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What do you call death and an assisted death?

By Derek Humphry

Recent controversy in Oregon about the best term to describe how a doctor helps a terminally ill person to die under the Oregon Death With Dignity Act (1994) set me thinking about all the terms we use to describe ways of dying and death.

The row in Oregon is between people on the ‘choice’ side who abhor words like suicide, euthanasia, and even hemlock, while on the ‘pro-life’ side they want the foregoing words to be clearly spelled out because they think it helps draw attention to their opposing case. They want the stigma of the word ‘suicide’ to be kept for political reasons.

Since the hastened death law became operative in 1998, the Oregon Department of Human Services (DHS) has always used the term ‘physician-assisted suicide‘ in its annual reports on when and how the law is used. All medical and academic journals use the same term.

Journalists and broadcasters bluntly refer to the Oregon law either as ‘suicide’ or ‘assisted suicide’ – rarely mentioning that only a licensed physician can do this, and after observing a number of rules.

Oregon is the only place in North America where a physician, obeying certain obligatory guidelines, can prescribe a lethal overdose for a dying patient who requests this and chooses to drink it. Belgium, the Netherlands, and Switzerland permit similar help with death but do not have the same trouble with what to call it.

After vacillating about whether to call the procedure ‘physician-assisted death’ – and meeting lots of criticism from the right-to-life forces that this could mean any number of things – the DHS plumped for the innocuous term “Death With Dignity.”

But the flaw is that this also is a term which could mean different things to different people. ‘Death With Dignity’ could mean an overdose of lethal drugs to one person, yet to another it could mean dying whilst thinking of Christ’s suffering on the cross. It’s the ultimate euphemism!

For the past eight years, the annual reports by the Oregon agency showing how the law has been working have been a goldmine to those who want to see how such an unusual law plays out. A spade was called a spade. But now, in upcoming reports, we have to wonder what the umbrella phrase ‘death with dignity’ really means.

I think the DHS should stick with ‘physician-assisted suicide’ – describing an action precisely. With the words ‘physician-assisted’ in front, the humanitarian manner of the suicide – and its lawfulness – is apparent to most people. Clearly it is not a sad, depressive suicide because only a competent, dying adult can get this sort of help from a doctor in Oregon. Provided the word ‘suicide’ is qualified with ‘physician-assisted’ in front, the public is well able to tell the difference between the justifiable and the tragic.

To wrap up our support for physician-assisted suicide in fancy language invites our critics to say that we are trying to change the law covertly and that we are ashamed of being frank about what we really want, neither of which is true.

Probably this debate is not over, so I offer a list of alternative terms for justifiable help in dying or for a chosen death, plus the euphemisms we use for death itself:

For when a doctor prescribes a lethal overdose which the dying patient chooses to drink (11 terms): Physician-assisted suicide; Physician-assisted death; Physician-assisted dying; Physician-hastened death; Death With Dignity; Aid in Dying; Medically-assisted dying; Medicide (Kevorkian MD book); Physician-managed death; Mercy killing. Terminal sedation.

For when a sick patient chooses to end his or her own life without medical help (14): Self-deliverance; Patient-directed dying (Preston MD book); Humane self-chosen death; Auto-euthanasia; Rational suicide; Hastened death; Right to choose to die; Choice in dying; Self-determination; Suicide; Assisted suicide; Final Exit (Humphry book); Managed death; Self-destruction.

Western society has long had its favorite euphemisms for avoiding expressing such an ultimate action as death. This Orwellian double-speak seems to have similar overtones to the Oregon debate. We seem to want to distance ourselves from the reality of the loss, making it abstract, applicable to others and not ourselves.

Common euphemisms to avoid saying “dead” (16): Passed away; Passed on; Gone to a better place; Departed; Gone to meet the Maker; Gone to meet the majority; Gone to the world of light; Gone to Davy Jones’s locker; Crossed to the other side; Gone to sleep with the fishes; Quietly slipped from our embrace; Succumbed; Called home; Got her/his final reward; Expired; Dearly departed.

The criminal world has its own set of avoidances of the reality of death such as: whacked, smoked, wasted, rubbed out, deep sixed and given cement overshoes.

Finally, there’s the humorous and sardonic: croaked, gave up the ghost, put on the wooden overcoat, total goner, kicked the bucket, dead as a doornail, snuffed it, bit the dust, bought the farm, flat-lined, dead as a doornail, is pushing up daisies.

© copyright 2006 Derek Humphry derekhumphry@starband.net

Derek Humphry, who was a reporter for the London Sunday Times l966-80, is the author of the bestseller ‘Final Exit’ available in English, Spanish and Italian. — Updated 22 November 2006

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