Tuesday, July 26, 2016

Against Euphemisms - Part 4 - Assisted Death

by Drew Rosielle

(This is the last of four posts by Drew on the language we use in hospice and palliative care. You may want to read his reflection on 10 years of practice or his other posts on euphemisms - "Comfort Care," "Palliative Sedation," and "Compassionate Extubation." - Ed.)

"Assisted Death" - So many problems here.

A) To start with, I don't see a need to replace 'euthanasia' or 'physician-assisted suicide' or 'assisted suicide' with new terms. Because those terms have, at the end of the day, well-defined, internationally agreed-upon definitions. The public may not understand those definitions well, true, but the solution to that is educating the public, not replacing the phrases with ones which are less accurate, less precise, more euphemistic.

B) I've seen people claim 'assisted death' to be a synonym for 'assisted suicide' and only suicide, not euthanasia, as well as it being a blanket term for both of them combined. It sort of makes sense as a blanket term - some phrase to capture the practices of medically-assisting death including both euthanasia and assisted suicide. At the end of the day I can live with this use of it, however it is still confusing, and, prima facie, could also be 'interpreted as including medical actions which are not considered to be euthanasia or assisted suicide (deactivating an LVAD, stopping ventilation in a patient with ALS who is totally ventilator dependent, clamping an ECMO circuit). These all involve removing/discontinuing life-prolonging/organ perfusing treatments which the overall biomedicalethical consensus treats as not suicide or euthanasia, which imply actively introducing treatments with the explicit intent of stopping the heart/breathing aka killing.

C) There is the 'optics' argument for removing the word suicide which I understand, suicide is generally considered to be a very bad thing ranging from tragic/horrible to a mortal sin. The proponents of legalized assisted suicide are arguing that it is moral and ethical, therefore it isn't suicide, or shouldn't be called suicide, because suicide is bad. I understand this argument, however I am not persuaded. Again, in part because 'assisted death' is more confusing, less accurate than 'assisted suicide' as above. Maybe 'assisted self-killing' would be better? 'Assisted self-administered lethal ingestion'? 'A terminally ill patient ending her/his life deliberately by taking a prescribed medication which was prescribed to them for the express purpose of ending the patient's life?' Maybe? Not parsimonious, but an accurate description of what you're talking about, without 'suicide.' I guess to me, however, deliberately taking a lethal dose of a drug to intentionally end your life that day, is suicide. That's what suicide means, acknowledging there are many ways of doing it which don't involve prescription medications. And the proponents of assisted suicide are making the argument that it is morally acceptable to do that in certain circumstances, and it is professionally acceptable for doctors to help patients do that. That's an argument one can make, and the proponents of legalized assisted suicide make that argument, but I don't at all see how that's an argument that the action is not suicide. It's an argument that there is a circumstance in which suicide is ethical, justified, moral, and within the scope of medical practice. Proponents, go ahead and make that argument, just don't argue that it's somehow not suicide. Calling it 'assisted death' however just seems to confuse and obfuscate, not clarify.

Drew Rosielle, MD is a palliative care physician at University of Minnesota Health in Minnesota. He founded Pallimed in 2005. For more Pallimed posts by Drew click here. 

Illustration Credit: Christian Sinclair CC-BY-SA-NC

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