The language of death

THIS WEEK, California Assembly Speaker Fabian Nunez and a group of Democratic legislators will reintroduce the California Compassionate Choices Act, which would allow terminally ill patients found to be of sound mind to request medication from doctors “to provide comfort with an assurance of peaceful dying if suffering becomes unbearable.”

Like the 1994 Oregon Death with Dignity law it is based on, the California bill nowhere mentions suicide, except to say that “actions taken in accordance with this bill shall not constitute suicide or homicide.”

That clause was framed to address concerns about legal liability and life insurance benefits, but the avoidance of “suicide” is also an implicit acknowledgment of the stigma attached to the “S-word.” The choice of words makes a big difference in how people come down on laws governing the choice to die. In a 2005 Gallup survey, 75% of adults agreed that doctors should be allowed by law to “end the lives” of patients suffering from incurable diseases if the patient and his or her family requested it. But when the question was worded as permitting doctors to “assist the patient to commit suicide,” only 58% of the respondents agreed. That’s one reason supporters of the measures have shied away from talking about “assisted suicide” in favor of a battery of gentler phrases, like “aid in dying,” “choice in dying” and “end-of-life choices.”

Not surprisingly, opponents hear those phrases as Orwellian euphemisms. When Oregon’s Department of Human Services announced that it would be dropping the phrase “assisted suicide” from its website, Dr. Charles Bentz, the director of a group opposed to the Oregon law, charged that the department was “trying to take away those stinging, harsh terms that can lead to guilt. They are backing away from calling it what it is -- a suicide and an act of medical killing.”

But is “suicide” really the appropriate label here? To most of us, the word suggests fanaticism, desperation or mental unbalance. Certainly most patients who want a doctor’s help to end their lives wouldn’t qualify as “suicidal” by the ordinary definition of the term. And like other words ending in the suffix “-cide,” “suicide” has overtones of criminality or wrongdoing -- it’s an act we speak of people “committing,” like grand larceny or adultery. In fact, the Oxford English Dictionary expands its definition of “suicide” as “the act of taking one’s own life” with the synonym “self-murder.”

To some of its opponents, “murder” is just what the California bill would permit patients and their doctors to perform. But most people are reluctant to speak of suicide when the choice to die seems defensible or at least understandable, in the same way we don’t use “homicide” to describe soldiers who kill in wartime. The New York City medical examiner’s office demurred from listing suicide as the cause of death for any of the people who jumped from the World Trade Center on 9/11. They recorded the deaths as homicides, following the logic that has the Oregon law instructing doctors to list cause of death as the patient’s disease.

Then, too, to describe phrases like “aid in dying” as euphemisms isn’t necessarily to condemn them. Every culture and every age has felt the need to find words that palliate the harsh realities of death and dying. Most of the English vocabulary of death had euphemistic origins. “Cemetery” is from the Greek word for a dormitory, and until the Crimean War, “casualty” was just a word for an accidental loss.

“Execution” and “capital punishment” were introduced to distance the brutal facts of state killing. And “suicide” itself was coined in the 17th century as a more decorous name for what Shakespeare called “self-slaughter.” Some euphemisms exist to lessen a sense of culpability -- “execution” and “collateral damage,” for example. But most are what the classicist Richmond Lattimore called “the alleviations of death.” Terms like “pass away,” “succumb,” “the departed” and “fallen” serve to comfort the dying and console the living.

Phrases like “hastened death” and “aid in dying” clearly belong in the second group, even if you think they also belong in the first. Or, at least, they represent the sort of softened language anyone would choose when sympathizing with a friend whose terminally ill mother had chosen to end her life. When you’re speaking to the bereaved, compassion should always trump ideology.

But all of this creates a familiar quandary for the media and government bodies. In an age that has polarized the vocabulary of moral and political values, it can be hard to find neutral linguistic ground. Most media (including the Los Angeles Times) still speak of assisted suicide, whatever reservations people may have about the phrase. For now, anyway, items like “aid in dying” and “end-of-life choices” are simply too vague to convey the specifics of the laws to the average reader. And while a reference in an Associated Press report to “a law that allows doctors to assist in hastening the death of a patient” may be more explicit, it doesn’t exactly roll off the tongue.

Ultimately, one or another term may very well emerge from the welter of euphemisms to become the new label for these choices. It’s worth remembering that “pro-choice” and “affirmative action” were regarded as oblique euphemisms when they were first introduced, and so were “welfare,” “social security” and “free enterprise” in earlier periods.

Even if the media wind up sticking with “assisted suicide,” the terminology controversies are bound to change the way people think about the issue. From civil rights to feminism to gay rights to modern conservatism, the success of influential social movements can be measured by their power to throw our settled vocabulary into disarray.

“Separate but equal,” “ladylike,” “deviant,” “liberal” and now “suicide” -- when the old words no longer appear transparent and uncomplicated, we’re obliged to either abandon them or justify them anew, reexamining our own attitudes along the way.