Aid in dying or assisted suicide? What to do when every phrase is fraught

Not long ago, a member of Compassion and Choices contacted me after I wrote that that the group advocated “physician-assisted suicide” in a book on end-of-life medical treatment. “Assisted suicide,” he said, was the term used by opponents, like the Catholic Church. He wanted me to use “aid-in-dying” instead.

Until then, it hadn’t occurred to me that, as is so often the case in hot-button issues in politics and medicine, language is power. We journalists name and often unwittingly frame debates, nudging our readers one way or another, because words carry emotional freight along with their explicit meanings. I was neutral and somewhat ambivalent, but not unsympathetic, to what is variously called “the right to die,” “aid-in-dying,” “expanded end of life options,” “self-deliverance,” or “death with dignity.” I had no idea that by calling it “suicide,” I was stacking the reader’s mental deck against it.

Now I do. Activist groups understand the power of naming, which is why gay liberation claimed "gay" as a substitute for “homosexual,” why the movement defending legal abortion calls itself “pro-choice” and the opposition claims “pro-life,” and why African-Americans banished the N-word from public discourse.

Which brings me back to the current debate. “Suicide” is like “homosexual.” It's not inaccurate, exactly, but the associations are clinical, judgmental, legalistic, even freighted with the notion of sin. Catholic theologians have written treatises against it. “Committing” suicide is illegal, like committing a burglary. “Suicide hotlines” are for sick people.

“Suicide” brings to mind a distraught teenager jumping off the Golden Gate Bridge. Is it really fair or accurate to use the same word to describe a 76-year-old with painful and terminal pancreatic cancer who intentionally shortens his life (or his dying) by a few weeks or months? These are two very different moral, emotional, and legal acts. Both will have repercussions for family members and are not to be taken lightly. But they are not the same.

Medical stories are full of such minefields and euphemisms, in part because the technologies surrounding modern death have created dilemmas our culture has no pre-existing language for. “Life support,” for example, sounds more affirming than it is when only human organs, not what we generally consider the “self” of a human being, are being kept “alive” in any meaningful sense. “Multi-organ systems failure” is usually doctor-speak for “dying,” and “advanced or chronic illness,” “multiple comorbidities,” and even the neutral term “prognosis” often serve as code for “fatal” and “incurable.”

Under a 1989 Supreme Court decision, all competent patients have a constitutional right to refuse, or ask for the withdrawal, of any form of medical treatment, including those that are life prolonging. This is neither “assisted suicide” nor “euthanasia,” but I have heard doctors freely use such terms when they disagree with a patient’s choice.

The right-to-die debate is not about to go away, given how troubled our society seems to be about how we die in the era of advanced medicine. So what terms should we use instead? I used the proponents’ term “aid-in-dying” in a New York Times Sunday Review essay recently, but it left me unsatisfied. It seemed vague and euphemistic, unfairly skewing and sanitizing a complex debate in the other direction. There are many ways to “aid” a dying person, and only a few involve prescribing a pill to hasten the process. Same goes with “death with dignity”: many dignified and pain-free deaths don’t involve lethal medication, and some palliative care and hospice physicians argue that we should focus instead on making sure everyone has access to them.

So what to do? The physician Atul Gawande, who is not a fan, recently used the slightly more neutral phrase “physician-assisted death.” When California’s governor signed the carefully worded “End of Life Option Act” recently, the New York Times used “assisted suicide” in its headline and photo captions, but unpacked the political nuance of words in the body of the story, referring to “what opponents call “assisted suicide” and supporters term “aid in dying.”

In the lede, the reporter avoided weighting the dice and simply described the content of the bill in neutral language: a law “to allow doctors to prescribe life-ending drugs to terminally ill patients.”

Personally, I wonder if we journalists could invent an entirely new phrase, such as “medically-facilitated end of life,” or “pharmaceutically-timed end of life.” Of all the current catchphrases, I’m personally partial to the “right to die,” because I think the essence of such bills is the declaration of a right, a new one historically, to time and control one's dying within a medical culture that often artificially prolongs the process.

But that’s just me. The language of “rights” carries baggage of its own, and others may not consider it neutral. Our current failure to settle on a neat phrase may be an indicator of the profound lack of consensus in our larger society about the moral and emotional issues we face at the hour of our deaths. Until we journalists develop an accurate, widely understood consensus phrase that is not the property of either side, unpacking the term, no matter how many words it takes, will have to do for me. 

Katy Butler is the author of “Knocking on Heaven’s Door: The Path to a Better Way of Death” and an occasional contributor to The New York Times.

Photo by Ulrich Joho via Flickr.