The euphemistic language for killing.

This article was published by the British Medical Journal blog on January 31, 2025.

David Albert Jones

By David Albert Jones
Director of the Anscombe Bioethics Centre

‘When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

‘The question is,’ said Alice, ‘whether you can make words mean so many different things.’

My article in the Journal of Medical Ethics is about the words ‘assisted dying’. I argue that the term is problematic not principally because it is euphemistic, which is true of many terms for controversial practices. The a key problem is that ‘assisted dying’ is ambiguous and hence the words are used inconsistently.

‘Assisted dying’ is best understood as an umbrella term for a doctor ending the life of a patient at the patient’s request (voluntary euthanasia) or a patient ending their own life with means provided by a doctor (physician-assisted suicide), for patients who may or may not be terminally ill.

In contrast, the term is also used, especially in the United Kingdom, with certain further stipulations, for example, only for physician-assisted suicide of adults with a terminal illness.

A good example of the confusion that follows is a BBC website article where it is stated that ‘assisted dying generally refers to a person who is terminally ill receiving lethal drugs from a medical practitioner, which they administer themselves.’

But later, in the same article, it is stated that ‘more than 200 million people around the world have legal access to assisted dying’. A link is provided to a map created by the British Medical Association, showing, ‘Physician-assisted dying legislation around the world’ (which is generally accurate except it mistakes France for Spain).

In most of the countries in this map, however, ‘physician-assisted dying’ is not limited to assisted suicide of someone with a terminally illness. Some countries also include euthanasia for those with terminal illness (as in Australia and New Zealand) or assisted suicide for those without terminal illness (as in Switzerland and Austria) or both assisted suicide and euthanasia for people without terminal illness (as in Canada, Belgium and the Netherlands).

In fact, only one country in the world, the United States, confines ‘assisted dying’ to assisted suicide for someone with a terminal illness, and this only in the 10 states (plus DC) where it is legal.

Contrast ‘medical aid in dying’ which was legalised in California in 2015, with ‘medical assistance in dying’ which was legalised in Canada in 2016. The first denotes assisted suicide by a patient who is expected to die within six months. The second, overwhelmingly, denotes euthanasia of someone whose death is ‘reasonably foreseeable’, without any specific timeframe. In 2021 the Canadian law was expanded to cover people whose death is not ‘reasonably foreseeable’, but already the law was very loose. The rate of assisted death in Canada is around ten times that in California. However, the great differences of practice in these two countries are obscured by the use of similar terminology.

In Australia, the law has expanded as successive states have legalised ‘voluntary assisted dying’. In 2017, Victoria permitted euthanasia only if someone was not physically capable of assisted suicide, and restricted eligibility to expectation of death within 6 months, except for people with neurodegenerative diseases. In 2021, Queensland allowed doctors to offer euthanasia at their discretion and set the time limit at 12 months. In 2024, the Australia Capital Territory gave patients a free choice of euthanasia or assisted suicide and gave no timeframe for expectation of death. The law in Australia has changed rapidly, coming to resemble that of Canada, but has kept the same language of ‘voluntary assisted dying’.

It may be that the Terminally Ill Adults (End of Life) Bill, currently in Committee Stage in the UK House of Commons is, at this stage, closer to Oregon than to Canada. However, the example of Oregon is not so reassuring as sometimes thought and the example of Australia shows how the language of ‘assisted dying’ can easily expand further to apply to a wider range of cases. Claiming that ‘assisted dying’ is only, or primarily, or generally, restricted to assisted suicide for terminal illness does not reflect the ordinary use of the term. What is more, such linguistic stipulations will not prevent the practice expanding over time under cover of this ambiguous term.

In my paper I show that, while the term ‘assisted dying’ is increasingly prevalent, ‘assisted suicide’ remains the more common term in the scholarly literature. It has the great virtue of clearly distinguishing this practice from euthanasia, with its higher rates of death and more serious abuses. The example of Australia shows how, once permitted, a shift can occur in ‘assisted dying’ from euthanasia being allowed only in exceptional circumstances to it becoming the norm. It is surely better to acknowledge that the practice being proposed is ‘assisted suicide’ than to obscure this with ambiguous language and, by doing so, perhaps open the door to euthanasia.