Truth, Euphemism, and Physician-Assisted Suicide

Physician-assisted suicide pithily and precisely names the act of a doctor prescribing a lethal drug at his terminally ill patient’s request. However, its advocates reject this name and propose euphemisms in its place, such as “death with dignity” and “end of life option.” These amount to advertisements for the disputed practice and ought to be rejected as imprecise, inaccurate, and jargonistic.

In his classic comedy routine entitled “They Are Only Words,” George Carlin lampoons Americans’ tendency toward euphemism. He says:

You can’t be afraid of words that speak the truth. I don’t like words that hide the truth. I don’t like words that conceal reality. I don’t like euphemisms or euphemistic language. And American English is loaded with euphemisms. Because Americans have a lot of trouble dealing with reality. Americans have trouble facing the truth, so they invent a kind of a soft language to protect themselves from it. And it gets worse with every generation. For some reason it just keeps getting worse.

Carlin—who loved to read and, famously, to joke about language—offers as one example of this declination into euphemism, the succinct, accurate, almost onomatopoeic World-War-I phrase “shell shock,” which sequentially becomes “battle fatigue” (in WWII), “operational exhaustion” (in the Korean War), and finally “post-traumatic stress disorder” (“PTSD,” in Vietnam and subsequent wars). Carlin notes that as language deteriorates, terms meant to grasp and help us treat anguish—such as shell shock—become longer, more abstract, and sterile while obscuring suffering. This leads to “pain buried under jargon.” Most troubling, Carlin notes that euphemistic terminology obstructs real therapy. He plausibly claims that had “shell shock” still been in use in their era, the distress of Vietnam veterans would have been more effectively treated.

Euphemisms for Suicide

Carlin’s insights come to mind as one reflects on the current linguistic campaign against the honest phrase “physician-assisted suicide” (PAS). Of course, “suicide” originates from the Latin “sui” meaning “of one’s self” and “cidium” meaning “a killing,” hence “to kill one’s self.” As it clearly, succinctly, and accurately indicates, PAS refers to a doctor helping a patient to kill himself. Specifically, as practiced in American jurisdictions that now permit the practice, PAS refers to a physician prescribing a lethal drug at the request of a competent, adult, terminally ill patient, who would then kill himself by taking the drug. Where legal, PAS has numerous requirements. For example, the patient must be a competent, terminally ill adult; expected to die within six months; not clinically depressed; a resident of the state; and so on. Put to the side these criteria and the wisdom (or lack thereof) of legalizing PAS. Rather, consider the terms currently used to describe this act.

Advocates of PAS reject the term “suicide.” They replace it with what they describe as “value-neutral” language. In Oregon and Washington, for example, the act is named “Death with Dignity.” If there is value-neutral language (surely a dubious claim concerning the taking of human life), would the phrase “death with dignity” serve as an example of value-neutrality? It seems not. Indeed, “dignity” (itself meaning “worthy”) applies to humans as having a special kind of value. Hence, “death with dignity” is not at all a value-neutral phrase. Rather, it is an advertisement, a promotion, a sanctimonious sales-pitch. The label refers to the specific act of ending one’s life by taking a lethal drug provided by one’s physician too generically. Whether or not that option instances a dignified death, the wording does not adequately capture the referent. It is too inclusive—like the famous slothful definition of “tree” as a “thing well known.”

The quest for so-called value-neutral language doubly merits suspicion: first, insofar as the search itself serves as a pretense for cloaking in objectivity the to-be-discovered terms; and, second, insofar as the loss of human life demands value-laden language, or better, truthful language, as the word “loss” illustrates—from the Old English los, meaning “ruin” or “destruction.”

Many who would never contemplate taking a deadly drug at the end of their lives hope to die in a manner they regard as dignified. Who would not want so to die? Who, however, would be so tendentious as to suggest—as do those who propose this descriptor—that for patients similarly situated to those who resort to PAS, taking a deadly drug alone constitutes a dignified death?

What of California’s “End of Life Option”? Here one observes a number of features that Carlin identifies in the descent into euphemism. First, we have the multiplication of words: we began with three and moved to four. Yet do we enjoy greater clarity?—Clearly not. Indeed, we have replaced that which all understand with an expression that can only raise a question: Which option? In addition to the increase in the number of words one also encounters the American propensity for what Carlin calls “soft language.” Taking one’s life is an “option”: something that one can opt for, something optional.

In both “death with dignity” and “end of life option,” we find the cushioning, to which Carlin refers, that attempts to shelter us against the hard edges of the human condition. Instead of truthfully asking if one wants a doctor to help kill one’s self (using language fit for adults), by circumlocution we ask if one wants the end of life option or to die with dignity (as if we were speaking to a child). These phrases make nonsense, fantasy, and magic of the actual, dreadful question before us. Indeed, they serve as answers to it, as those who fabricate them intend. Here we encounter the only slightly veiled attempt at marketing that underlies these jargonistic, childish terms.

Euphemism as Advertisement

This terminology of “with dignity” and “option” suggests consumption—as one would order a hamburger, “with fries”; or a car, “with all the options.” The U.S. being in large part a consumer society, it is prone to refer to death as something that one orders, as if one were checking a box on a form. Thus, by way of false advertising, we transform death into something consumable, rather than that which undoes us. Since the customer is always right, one tells one’s physician: “End of life option, please. Thank you.”

As G. K. Chesterton notes, modernity resorts to euphemism as a commercial promotion:

There is in the very titles and terminology of all this sort of thing a pervading element of falsehood. Everything is to be called something that it is not. . . . Everything is to be recommended to the public by some sort of synonym which is really a pseudonym. It is a talent that goes with the time of electioneering and advertisement and newspaper headlines; but whatever else such a time may be, it certainly is not specially a time of truth.

The search for supposedly value-neutral synonyms to replace “physician-assisted suicide” amounts to market research for the best brand name. As far as its advocates are concerned, however, actual value-neutral terms (if there were such terms for such matters) definitely will not do; for as Chesterton perceptively observes:

Publicity must be praise and praise must to some extent be euphemism. It must put the matter in a milder and more inoffensive form than it might be put, however much that mildness may seem to shout through megaphones or flare in headlines. And just as this sort of loud evasion is used in favour of bad wine and bad milk, so it is used in favour of bad morals. When somebody wishes to wage a social war against what all normal people have regarded as a social decency, the very first thing he does is to find some artificial term that shall sound relatively decent. He has no more of the real courage that would pit vice against virtue than the ordinary advertiser has the courage to advertise ale as arsenic.

Just as no one would market ale as arsenic or propose to replace actual therapy with a doctor’s giving a patient a deadly drug, so also boosters of PAS cannot bring themselves to speak of what they tout. For the taking of one’s life is not decent, not wholesome, and not to be lauded. Nor is helping another do the same. Moreover, we all know these and allied truths as among the first things that we ever knew. We duly avoid death throughout our lives, and we appropriately and assiduously preserve our lives and advise others to do likewise. Hence, a wink and a nod of tacit understanding accompany evasions such as “death with dignity” and “end of life option.” We all know that of which we—(sotto voce) “do not!”—speak.

As Carlin trenchantly advises us, we should “not be afraid of words that speak the truth.” Rather, we should find “simple, honest, and direct language.” Only after having done so can we adequately debate the ethical, legal, and political wisdom of prohibiting or removing the prohibition of a physician’s prescribing a lethal drug at his patient’s request. Otherwise, we run the risk of drinking arsenic as if it were ale, while burying who knows what suffering under jargon unfit for animals capable of truthful speech.

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