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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

Article
Comment
Freedom of Belief
Politics
War & peace
5 min read

Iranians long for regime change, but weigh up the cost

Dreams are easier to utter than act upon

Steve is news director of Article 18, a human rights organisation documenting Christian persecution in Iran.

Smoke rises from the site of a bomb amid a high wide view of a city at twlight
Tehran.

I received an unexpected response from an Iranian friend of mine this week after asking how he and others were feeling in the wake of the ongoing crisis. 

My friend - like many, a staunch advocate of regime change in Iran - told me that despite his long-standing enmity against the Islamic Republic and its leaders, the conflict had if anything brought Iranians together against a new, common enemy. 

For while he and many others would love to live in an Iran that offered them greater freedoms, they are also fiercely proud of their country and, as he put it, will seek to defend it at all costs. 

Both this friend and other Iranians that I have spoken to since the bombs began to fall last Friday have highlighted how Iran’s “territorial integrity” has been breached by Israel, in violation of international law. 

And so while some might perceive an attack on a tyrannical regime and its nuclear arsenal to be an exception to this rule, it should hardly surprise us that those within the country affected may take a different view. 

Both the Israeli prime minister, Benjamin Netanyahu, and the exiled crown prince of Iran, Reza Pahlavi - whom many perceive to be the most realistic leader of any new revolution - have used their platforms to call on Iranians to seize this moment to rise up and reclaim their land. 

Yet, with bombs falling all around them and a weakened regime still known to be capable of brutally responding to any attempts to revolt, such dreams are easier to utter than to act upon. 

Meanwhile, as Tehranis are encouraged to flee their city and some have already seen homes, loved ones or livelihoods destroyed, it may well be that Iranians have other things on their minds at present than attempting to overthrow their oppressors. 

One very present concern for many Iranians at the moment will be the fate of loved ones who remain in prisons as the aerial bombardment continues. 

Tehran’s Evin Prison, for example, is on the edge of District 3, which residents were told they must evacuate on Monday ahead of another onslaught. 

But as the Australian-British former political prisoner Kylie Moore-Gilbert noted in an interview with Sky News, the prisoners in Evin had no option to flee and instead found themselves locked inside tiny cells, hearing the sound of bombs and rumours of what was taking place but without any real clarity. 

“Nobody's going to have a clue what's going on, and it's utterly terrifying to think that you're locked in a place, you can't flee, you hide, you can't take action to protect yourself, and you don't have access to information,” she said.  

There is not even any guarantee, Moore-Gilbert noted, that these prisoners will be being taken care of by the prison guards, who will no doubt have other things on their mind. 

“There are literally thousands, dozens of thousands, if not hundreds of thousands, of innocent people in prison in Iran, most of them Iranian civilians,” she said. “The prison population inside that country is enormous. The conditions are dire in the best of days. Do they even have electricity? Do they have running water? What on earth is going on? My heart goes out to them.” 

Among the many prisoners in Evin are a handful of Christians, detained or serving sentences on charges related to their religious activities but framed as “actions against national security”. 

Like many Iranians, Christians, as a long-oppressed minority, have every right to hope for a change in the country and a future Iran that would better embody the prophetic words from the Book of Isaiah, believed to have found their fulfilment in Jesus, of “freedom for the captives” and “good news for the poor”. 

And yet Iranian Christians must also wrestle with the biblical command to “submit to the governing authorities” and to “give to Caesar what is Caesar’s, and to God what is God’s”. 

It is, then, perhaps no surprise that in recent years, as hopes of regime change have regularly come and gone, that Iran’s Christians have tended to focus their prayers instead on the increase of “God’s kingdom”, as many more Iranians have continued to find new hope in the Christian faith. 

Such hopes, in theological terms, are built on firmer foundations than any dreams for a change in the nature and essence of tyrannical regimes like the one currently still clinging onto power in Tehran. 

And whatever the future brings, when this current crisis is over, the Iranians who have found their ultimate source of hope and joy in Jesus Christ will know that they still have something to hold onto, whatever they may have lost: the promise of God’s presence with them today and a bright future for tomorrow. 

It may be that another revolution is what many Iranians crave, but there is also something revolutionary, I believe, about the prayer that Jesus taught, which leaves the ultimate course of our lives in the hands of God. 

“Your will be done,” Christians have prayed throughout the centuries; and Iranian Christians will continue to pray this whatever the future holds for them. 

It is perhaps little wonder, then, that it is the Gospel message that Iranian Christians have continued to preach, in spite of persecution, and regardless of whichever direction the whims of popular support have turned. 

One of the passages that an Iranian colleague of mine most frequently recites in our team meetings is the call for us to “act justly, to love mercy, and to walk humbly with our God”, and I was reminded of this as I noted the response of British-Iranian bishop Guli Francis-Dehqani to the current crisis. 

The bishop, the bookies’ favourite to be the next Archbishop, prayed simply for the Lord to “have mercy”. 

As a lover of The Lord of the Rings, I am also reminded of the line from Gandalf, when Frodo is claiming that Bilbo should have finished off Gollum when he had the chance: 

“Do not be too quick to deal out death and judgment. For even the very wise cannot see all ends.” 

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