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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

Belief

Creed

Education

24 January 2025

7 min read

The myth of secular neutrality

Where academia went wrong.

Alex Stewart

Alex Stewart is a lawyer, trustee and photographer.

A phrenology head is shown with its eyes closed.

David Matos on Unsplash.

In the recent horror-thriller Heretic, Hugh Grant plays Mr. Reed, a sharp-witted psychopath who imprisons two missionaries, subjecting them to ceaseless diatribes about the supposed irrationality of all religions. Mr. Reed is also a terribly smug, self-righteous bore, a caricature of the fervent atheist who dismisses faith as mere superstition while assuming atheism is objective and neutral.

This kind of assumption lies behind the criticisms directed by secularists at those who argue from a position of faith, as we saw recently with the debates on the Assisted Dying Bill. Yet, the notion of secular objectivity is itself a fallacy. Secularism, like any worldview, is a perspective, ironically one that is deeply indebted to Christianity, and humanity’s history of abandoning faith and its moral foundation has had disastrous consequences.

Secularism is a bias, often grounded in an ethical vanity, whose supposedly universal principles have very Christian roots. Concepts like personal autonomy stem from a tradition that views life as sacred, based on the belief that humans are uniquely created in God's image. Appeals to compassion reflect Jesus’ teachings and Christian arguments for social justice throughout history. Claims that the Assisted Dying Bill was "progressive" rely on the Judaeo-Christian understanding of time as linear rather than cyclical. Even the separation of the secular and sacred is derived from Jesus’ teaching to “render to Caesar what is Caesar’s and to God what is God’s”. Authors like Tom Holland in Dominion and Glen Scrivener in The Air We Breathe have shown how Western societies, though often disconnected from their Christian roots, still operate within frameworks shaped by centuries of Christianity.

The antidote to human pride and self-deception was to be found in the Almighty. Ironically, it was this humility, rooted in a very theological concern about human cognitive fallibility, that gave birth to the scientific method.

A political secularism began to emerge after the seventeenth century European religious wars but the supposed historical conflict between science and religion, in which the former triumphs over superstition and a hostile Church, is myth. Promoted in the eighteenth century by figures like John Draper and Andrew White, this ‘conflict thesis’ persists even though it has been comprehensively debunked by works such as David Hutchings and James C. Ungureanu’s Of Popes and Unicorns and Nicholas Spencer’s Magisteria. Historians now emphasize the complex, often collaborative relationship between faith and science.

Far from opposing intellectual inquiry, faith was its foundation. Medieval Christian Europe birthed the great universities; this was not simply because the Church had power and wealth but because knowledge of God was viewed as the basis for all understanding. University mottos reflect this view: Oxford’s "Dominus illuminatio mea" (The Lord is my light), Yale’s "Lux et Veritas" (Light and Truth), and Harvard’s original "Veritas Christo et Ecclesiae" (Truth for Christ and the Church). This intertwining of faith and academia fuelled the Enlightenment, when scientists like Boyle, Newton, and Kepler approached the study of creation (what Calvin described as ‘the theatre of God’s glory”) as an affirmation of the divine order of a God who delighted in His creatures “thinking His thoughts after Him”.

Their Christian beliefs not only provided an impetus for rigorous exploration but also instilled in them a humility about human intellect. Unlike modernity's view of the mind as a detached, all-seeing eye, they believed man’s cognitive faculties had been diminished, both morally and intellectually, by Adam’s fall, which made perfect knowledge unattainable. Blaise Pascal captures this struggle with uncertainty in his Pensées.

“We desire truth, and find within ourselves only uncertainty....This desire is left to us, partly to punish us, partly to make us perceive from whence we have fallen.”

For Pascal and his believing contemporaries, the antidote to human pride and self-deception was to be found in the Almighty. Ironically, it was this humility, rooted in a very theological concern about human cognitive fallibility, that gave birth to the scientific method, the process of systematic experimentation based on empirical evidence, and which later became central to Enlightenment thinking.

Orwell was not alone in thinking that some ideas were so foolish that only intellectuals believed them.

Although many of its leading lights were believers, the Enlightenment era hastened a shift away from God and towards man as the centre of understanding and ethics. Philosophers like David Hume marginalized or eliminated God altogether, paving the way for His later dismissal as a phantom of human projection (Freud) or as a tool of exploitation and oppression (Marx), while Rousseau popularised the appealing idea that rather than being inherently flawed, man was naturally good, only his environment made him do bad things.

But it took the nihilist Nietzsche, the son of a Lutheran pastor, to predict the moral vacuum created by the death of God and its profound consequences. Ethical boundaries became unstable, allowing new ideologies to justify anything in pursuit of their utopian ends. Nietzsche’s prophesies about the rise of totalitarianism and competing ideologies that were to characterise the twentieth century were chillingly accurate. Germany universities provided the intellectual justification for Nazi atrocities against the Jews while the Marxist inspired revolutions and policies of the Soviet and Chinese Communist regimes led to appalling suffering and the deaths of between 80 and 100 million people. Devoid of divine accountability, these pseudo, human-centred religions amplified human malevolence and man’s destructive impulses.

By the early 1990s, the Soviet Union had collapsed, leading Francis Fukuyama to opine from his ivory tower that secular liberal democracy was the natural end point in humanity's socio-political evolution and that history had ‘ended’. But his optimism was short lived. The events of 9/11 and the resurgence of a potent Islamism gave the lie that everyone wanted a western style secular liberal democracy, while back in the west a repackaged version of the old Marxist oppressor narrative began to appear on campuses, its deceitful utopian Siren song that man could be the author of his own salvation bewitching the academy. This time it came in the guise of divisive identity-based ideologies overlayed with post-modern power narratives that seemed to defy reality and confirm Chesterton’s view that when man ceased to believe in God he was capable of believing in anything.

As universities promoted ideology over evidence and conformity over intellectual freedom, George Orwell’s critique of intellectual credulity and the dark fanaticism it often fosters, epitomized in 1984 where reality itself is manipulated through dogma, seemed more relevant than ever. Orwell was not alone in thinking that some ideas were so foolish that only intellectuals believed them. Other commentators like Thomas Sowell are equally sceptical, critiquing the tenured academics whose lives are insulated from the suffering of those who have to live under their pet ideologies, and who prefer theories and sophistry to workable solutions. Intellect, he notes, is not the same thing as wisdom. More recently, American writer David Brooks, writing in The Atlantic, questions the point of having elite educational systems that overemphasize cognitive ability at the expense of other qualities, suggesting they tend to produce a narrow-minded ruling class who are blind to their own biases and false beliefs.

It was intellectual over-confidence that led many institutions to abandon their faith-based origins. Harvard shortened its motto from "Veritas Christo et Ecclesiae" to plain "Veritas” and introduced a tellingly symbolic change to its shield. The original shield depicted three books: two open, symbolizing the Old and New Testaments, and one closed, representing a knowledge that required divine revelation. The modern shield shows all three books open, reflecting a human centred worldview that was done with God.

However, secular confidence seems to be waning. Since the peak of New Atheism in the mid-2000s, there has been a growing dissatisfaction with worldviews limited to reason and materialism. Artists like Nick Cave have critiqued secularism’s inability to address concepts like forgiveness and mercy, while figures like Ayaan Hirsi Ali and Russell Brand have publicly embraced Christianity. The longing for the transcendent and a world that is ‘re-enchanted’ seems to be widespread.

Despite the Church’s struggles, the teaching and person of Christ, the One who claimed not to point towards the truth but to be the Truth, the original Veritas the puritan founders of Harvard had in mind, remains as compelling as ever. The story of fall, forgiveness, cosmic belonging and His transforming love is the narrative that most closely maps to our deepest human longings and lived experience, whilst simultaneously offering us the hope of redemption and - with divine help – becoming better versions of ourselves, the kind of people that secularism thinks we already are.

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