Euthanasia / Assisted Suicide - Archive

When Killing Yourself Isn’t Suicide: Word Games in the Battle of Physician-Assisted Suicide

The Vermont legislature has fast-tracked a bill to legalize physician-assisted suicide, and California may not be far behind. If the legislatures in these states do vote to redefine physician-assisted suicide as a legitimate and legal “medical treatment,” a large part of the blame, strange though it may sound, can be laid at the feet of postmodernism.

The deconstruction of language, with disregard for facts and accurate definitions, is infecting medical and health-care ethics and policies.

Case in point: In order to further the legitimization of assisted suicide, the American Public Health Association (APHA) embraced the political advocacy of assisted-suicide supporters in November when it decided that “physician-assisted suicide”­an accurate and descriptive term­ should be replaced with the euphemistic advocacy-phrase “aid in dying.”

At its annual meeting, the organization approved an interim policy: Urges health educators, policy-makers, journalists and health care providers to recognize that the choice of a mentally competent, terminally ill person to choose to self-administer medications to bring about a peaceful death is not “suicide,” nor is the prescribing of such medication by a physician “assisted suicide.” Urges terms such as “aid-in-dying” or “patient-directed dying” be used to describe such a choice.

This policy will become permanent if confirmed by the APHA’s governing council in 2007.

The stakes in this semantics game are high. At issue ­and indeed, the whole point of this postmodernist exercise ­is whether activists will be able to convince other states to join Oregon in redefining the crime of assisted suicide as a legitimate “medical treatment.” If that happens, funding of assisted suicide would soon follow, just as it has in Oregon, where the act of facilitating suicide is now deemed a state-funded form of “comfort care.”

In one sense, the opening of this new front in the assisted-suicide debate reveals that the movement, thought to be unstoppable when Oregon passed the nation’s first assisted-suicide law, understands that it has failed to convince America that suicide should be part of medicine’s armamentarium.

In the more than ten years since the passage of the Oregon law, state after state has considered legalizing assisted suicide. Each time, there was early support for the measure. Yet, in each instance, when the official vote was taken, support had evaporated and the proposal went down in defeat.

This left assisted-suicide proponents, particularly Compassion & Choices (C & C) (formerly the Hemlock Society), which spearheaded most of these legislative proposals, searching for some way to improve their position. So C & C commissioned research and polling. They found that people have a negative impression of the term “assisted suicide,” but, if euphemistic slogans like “death with dignity” or “end of life choices” were used to describe the same action, response was relatively positive.

Likewise, poll respondents were more apt to approve letting doctors “end a patient’s life” than they were to approve giving doctors the right to “assist the patient to commit suicide.” According to one polling firm, the apparent conflict was a “consequence of mentioning, or not mentioning, the word ‘suicide.’”

As a result, assisted-suicide advocates concluded that the accurate word “suicide” had to go. They embarked on a crusade to erase and replace it with kinder, gentler language that masked the harsh reality of what was being discussed.

Their line of attack aimed at three target groups: the media, the state of Oregon, and major public-policy organizations. If those groups could be persuaded to adopt new language, opposition would supposedly disappear. Accordingly, they issued press releases claiming that use of the term “assisted suicide” demonstrated insensitivity to dying patients and to the physicians who assisted them.

In one C & C press release, Dr. Peter Goodwin, who has presided over a number of assisted-suicide deaths, said, “As a physician, I resent the term ‘physician-assisted suicide.’ I never felt I was assisting a suicidal patient, but rather aiding a patient with his or her end of life choice.”

Thus far, however, the press has, for the most part, not jumped on the name-change bandwagon. For example, the Associated Press bureau chief in Portland, Oregon, said, “We have thought about it and we feel ‘suicide’ describes the act of taking one’s life, so we’ll stick with it ­ for the time being.”

Likewise, the Register-Guard (Eugene, Oregon) will continue to use the terms “doctor- or physician-assisted suicide,” since they have chosen “to err on the side of plain English.”

The government of Oregon, however, is another story. The Oregon Department of Human Services (DHS) is the entity charged with compiling annual assisted-suicide statistics, and, since those statistics are inevitably part of any debate or discussion about new assisted-suicide measures, C & C needed the DHS to replace the offending “s-word” in the reports.

To accomplish this, C & C first sent a formal request to the state agency, suggesting that the terms “aid-in-dying,” “directed dying,” or “assisted dying” be used in official state reports. Then the group upped the ante when it brought lawyers to a meeting with the DHS to discuss the language substitution and implied that, if it were not made, litigation might follow.

Rather than risk a legal wrangle (or, perhaps, out of sympathy for the cause), the state acquiesced. On October 16, state officials announced that, in the future, physician-assisted suicides in Oregon would be listed as “physician-assisted death.” However, this label was changed after a number of Oregonians objected to its ambiguity, since it could refer to anything from plumping a pillow or wiping a brow to intentionally giving an overdose of a lethal drug.

The state agency finally settled on the phrase it would use instead of “physician-assisted suicide.” In all future official communication, the state of Oregon will refer to patients who die from physician-assisted suicide as “persons who use the Oregon Death with Dignity Act.”

Assisted-suicide activists were ecstatic. According to Kathryn Tucker, C & C’s director of legal affairs, “This will be a sea change because how you speak of things strongly influences how you think of them.”

The victory in Oregon was equaled when the APHA announced that it would embrace the misleading language. With over 50,000 members from over 50 occupations in the public-health field, APHA has a long arm. According to its web site, “APHA has been influencing policies and setting priorities in public health for over 125 years.”

Now it will give the media an excuse to shift from precise and accurate descriptive language about assisted suicide to the words of pure political advocacy.

Clearly, the APHA’s adoption of a policy intended to mask the reality of suicide and to legitimize its facilitation by describing it in innocuous terms constitutes thinly veiled support for passage of laws permitting physician-assisted suicide.

This is a big shift from 1999, when then-U.S. Surgeon General David Satcher declared, “Suicide is a serious public health problem,” and urged implementation of a comprehensive national strategy for suicide prevention.

At the time, he did not recommend that those who had been diagnosed (or misdiagnosed) with a terminal illness be exempt from efforts at suicide prevention. But Satcher himself has now caught assisted-suicide fever. In 2006 (when he was no longer the surgeon general), he wrote a letter supporting a California bill that was identical to Oregon’s law. (The California bill failed.) In his letter, he referred to assisted suicide in Oregon as “legal aid in dying in Oregon.” Apparently, suicide is no longer a problem if it isn’t called “suicide.”

Let’s think about how this works: Take a patient who has been diagnosed with a terminal condition. If that patient asks her doctor for sleeping pills so she can sleep comfortably at night, and if the doctor prescribes them, but she takes all of the pills at once and dies, her death is called “suicide.”

But, if that same patient asks her doctor for sleeping pills so she can die, and if the doctor prescribes them for that purpose, and she takes all of the pills as directed and dies, her death is not called “physician-assisted suicide.”

Assisted-suicide advocates say that that’s proper, but really it’s just political correctness. By bringing postmodernism to health-care public-policy, they hope to drive their agenda to victory.

[Rita L. Marker is an attorney and executive director of the International Task Force on Euthanasia & Assisted Suicide. Wesley J. Smith is a senior fellow at the Discovery Institute, an attorney for the International Task Force on Euthanasia and Assisted Suicide, and a special consultant to the Center for Bioethics and Culture. Rita L. Marker & Wesley J. Smith =]