Is It Death With Dignity Or Assisted Suicide? Words Shape Opinions

Dec 8, 2014

If you heard someone was planning to kill a baby, your first reaction might be to call 911. If you heard someone wanted to prevent unwanted pregnancy, you might applaud that work.

Yet both of terms are used by activists to refer to the same act: abortion.

Word choice shapes how we perceive an issue. As Colorado gears up for a debate over another contested ethical issue – proposed legislation granting a terminally ill patient the ability to take life-ending drugs prescribed by his or her doctor – those involved say the words used to describe the act will have an important role in how it is perceived.

"How you label something, controls to a substantial degree how people think about it," said Margaret Battin, a University of Utah ethicist who has written extensively about end-of-life issues.

In the abortion debate, she points out, "opponents call the entity in question things like 'little tiny baby.'" Proponents, on the other hand, might use the impersonal term "fetal tissue."

The language used to describe terminally ill patients requesting life-ending prescription medication can be equally loaded. The term, "assisted suicide," once widely used to describe the practice, is now shunned by those in favor of the practice, while those opposed insist it is the correct phrase.

Advocates, realizing that suicide has negative connotations associated with sin and desperation, shifted their language, said Battin. Now, most supporters of the practice, as well as those availing themselves of it, tend to refer to it as death with dignity, or aid in dying.

"The opposition has continued to use the term assisted suicide, capitalizing on the negative connotations of that term," she added. In contrast, "Aid in dying has much warmer connotations."

A 2013 Gallup poll tested this wording difference, and found that 70 percent of Americans were in favor of allowing doctors to hasten a terminally ill patient's death if the patient asked for that option. When the word "suicide" was inserted into the question, support dropped to 51 percent.

A Gallup poll asked the same question about physician-assisted suicide two different ways, and got a much lower approval when the term "suicide" was included.
Credit Gallup

The Media's Vocabulary

Media coverage of the topic has tended to refer to the practice as "physician-assisted suicide."

Both The Associated Press and The New York Times, which use the term "physician-assisted suicide," declined to comment for this story. NPR has also used that phrase in recent stories, although it does not have its own guidance on the language.

Mark Memmott, supervising senior editor for Standards and Practices at NPR, said on issues the organization has not specifically addressed, they turn to the AP style guide. In a Q&A discussing the topic, the style guide says "physician-assisted suicide is the customary first description."

"Assisted suicide" might have once been seen as a neutral phrase, but shifts in how both opponents and proponents use that term has changed the terms of the debate. To use that term exclusively now is to implicitly side with opponents of the practice, said Timothy Quill, a doctor and professor of Medicine, Psychiatry and Medical Humanities at the University of Rochester who directs the Center for Ethics, Humanities and Palliative Care.

"I would say that keeping it called assisted suicide is also an advocacy term, because people who are politically opposed to this really want it to be called that way and they will advocate very vigorously for it to be called that."

Carrie Gordon Earll, vice-president of public policy at Focus on the Family, a Colorado-based Christian group that opposes the practice, said the push to change the terminology is an attempt by advocates to hide the reality of what is happening.

"When you talk about changing the law to permit doctors to cross the line between caring for patients and killing patients, we need to call it what it is. When you hear terms like aid in dying or death with dignity, those are specifically designed to muddy the waters," she said.

Many people can die with dignity regardless of whether they choose to end their lives with a specific action, said Earll. Death with dignity is a mild-sounding phrase that hides the fact that suicide is a negative act, she said.

"When you have proponents of such a huge change in the law who insist on using euphemisms to confuse and conceal the goals, there's something maybe wrong with the agenda. And people need to pay attention to this push to redefine the terms."

Roland Halpern is a Colorado-based advocate for the group Compassion and Choices, which supports bills such as those on the books in Oregon, Vermont, and Washington legalizing the practice of physicians giving terminally ill patients life-ending prescriptions.

His group shuns the phrase assisted suicide. Halpern acknowledged that the wording used to describe the practice has changed over time, as those availing themselves of the option, as well as advocates, realized that the connotations of suicide cast a pall upon the practice.

"As a society we look at suicide as having a very negative, violent connotation. And when someone is at end of life and taking a life-ending medication it's not violent," he said.

"We also like to point out that terms like suicide can stigmatize the survivors who have lost a loved one. It can create problems with certain religious faiths in terms of last rites or memorial services, and it can have some problems with the payout of insurance coverage."

Laws Avoid "Suicide" In Language

Even if what patients are doing – taking a life-ending drug – fits the dictionary definition of suicide, it does not fit the definition in popular culture, said Senator Claire Ayer, who sponsored 2013 Vermont legislation legalizing the practice.

"Suicide is an act of desperation," said Ayer. "On the other hand, physician aid in dying is a completely rational decision."

The three states with legislation on physician-aided death all include language in the law stating such a death should not be considered a suicide, assisted suicide, mercy killing or homicide. In some states, assisting a suicide is considered a crime, and can affect insurance payouts as well.

Ayer said she finds it troubling that the media continues to use the term "physician-assisted suicide."

"Because I think it is taking a term that is pejorative, that is sad, that is desperate, and applying it to something that could be a really good option for very, very few people.

Battin, the University of Utah ethicist, suggested that those wishing to remain neutral on the topic should either describe the practice more precisely using more words, or maybe alternate the terms they use to describe it.

Some records of deaths under such laws refer them as "death under the death with dignity statute or law," she said.

That kind of language lets a person bring their own judgments into the action, said Battin.

If you think it's morally wrong and want to view it as a suicide, "that's still open to you. If you think of it as aid in dying and that there is something right and humane and respecting of individual choices," that option is there as well.