Euphemisms mask the true nature of assisted suicide and euthanasia

This article was written by Noreen O'Carroll and published by Mercatornet on January 19, 2022. This article was originally published in the Summer issue of the Irish journal Studies.

By Noreen O'Carroll

Disguising the true meaning of words is a powerful weapon in the "right to die" armoury

The lower house of the Irish Parliament, the Dáil Éireann is currently considering the “Dying with Dignity Bill 2020”. The most striking feature of this bill is that it does not mention the words “assisted suicide” or “euthanasia” in any of its qualifying criteria or provisions but instead uses expressions and phrases such “assistance in dying”; “the prescription of substances which can be orally ingested”; “prescribing and providing the means of self-administration”; and “the substance or substances may be administered”.

Language matters. It can persuade us to buy products when they are labelled and packaged attractively. It can also shape people’s attitudes and approaches to controversial issues and questions. Assisted suicide and euthanasia are labelled and packaged attractively in the Dying with Dignity Bill through the use of euphemistic terms that obscure important ethical and empirical distinctions. But they are very influential in swaying public opinion in favour of assisted suicide and euthanasia.

Euphemisms designate something unpleasant by a milder term. In the bill euphemisms operate by dissociating language from the experience of reality and putting something illusory in its place instead.

What’s in a name?

This can be seen in the title and provisions of the bill. The title is quite misleading. By using the euphemism “dying with dignity” it dissociates the choice to take one’s life intentionally, or have one’s life ended deliberately by a healthcare professional, from the experience of “suicide” or “euthanasia”, which is what the bill’s provisions are about.

This is a cause of considerable distress to all who have lost a loved one who died naturally with dignity, because it implies that a death with dignity is only achieved by assisted suicide or euthanasia.

It has been suggested that the rationale for using euphemistic language in the bill is to better reflect the wishes of patients with terminal illness whose desire is for a death with dignity. However, legislation doesn’t apply to patients only; it also affects others – doctors, nurses, families, communities and society as a whole.

A more linguistically appropriate title for the bill is, arguably, the “Assisted Suicide and Euthanasia Bill”.

The provision for assisted suicide in Section 11 of the bill is expressed in language stating that a medical practitioner may prescribe or provide a substance or substances which can be orally ingested or self-administered by a person; or prepare a device which will enable that person to self-administer the medicine, “with the purpose of enabling that person to end his or her own life”.

The euphemisms “orally ingesting” and “self-administration” dissociate the idea from the reality of the experience of committing suicide by ingesting or self-administering lethal medication prescribed or provided by a doctor or nurse; the definition of terms in Part 1 of the bill states that an “assisting healthcare professional means a registered medical practitioner or a registered nurse who has been authorised by the attending medical practitioner to deliver any substance or substances prescribed”. In this situation, the patient is the direct causal agent ending his or her own life.

Absent words

The absence of the words “suicide” and “assisted suicide” is striking. The provision for euthanasia in Section 11 of the bill is also expressed euphemistically, stating that in the case that it is not possible for a person to self-administer, “then the substance or substances may be administered” – and this too is qualified by the phrase “with the intention of enabling the person to end his or her own life”.

This is less than honest. Obviously, if the patient is unable to self-administer and the substances may be administered, then clearly someone else is involved. Who? The identity of the healthcare professional who euthanises the patient is disclosed in Section 11 (6) as either “the attending medical practitioner or the assisting healthcare professional”, who can be either a doctor or a nurse. The doctor or nurse is legally obliged to remain with the person “until the person has self-administered the substance or substances or have it or them administered”. This situation is one where the doctor or nurse is the direct causal agent who ends the patient’s life.

Couched in euphemistic language, this is euthanasia and specifically voluntary euthanasia when it is done at the request of the patient. The idea conveyed in the words “the attending medical practitioner or assisting healthcare professional must remain with the person until the person has self-administered the substance or substances or have it or them administered” (my emphasis) is dissociated from the experience it is intended to convey – of one’s life being ended deliberately through the administration of a lethal substance by a doctor or a nurse. The absence of the words “euthanasia” and “voluntary euthanasia” is striking.

Conscientious objection

The provision for conscientious objection in Section 13 of the bill obliges medical practitioners who do not want to participate in ending the life of a patient to make arrangements “for the transfer of care” of the patient to another medical practitioner.

“The transfer of care” is a euphemism for compelling a doctor who does not want to co-operate in ending a patient’s life intentionally to send the patient to another doctor who will do so. This is a travesty of genuine conscientious objection, because it compels doctors to be complicit in acts they believe to be morally wrong and unjustifiable.

When is suicide not suicide?

When he introduced the bill in the Dáil, Mr Kenny argued that “assisted dying” should not be conflated with suicide and that a terminally ill, mentally competent patient who wants to end their life is not suicidal. He said: “I take exception to conflating this with suicide. People with a terminal illness are not suicidal”.

At the second stage, when the government proposed referring the Dying with Dignity Bill 2020 to a special Oireachtas committee to consider the legislation and report back within a year, he referred to “assisted suicide” but that it was irresponsible to conflate assisted dying with suicide, which had very different connotations.

However, it is a distortion of language to suggest that someone who takes their own life with assistance from a doctor is not suicidal.

The word “suicide” means to kill oneself, derived from Latin, sui (of oneself), and caedo (to kill). The words infanticide, homicide, parricide and gendercide derive from the same root. To suggest that someone is not committing suicide when they take their own life with assistance from a doctor flies in the face of the word’s meaning.

Ireland has a national suicide prevention strategy, Connecting for Life, published jointly by the Department of Health, the HSE, the National Suicide Prevention Office and Health Ireland. This defines the word “suicide” and its cognates in fidelity to its root meaning of “to kill oneself”: “Suicide is death resulting from an intentional, self-inflicted act”. The foreword to the strategy states: “Suicide prevention is everybody’s concern. This national strategy sets out what we must do as a government and society to protect and save lives. Since suicide is a ‘whole-of-society’ issue, we’re taking a ‘whole-of-government’ approach….”

One wonders whether the 81 TDs who voted to progress the Dying with Dignity Bill 2020 have ever heard of, or read, Ireland’s national suicide prevention strategy.

Remarkably, in his Dáil speech Mr Kenny did not make any reference to the bill’s provision for voluntary euthanasia. Yet there is a world of difference between a person committing suicide with assistance from a doctor or nurse, and that person having his or her life ended by a doctor or nurse following a request to do so. The World Medical Association defines the former as “assisted suicide” and the latter as “voluntary euthanasia”.

The use of euphemistic language in the Dying with Dignity Bill 2020 is in line with what is happening in other jurisdictions.

In the United States, where assisted suicide has been legalised in some individual states, the legislation is given titles such as Death with Dignity Act (Oregon, Washington State, Washington DC, and Maine); Patient Choice and Control at the End of Life (Vermont); End of Life Option Act (California), Our Care Our Choice Act (Hawaii); Aid in Dying for the Terminally Ill Act (New Jersey). In Canada the criminal code was amended to include “Medical Assistance in Dying (MAID)”, legalising assisted suicide and euthanasia. In Australia the states of Victoria, Western Australia and Tasmania have all passed Voluntary Assisted Dying laws making assisted suicide and euthanasia available.

Dr Noreen O’Carroll is a lecturer in medical ethics at RCSI University of Medicine and Health Sciences.

Portugal's President de Sousa vetoes euthanasia bill.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

President Marcelo Rebelo de Sousa

The Associated Press reported that Portugal's President, Marcelo Rebelo de Sousa, has vetoed the second euthanasia bill this year, a bill that was passed by Portugal's parliament in early November.

President de Sousa reportedly vetoed the second euthanasia bill because of contradictions in the language of the bill. According to the Associated Press article:

This time, the president is returning the reworded law to the national assembly, according to a statement posted on the Portuguese presidency’s website late on Monday, arguing that further clarification is needed in “what appear to be contradictions” regarding the causes that justify resorting to death with medical assistance.

Whereas the original bill required “fatal disease” as a pre-requisite, the president’s argument followed, the renewed version mentions “incurable” or “serious” disease in some of its formulation. No longer considering that patients need to be terminally ill means, in De Sousa’s opinion, “a considerable change of weighing the values ​​of life and free self-determination in the context of Portuguese society.”

My reading of the euthanasia bill was that it was oriented to euthanasia of people with disabilities.

On January 29, Portugal's parliament passed a first euthanasia bill. On February 19, President de Sousa did not to sign the bill into law but instead he referred the bill to Portugal's Constitutional court for evaluation. President de Sousa stated that he thought that the bill was: 

"excessively imprecise," potentially creating a situation of "legal uncertainty."

On March 15, Portugal's Constitutional court rejected the euthanasia bill. The Portuguese American Journal reported that the Constitutional court decided that:

“the law is imprecise in identifying the circumstances under which those procedures can occur.” The court stated the law must be “clear, precise, clearly envisioned and controllable.” The law lacks the “indispensable rigor.

In July, 2020 I reported that the Portuguese Medical Association informed the government that they will not permit doctors to participate on the euthanasia commission (the commission to approve euthanasia). At the same time, a group of 15 law professors, including Professor Jorge Miranda, known as the father of Portugal's Constitution, stated that the euthanasia bills are unconstitutional.

 

Parliament is dissolving on December 5. A new bill cannot be debated until after the January 30, 2022 election.

 

More information about this topic:

• Portugal passes euthanasia bill. Urge President de Sousa to veto the bill (Link). 
• Portugal's Constitutional court rejects euthanasia law (Link). 
• Portugal's President did not sign euthanasia bill. He sent it to Portugal's Constitutional court (Link).
  

Providing or facilitating suicide is a betrayal of a fundamental ethos of psychiatry.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Mark Komrad

Last week I published an article titled: Is assisted suicide a suicide? based on the ongoing debate in the Psychiatric Times between Psychiatrist, Dr Mark Komrad and long-time euthanasia and assisted suicide activist Margaret Battin PhD.

One physician responded to one of Dr Komrad's articles that were published in the Psychiatric Times with his personal story of accompanying his mother when she died by assisted suicide in Switzerland. Komrad's response did not challenge this physician but rather delved into The Meaning of Compassion.

I have great respect for Dr Komrad. Komrad explains compassion based on the following proposition: Proponents of medical aid in dying often accuse their opponents of lacking compassion. But what does that word really mean?

Dr Komrad writes:

I am grateful for Michael von Poelnitz, MD’s letter “A Psychiatrist’s Personal Perspective on Medical Aid in Dying.” It is a valuable addition to Psychiatric Times ongoing debate on assisted suicide. I feel great compassion for him and his mother. I also appreciate his proper use of the word kill in this context, referring to the procedure used with his mother in Switzerland, as opposed to many of the other euphemisms that are often deployed, particularly by proponents of assisted suicide and euthanasia. Language plays a very important role in this conversation. Indeed, as George Orwell famously said, “If thought corrupts language, language can also corrupt thought.”

The letter seems to imply that the medical killing discussed in my article about developments in Canada is involuntary, in contrast to the voluntary and cooperative nature of the process in his mother’s case. I note in my opening paragraph, however, that all these laws involve voluntary participation by patients in these procedures. Typically, a patient makes the initial request. However, some Canadian colleagues tell me they are being pressured to inform potentially eligible patients of the euthanasia option, even if patients do not bring it up. Even some physicians who are conscientious objectors are pressured to do this. However, there is also evidence that euthanasia is provided without request for some incompetent patients in the Benelux countries (Belgium, the Netherlands, and Luxembourg) who have no family members available for proxy consent, nor advanced directives for euthanasia.

The letter also raises the issue of who does the killing. In some cases, it is indeed a patient’s psychiatrist. In one Dutch series, Scott Kim, MD, PhD and his team found that 73% of psychiatric euthanasias in 66 patients were performed by doctors who were already caring for the patient. Specifically in cases involving euthanasia for personality disorders, 30% of the euthanizing physicians were psychiatrists. As psychiatric euthanasia becomes available in 2 years in the large nation of Canada, numerous psychiatrists will have to confront euthanasia as a legal option for their suicidal patients, and they will increasingly be in positions to possibly approve it, and even provide the service.

Finally, a standard canard of those favoring euthanasia and assisted suicide is to portray those opposed to it as lacking empathy for patients’ agonies. I would turn that charge around. A core competency in psychiatry is to have a deep immersion and empathic understanding for such feelings, to have what Karl Jaspers, MD, PhD called verstehen— a sense of standing in a patient’s shoes. What the letter calls “a willingness to go beyond one’s own limitations in order to sense and perceive more broadly” should not mean transcending empathic understanding to aid and abet suicide. Rather, it should give us a deeper standpoint from which to deploy support and advocacy, to help patients find a path into the future, to help mobilize their support systems and state-of-the-art palliative care, and to attend to them devotedly in their suffering—demonstrating the true meaning of compassion: to suffer with. To provide or facilitate their suicide is a betrayal of a fundamental ethos of psychiatry.

More articles related to Dr Mark Komrad (Link).

Dr Komrad is a psychiatrist on the teaching staff of the Johns Hopkins Hospital in Baltimore, Maryland. He is also clinical assistant professor of Psychiatry at the University of Maryland, and Teaching Faculty of Psychiatry at Tulane University in New Orleans.

Victoria euthanasia Bill: "Offence to Induce Self-administration of a Voluntary Assisted Dying Substance" Is an Oxymoron and Unenforceable

This article was published by Choice is an Illusion on November 20, 2017

Oxymoron

By Margaret Dore, Esq., MBA

In the Victoria Australia euthanasia bill, Clause 86, contains the "offence to induce self-administration of a voluntary assisted dying substance." The Clause states:

A person must not, by dishonesty or undue influence, induce another person to self-administer a voluntary assisted dying substance in accordance with a self-administration permit.

This clause is too vague and uncertain to be enforced for the following reasons. 

The terms, "dishonesty" and "undue influence" are not defined in the bill. The clause, itself, is an oxymoron, i.e., a combination of contradictory and incongruous words ("dishonesty" or "undue influence" to induce another person to administer a "voluntary" substance "in accordance" with a "self-administration" permit). The offence is simply unenforceable.

It is assisted suicide not "medical aid in dying."

Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

The Colorado Secretary of State recently confirmed that enough signatures were collected for the assisted suicide question to be on the ballot.

The assisted suicide lobby is urging the media to replace the term assisted suicide with "Medical Aid in Dying." 

The term is assisted suicide is understood by the public and it is used by institutions such as the American Medical Association which states in its policy on Physician-Assisted Suicide that:

Physician-Assisted Suicide is fundamentally incompatible with the physicians role as healer, would be difficult or impossible to control, and would pose serious societal risks.

Brandon Rittiman from 9News published a clear report explaining: Why 9News uses the words assisted suicide. Rittiman states:

Supporters of that law have asked 9NEWS not to call it assisted "suicide." They'd rather we call it "medical aid in dying." 

What follows is our explanation of why we are not going to grant that request: 

First off, 9NEWS has no position on this ballot question. Nor do we take the issue lightly. 

We have a duty to tell you about it in simple, direct language. That’s why we’re not going to stop using the word “suicide.” 

Supporters of the measure argue the word “suicide” is too friendly to the opposition because it may make you think of someone who ends their life for no good reason. 

In contrast, the proposed law does require a reason: you’d need to be diagnosed with a terminal illness to get a life-ending prescription. 

But in plain English, that’s still “suicide.” 

Merriam-Webster defines suicide as:

“The act or an instance of taking one's own life voluntarily and intentionally especially by a person of years of discretion and of sound mind.”

The Oxford Dictionary puts it more simply:

“The action of killing oneself intentionally”

Dictionary.com goes with:

“The intentional taking of one's own life.”

All three definitions have something in common: they don’t depend in any way on the reason a person chooses to end their life, just that they do so on purpose. 

Supporters of this proposal want to change the dictionary definition of suicide. They might succeed one day. 

Changes in the law can end up changing our language. 

But it’s not our job in the news business to change the dictionary. 

It’s our job to use plain language that’s current and accurate-- and that’s what we’ll keep doing.

The New Mexico Supreme Court recently decided that "aid in dying" is assisted suicide, in a case where they decided that there is no right to assisted suicide in New Mexico.

Great News: The New Mexico Court of Appeals struck down an activist assisted suicide decision, upholding protections in law from assisted suicide.

Alex Schadenberg

By Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Washington Times reported yesterday that the New Mexico Court of Appeal overturned Nash's activist assisted suicide decision, to once again prohibit assisted suicide.

The New Mexico Court of Appeals handed a defeat to the right-to-die movement Tuesday by striking down a lower-court ruling establishing physician-assisted suicide.

The three-judge panel ruled 2-1 that the district court had erred when it determined that “aid in dying is a fundamental liberty interest.”

Protections from assisted suicide have been upheld in New Mexico.

On January 13, 2014; Judge Nan Nash, of the Second Judicial District in New Mexico made an activist decision in the case Morris v New Mexico. Nash legislated from the bench giving New Mexico doctors the right to prescribe lethal drugs to assist the suicide of their patients.

The case concerned Aja Riggs, a woman with uterine cancer, who said that she wanted to die by assisted suicide, and two doctors who were willing to prescribe lethal drugs.

The argument in the case was based on a word game.

The case argued that "aid in dying", which is also known as assisted suicide, is not prohibited by the New Mexico assisted suicide law because "aid in dying" is not assisted suicide.

The case argued, that if "aid in dying" is assisted suicide, then the New Mexico assisted suicide law is unconstitutional because it undermines the right to privacy and autonomy.

Aja Riggs is now in remission.

But, Aid in dying is assisted suicide and assisted suicide does not constitute medical treatment. Therefore prohibiting assisted suicide does not undermine the right to privacy or autonomy.

A similar case was dismissed by the Connecticut court in 2010.

Riggs told the Albuqueque journal last December that she is now in remission. She is fortunate that the court did not give her an exemption to die by assisted suicide.

Laura Schauer Ives, an attorney for Riggs and the two doctors, said after Tuesday's ruling that she plans to appeal the case to the state Supreme Court.

• New Mexico court of appeal heard assisted suicide case.
• New Mexico Attorney General appeals assisted suicide court decision.
• New Mexico lower court parrots the language and platitudes of assisted suicide advocacy groups.
• Attorney General must appeal assisted suicide court decision in New Mexico.

Summary of Liz Carr's speech at Not Dead Yet - UK rally.

The summary of Liz Carr's speech was published by Dr Peter Saunders on his blog.

Not Dead Yet assembled at 10 Downing St.

People with disabilites descended on Westminster today in droves to lobby MPs on Rob Marris’s Assisted Dying (no 2) Bill.

Marris's assisted suicide bill is due for its second reading on 11 September.

Stand-up comedian and actress Liz Carr addressed the gathering and was introduced by former Paralympian Baroness Tanni Grey-Thompson.

They later visited 10 Downing Street to hand a letter to the Prime Minister.

The following is a summary by Dr Peter Saunders of Liz Carr’s speech. This is based on his (not fully legible) handwritten notes and does no justice to Liz's sense of humor and eloquence but at least it will give you the general gist. The talk was recorded so I will post a link to the video here once it has been produced. Any errors in transcription are his alone:

Liz Carr as Clarissa Mullery in Silent Witness.

Summary of Liz Carr's speech

We shouldn’t be fooled by the term ‘assisted dying’. This is assisted suicide. So let’s call it what it actually is. It’s about people having help to kill themselves.

The former name of Dignity in Dying (DID), the organisation pushing this bill, is the ‘Voluntary Euthanasia Society’. They will use any euphemism to distort the facts and disguise their wider agenda.

Their main weapons are misinformation, emotion and fear – fear about pain, dependence and disability. So we have to fight this fear with facts and truth.

Is there anyone in this room who wouldn’t prefer a pain free death with dignity? Of course not. We all want that. But this law is not the way to achieve it.

Assisted suicide is not about having a painless and pleasant death either. The drugs are unpleasant and they often do not work quickly. Far better to be in the hands of a doctor trained in good palliative care who can relieve your symptoms properly.

We are being cast as uncompassionate for opposing this bill. But we are not the people who lack compassion. We understand what it is like to suffer and to have limited options.

I’m able to speak here today because I am loud, articulate and have been on telly. But I speak on behalf of many who are unable to speak in their own defence – vulnerable and disabled people who don’t have access to the drugs, housing , social care, support and choice they would like.

Tanni Grey-Thompson

DID talk about having choice, but I speak for people who do not have a real choice. The proponents of this bill are offering a very narrow choice indeed to a very limited number of people.

If DID really believe in compassion then why don’t they use some of their millions of pounds of resources to ensure that everyone who is vulnerable or dying has good care and support rather than being steered toward suicide?

Anyone can have worth and dignity if they have proper care and support.

The term ‘right to die’ is rubbish. We are all going to die. What is really being talked about here is the right to be killed, something altogether different.

Suicide is already legal and everyone who is serious enough about it is already able to kill themselves. But this bill is about people who want someone else to do it for them. It’s about socially approved suicide. It’s about making suicide socially acceptable when it is actually something we should be trying to prevent.

Anyone can already kill themselves without assistance – by simply stopping eating, taking an overdose or even driving their wheelchair down the stairs. I’m using these examples to make a point – not suggesting that anyone do it. But the point is, why then do we need to change the law to allow people to be assisted to do what they can already do without assistance?

This bill wouldn’t actually help the tiny number of people like Tony Nicklinson who are unable to kill themselves. We will then be told that it is cruel to discriminate against these people and that we should legalise euthanasia as well.

We hear a lot about the term ‘slippery slope’. I don’t use this term because this widening of the law we see in every country that has legalised it is not a passive process. It’s much more accurate to call it ‘incremental extension’.

Let’s have no illusions about the wider agenda. I was in Luxembourg just after they changed the law. The MPs who were pushing for it wanted it for children and elderly people with dementia as well. But they knew they wouldn’t get it so they went for the softer target of the terminally ill.

It is no different here. DID say it is only for mentally competent adults with less than six months to live but think about the people they are using to make their case – Tony Nicklinson, Debbie Purdy, Jeffrey Spector, Paul Lamb, Terry Pratchett. Not one of them actually fits with their definition. None of them are actually terminally ill.

But through these cases they are softening up public opinion for a much bigger legal change.

They say they only want suicide for people with terminal illnesses. And yet they also say they want to prevent vulnerable people – say with mental illnesses – from committing suicide. But many people with terminal illnesses are not desperate to die and many people without terminal illnesses are.

So why do we have one law for one group and another law for the other? This is really just discrimination. It’s saying that it is good for people who are terminally ill to kill themselves – but bad for younger people with mental illness to do so.

But we can’t on the one hand push for suicide prevention for one group of people and encourage suicide for another group. This is a dangerous and confusing mixed message.

And just how workable will this law be in practice? Two doctors are supposed to assess whether a given patient has mental capacity, is terminally ill and has not been coerced. Think of how busy your own GP is and how well they know you. How can they possibly be expected to make an objective judgement about these things?

When I did my euthanasia tour I talked to people involved in the group Compassion and Choices – the equivalent of DID in the US. Their strategy was very clear – push for 10-15 years with stories of desperate cases and eventually public opinion will change and the law will follow.

DID are using the same techniques here and lining up all their celebrities to endorse it. They have all the money and all the media support. But we have no money and our only celebrities are me and the Pope!

I am terrified by this bill. I am terrified because as a disabled person I have experienced first-hand how poorly our society values disabled people. It's the same with elderly people.

I’m always been told, ‘If I was like you I’d kill myself’. ‘If I was like you I’d want to die.’ There are people who sincerely believe that people like me are better off dead.

But I don’t want to die. And to talk about choice when so many vulnerable and disabled people do not have a choice about basic care, housing and support is to put us in a very dangerous position indeed.

This is really serious. It’s about life and death. If this bill becomes law some disabled and vulnerable people will be subjected to exploitation and abuse and will die as a result.

The very reason we don’t allow capital punishment in this society is because the best police investigation and the best judges can come to the wrong conclusion and execute an innocent person.

This bill if passed will also mean that innocent people get killed. The current law protects people against this kind of abuse. It does not need changing.

I appeal to you to join me on 11 September in opposing this bill.

Selling assisted suicide in California. Wordplay is not enough.

This article was published by the National Review online on May 20, 2015.

Jacqueline Harvey

By Dr Jacqueline Harvey

Suicide is hard to sell. After 23 years of failed attempts to legalize assisted suicide in California, lawmakers and lobbyists may have finally found a strategy that works: They just won’t call it suicide. And on the death certificate, they’ll simply lie.

Entitled the “End of Life Option Act,” California Senate Bill 128 mandates that “the cause of death listed on an individual’s death certificate who uses aid-in-dying medication shall be the underlying terminal illness,” not the lethal dose of poison that actually caused the individual’s death. Advocates of assisted suicide coined the term “aid in dying” and concocted the rationalization that killing oneself does not qualify as suicide if you have a life expectancy of six months or less. Yet it appears that it is not palatable enough to list the preferred misnomer, “aid in dying,” as the cause of death and that the only way lawmakers and lobbyists feel they can sell self-destruction is to falsify public records. 

Suicide, Stigma, and Branding 

In 1992, California became the second state to place the assisted-suicide issue directly before the voters, a year after a similar ballot initiative was defeated in Washington State (but two years before an initiative narrowly passed in Oregon). In these early case studies on the power of wordplay, assisted-suicide proponents found that the word “suicide” was deadly to their cause. People recoil from it. Polls show that support for assisted suicide decreases by as much as 20 points when the word “suicide” is used, even though the substance of the question being asked remains unchanged. When we consider that California Proposition 161 failed by a margin of 54 to 46, it is clear how important semantics are.   

Six previous legislative attempts, from 1994 to 2007, failed. It seems that taking care to control language does not by itself distract people from the truth that a person taking poison to hasten her death is practically the very definition of suicide. Proponents of assisted suicide feel the need to call it anything but suicide and to rationalize it, because suicide is a deeply disturbing act, which we combat through suicide-prevention programs, even going so far as to physically detain persons until they are deemed to be no longer a threat to themselves. We talk suicidal people down from ledges. Assisted suicide asks these vulnerable people if they need a push.

That the End of Life Option Act tries to hide what really happens when a patient chooses to end his own life echoes the shame inherent in suicide. It also highlights the downright sanctimonious double standard in discussions of the physically and the mentally ill. When media applaud physically ill persons like the late Brittany Maynard for choosing self-destruction, or “aid in dying,” this points the finger at persons who take their own lives even though they do not have terminal physical illnesses. To euthanasia advocates, those poor mentally ill people committed suicide, but yet there is no attempt to spare them the posthumous shame of whitewashing their death certificates. The cause of death for these persons will not be listed as “depression” or “schizophrenia” or whatever underlying anguish led them to suicide. 

To be consistent, of course, rationalizations for self-destruction cannot stop with the physically ill. Many argue that, while a terminally ill person may prefer death to continuing to live even a few more months with his physical affliction, they fail to see how those who suffer with mental illnesses may prefer death to living for years with their affliction. In the Netherlands, after many years, legal assisted suicide for the dying has evolved into death on demand, with six out of ten doctors admitting to killing a patient who was simply “tired of living.” California is approaching that slippery slope. 

When Terminal Illnesses Are Not Terminal 

Assisted-suicide advocates insist that a terminal diagnosis with an arbitrarily projected life expectancy of six month is the difference between assisted suicide being sanctioned as “aid in dying” or condemned as suicide. They fail to consider that some patients with terminal illnesses do not die from their diagnosed disease. 

Consider this woman who, nine years ago, was given just two months to live after receiving the same diagnosis as Brittany Maynard. She continues to thrive. Had she chosen “aid in dying” on receiving her diagnosis, would that have been suicide? It certainly would have been a tragic, unnecessary loss of a human life. 

Then there is Jeannette Hall, who was diagnosed with squamous cell carcinoma in 2000. She rejected assisted suicide at the last moment and continues to speak out against assisted suicide. Had she decided differently back then, Jeannette would not have committed suicide, under the terms of Senate Bill 128: She would have died of squamous cell carcinoma, according to her death certificate, not the lethal dose of poison she ingested. This law not only has the potential to take years from people’s lives, it has the potential to pressure them into taking their own lives when they could have beaten their illness. 

California lawmakers think that even “aid in dying” is an undignified cause of death and that it should be kept out of public records. Clearly they recognize the truth of what assisted suicide is and are trying to hide it. Suicide is suicide, no matter how California lawmakers attempt to sanitize and sell it. 

Jacqueline C. Harvey, a public-policy scholar with Euthanasia Prevention Coalition International, has a Ph.D. in public administration and policy and focuses on end-of-life legislation at the state level. Follow her on Twitter @drjcharvey. 

Canadian Medical Association (CMA) delegates opposed euthanasia and assisted suicide

By Alex Schadenberg

The CMA rejected a proposal to support euthanasia and/or assisted suicide at its 146th Annual meeting that was held in Calgary Alberta (August 21 - 23).

Many media articles falsely suggested that the CMA fear debating the issues of euthanasia and assisted suicide, and yet the CMA delegates debated the issues and they voted against changing the language of the debate and they did not change their position.

Dr. Louis Hugo Francescutti

A post media news article quoted incoming CMA president Dr. Louis Hugo Francescutti as saying: 

doctors are not ducking the issue. "What physicians do when they're not sure is pause and reflect and ask for consultation."

Doctors voted to reject having a: 

“large-scale public consultation to regard medical aid in dying as appropriate end-of-life care”

When reading the media reports and the publication from the CMA it appears that they rejected the consultation based on the "loaded language" within the resolution.

For the same reason, the delegates at the CMA annual meeting rejected a resolution calling for them to: 

replace the term “physician-assisted suicide” with “physician-assisted death” in all its official documents. 

The euthanasia lobby must have realized that they didn't have enough support to change the CMA policy so they focused on changing the language of the debate.

The CMA meeting passed a motion to: 

support the right of any physician to exercise conscientious objection when faced with a request for medical aid in dying.

The CMA also passed the following palliative care resolutions:

• making palliative care services at home available to every person nearing the end of life
• integration of palliative care services into community and chronic care service delivery
• support for implementation of a collaborative palliative care model
• creation of a curriculum for training in palliative care.

It is interesting that some media articles falsely report that the CMA is unwilling to debate "assisted death" after an annual meeting where the CMA focused on the issues related to "assisted death." This is probably because the CMA remains opposed to euthanasia and assisted suicide.

The same tactic is used by some media when they claim that the federal government refuses to debate the issues of euthanasia and assisted suicide after they had a thorough debate on the issues in 2010 and rejected Bill C-384 by an overwhelming vote of 228 to 59.

I challenge the media to allow an open debate on the issues of euthanasia and assisted suicide rather than writing one-sided articles that only quote the leaders of the euthanasia lobby while ignoring the facts of the issues and the studies that prove that legalizing euthanasia is not safe.

The media need to be willing to report the facts that were published in 2012 from the 5 year meta-analysis of the Dutch euthanasia law that found 23% of all assisted deaths were not reported? The media needs to stop ignoring the study that found 47% of all assisted deaths in the Flanders region of Belgium were not reported?

The media needs to be concerned that a 2010 study found that 32% of assisted deaths in the Flanders region of Belgium were done without request.

Capital Punishment was outlawed to ensure that no Canadian is executed after a wrong conviction.

We cannot turn a blind eye to the case of the Italian man, with a botched diagnosis who was killed by assisted suicide in Switzerland or that the Netherlands have approved eugenic euthanasia for newborns with disabilities.

Canadians and especially Quebekers need to know why legalizing euthanasia is not safe. Patient safety must be paramount in our medical system.

Euthanasia and assisted suicide are life and death issues. We cannot treat it lightly.

More articles on this topic:
- Canada's Health Minister says No to euthanasia and assisted suicide.
- Canadian doctors oppose euthanasia and assisted suicide.
- Rebranding killing and suicide. The ugly truth about euthanasia.
- Most Canadian doctors oppose euthanasia.

Rebranding Killing and Suicide: The Ugly Truth About Euthanasia.

This article was written by Dr. Will Johnston, the chair of the Euthanasia Prevention Coalition - BC and published in the Huffington Post on August 19, 2013

Dr. Will Johnston

Dr. Will Johnston - Vancouver BC

The Canadian Medical Association is meeting this week, and the buzz is that euthanasia and assisted suicide will be discussed. Euthanasia activists are striving to neutralize the medical opposition to their plans, and want the CMA to compromise its clearly stated principle forbidding doctors killing patients. If this principle is broken, an invasive weed will have entered our garden.

As an analogy, remember it took centuries of work to rid our society of capital punishment. Finally, we reached the point that we did not trust any system with the legal power to kill. Did we say to ourselves, "There are probably only a few innocent people executed, and one of them is very unlikely to be me... or someone I care about." ? No, the mere possibility that the law would be wrongly used -- on anyone -- was finally enough to justify a complete prohibition of the death penalty.

Moreover, it was time for the state to stop implicating itself in any killing. Why then, a few years later, are we talking about the state giving legal power to doctors to allow them to kill selected patients? Do we truly believe that those failures to protect the depressed and vulnerable under other suicide and euthanasia systems could never happen here? Do we have any idea what we would be trading for our present privilege of insisting that our doctors and nurses are not willfully implicated in any killing, ever?

The art of euphemism -- of sugar coating your verbal meaning -- has been raised to a syrupy peak by the proponents of euthanasia. When killing and suicide can be rebranded in the hearts and minds of average Canadians, the death lobby wins. What is truly being promised is the medical equivalent of a silent bullet in the head. The irony is that we don't need it. Symptom control at the end of life has never been better, and the right thing to do is to deliver it when needed. 

Most of the euthanasia advocates I have met witnessed the poorly managed death of someone close to them and so joined the nearest right-to-die lobby group. This is naive but understandable. For these activists, indignation at seeing substandard care has trumped common sense. Common sense should tell us that we and our loved ones will not be safer or more empowered when the right to kill is given to doctors and nurses, under any system that can be dreamed up.

Canadians were recently horrified by the deaths of two children when a deadly snake could not be kept caged. The suicide and euthanasia system so desperately wanted by some activists would be like that cage: The snake would not stay in it forever. We are now the fortunate inhabitants, like most people in the civilized world, of a place where euthanasia has been banned. If ever legalized, it will send its tendrils into every hospital and care facility.

With each challenge to the ban, the euthanasia promoters have only to win once. In defending itself, Canada has to win every time. The vote against euthanasia was 79% in Parliament in 2010, and it was rejected by 74% of doctors in a recent CMA poll. This should not lead to complacency. The assaults on the key medical principle will not stop. Our wisdom will need endurance.

Gallup: Support for assisted suicide fluctuates based on the wording of the question.

Support for assisted suicide in America is at a low when the question includes the word "suicide"

By Alex Schadenberg, 
International Chair, Euthanasia Prevention Coalition.

A Gallup survey conducted (May 2 - 7, 2013) found that support for assisted suicide fluctuates by almost 20% based on the wording of the question.

The survey found that: 

51% of Americans support assisted suicide when the process is described as doctors helping a patient "commit suicide" while 70% of Americans supported assisted suicide when it was described as allowing doctors to "end the patient's life by some painless means."

The report from Gallup stated:

Gallup has asked both questions of U.S. adults aged 18 and older annually since 2001, as part of its Values and Beliefs survey. This year's update was based on interviews with 1,535 adults, and each question was asked of a separate half-sample.

Gallup reported that support for assisted suicide is down in recent years. The recent Gallup poll indicated that 45% of Americans were opposed to assisted suicide, which is the highest level since the poll question began in 1996. Gallup reported that:

... current support -- with 51% of Americans in favor and 45% opposed -- is similar to that of the previous three years, and is nearly identical to attitudes in 1996. In the interim, support steadily rose to 68% by 2001 and remained above 60% through 2004, after which it started to falter.

We learned from the recent defeat of the assisted suicide referendum in Massachusetts that once people learn more about assisted suicide, they become less likely to support it. 

Polling originally indicated that people in Massachusetts supported assisted suicide. After a good campaign informing Massachusetts voters of what assisted suicide is, it was defeated.

Several years ago I attended the World Federation of Right to Die Societies Conference. The euthanasia lobby knew from polling and focus groups that changing the language of the debate and message discipline would lead to more support for assisted suicide and euthanasia. 

The Gallup survey report concluded that:

A wording that refers to the patient's intention to end his or her life as "suicide," doesn't say family members are involved in the decision, and doesn't specify that the procedure will involve "painless means" produces lower support than the alternative wording. However, the resulting difference offers important insights into the complex nature of Americans' views on this question, as well as the negative connotation suicide has, generally. Underscoring this, the same poll finds just 16% of Americans saying suicide is morally acceptable. At the same time, the public is evenly split over whether "doctor-assisted suicide" is morally acceptable: 45% say it is, and 49% say it is not.

The Euthanasia Prevention Coalition has also learned that certain language is more effective. We agree with the Gallup poll that the use of the term assisted suicide or assisting a suicide is more effective than terms like: prescribed death, aid in dying or assisted dying.

Links to previous polling information.
- Do Americans want to legalize assisted suicide?
- Canadians want good end-of-life care not euthanasia or assisted suicide.
- More Americans believe that assisted suicide is morally wrong.
- Why the assisted suicide referendum was defeated in Massachusetts.

There is no role for palliative care in providing euthanasia

The following letter was written by Dr. Manuel Borod, the director of Supportive and Palliative Care at the McGill University Health Centre in Montreal Quebec. 

This letter was published in the Montreal Gazette on January 21, 2013 under the title: There is no role for palliative care in providing euthanasia

Re: “End of life rules to be set out in new law” (Gazette, Jan. 16) 

Dr. Manuel Borod

In the reports about the proposed end-of-life legislation, there have been numerous statements that may confuse readers. 

You report that the proposed law would protect the right to refuse treatment, withdraw treatment, withhold treatment, receive palliative care — including the right to receive palliative sedation, and the right to have medical assistance in dying. The first four of these rights are already generally accepted standards of care. 

And a statement describing palliative sedation as “the process of putting a dying patient to sleep, ending feeding and artificial hydration, a procedure that ends in death” is completely misleading and false. Palliative sedation is legal, does not necessarily hasten death (as noted, the patient is dying), and on our palliative care ward, we have very specific policies and follow international guidelines as to when and how to initiate this treatment. 

The only thing new here would be to allow an act that directly causes death, and this is euthanasia. The rest is a smokescreen. 

It is an affront to all those who care for the terminally ill to refer to this act as death with dignity — it is our objective that all our patients die with dignity. It is also misleading to refer to euthanasia as medical or physician aid in dying — once again, all the physicians, nurses, psychologists, social workers, music therapists, occupational therapists, physiotherapists, spiritual care counsellors, pharmacists, dietitians, volunteers and coordinators who work with the dying patient offer aid in dying. 

This has become a political and legal issue, and the lawmakers should call this act what it really is: lawful death or legally acceptable death. 

If the legislators decide to put this act into law, they should also provide for judges and technicians to approve the request and carry out the orders. There is no role for palliative care in providing euthanasia for terminally ill patients. The proposed law calls for improving and expanding the role of palliative care. The opposite will result if palliative care and euthanasia are expected to coexist under the same roof. 

Manuel Borod MDDirector, Division of Supportive and Palliative CareMcGill University Health CentreMontreal