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| 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.
7 comments:
I prefer the term,"Murder".
Although it may seem odd, I disagree with this analysis. When David Jones says the following:
"‘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."
he is apparently subscribing to the view that assisted suicide and euthanasia are different enough to treat them differently in general discussion. However, this causes a real problem for people in places like Canada where we are dealing with euthanasia, not assisted suicide.
In fact, the most important insight we bring from Canada is that assisted suicide is essentially the same as euthanasia and will inevitably morph into that practice over time. If we discriminate too closely between the two, people will just ignore Canadian experience. Worse still, it gives cover to activists in the USA (and UK etc.) attempting to pass entry level assisted death laws, with the full intention of moving later to actual euthanasia. Tragically, however, we often see people, even on our side, who believe Canadian experience is irrelevant to their debates.
Better, I think, is to call all forms "assisted death", in the same way we understand that all alcoholic beverages are some kind of booze. Naturally beer is different from wine, and both are different from hard liquor, but they are all essentially the same in a very meaningful way.
As for our coalition, I believe in confronting "assisted death" we are signalling that we hit all the bases. In fact, that is what the term assisted death is for (as Mr. Jones correctly states in beginning his article) -- an umbrella term to contain both assisted suicide and euthanasia.
To say we must return to speaking of only one at a time makes our task more difficult in designing coordinated messaging which can stand in all countries.
So (long story short) if the subject is only assisted suicide in a particular jurisdiction at this time, it is still worthwhile to use the term "assisted death", because it signals to people that assisted suicide is only a toe in the water for something greater.
I believe Mr. Jones linguistic point is off base. There is a real need for some umbrella term like assisted death.
Call it Assisted suicide, Assisted death, murder, killing… I am just hoping we don’t reach the point as we do with abortion of people getting into serious trouble for calling a spade a spade as a French TV network did who correctly described abortion as a leading cause of death. Just let’s hope we never reach that point with assisted death (or assisted suicide or murder) whatever term you prefer we need to fight tooth and nail to stop it from happening at all.
How about “medical killing”? -- Thomas Lester
I agree 100% with calling a spade a spade. And yes, in public debate we are already at the point where using the word suicide is condemned to the point where speakers before government reviews, or the writers of serious articles will be entirely discounted for using it. Murder, is just impossible to use. However, we know the truth. And by speaking to the people, we may, I believe, eventually turn the tide on this. In the end, politicians and academics are paid by the people. They are not paid to insult and belittle our convictions.
We have their food bags in our hands.
That said, in academic debate, I think we should push this distinction of Lester's "medical killing", because it is separate from a libertarian "right to die". Hard core right to die activists believe that anybody should be allowed to choose to die, for any reason, at any time.
I don't agree with that, of course, but (as we are learning in Canada) medical killing is even more pernicious, because the pretense in that case is that people suffering from medical conditions have a special, reasonable, motivation to die. It therefore becomes normal to suggest that such people die. To believe that they SHOULD die. And as we see in Canada, a medical system tooling up to do just that as efficiently as possible.
In fact, the basic right to die folks believe that mental competence is absolutely necessary to the proper exercise of such a right, but the medical killing folks are setting their sights on the incapable as well.
So let us agree among ourselves that this is homicide, and let us combat it in the most articulate way we can, in language that ordinary people understand, and also, at the government and academic level, using whatever terms we must (in order to get through the door).
The main thing is to continue our work of opposition. Bring ordinary people on board. Democratically move the goal posts on what our would-be rulers can get away with in suppressing ordinary language, ordinary feeling, and common sense.
Thank you for reminding us of that.
Folks, To Be Honest With Ourselves & Everyone Everywhere The REAL NAME FOR ASSISTED SUICIDE & EUTHANASIA IS "SUPPORTERS OF KILLING & KILLERS & DOING SO IN SUCH A WAY THAT IS NOT ONLY ABUSIVE BUT EVIL, CRUEL, INHUMANE, UNNATURAL, UNLAWFUL, UNETHICAL, IMMORAL, AND TRYING TO DISGUISE AND LIE & DECEIVE BY TRYING TO MAKE IT LEGAL JUST BECAUSE MONEY IS INVOLVED AS A BRIBE FROM A THIRD-PARTY (i.e.: DONATIONS, DONORS, GOVERNMENT, PHARMACEUTICAL-GARBAGE-MAKING COMPANIES, etc...)
Thank you Ms. Rules, great comment.
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