinians and Israelis alike, in equal measure. To support diplomatic initiatives, political arrangements and grass roots efforts that are all oriented toward their mutual flourishing,

For people of Christian faith, these dark days have now taken us into our season of Advent. The American Episcopal theologian Fleming Rutledge says “Advent always begins in the dark.” But it ends with the arrival of God in our midst, God with those in the ravaged kibbutzim of southern Israel. God with those in the bombed out wreckage of the cities and refugee camps of Gaza. And God with those cowering in fear in their homes in Bethlehem, the very place where the Christian story begins. In a normal year we sing, some years deeply from our hearts and our sadness, 'O Come O Come, Emmanuel, and rescue us'. This year that cry is nearly guttural for many of us. But it is a cry rooted in a belief that God has not forsaken us in our hatreds and our violence and our inhumanity. He is a God of transformation and invites us to join him in the work of healing and repair. Jesus came to make the world more merciful and just, to teach us to love our enemies, and to show us how to care for the weak and the vulnerable. He told us the peacemakers are blessed. His universal invitation to live as his ambassadors of reconciliation and healing still echoes down through the centuries as a calling the world so desperately needs. This Advent, let us live as agents of hope as we work for a future in Israel/Palestine---and in our own communities-- in which all can flourish in justice, security, freedom and dignity.