On the use of language. Assisted Suicide or Medical Aid in Dying?

Gordon Friesen

By Gordon Friesen
President: Euthanasia Prevention Coalition

What's in a name ?

"That which is called a rose by any other name would smell as sweet"

Thus runs the amazingly fertile thought of the single most quoted speaker of the English language. And within the context of Romeo's love for Juliet we are happy to approve.

However the exact correspondence of words to their objects is crucial to coherent thought, and doubly crucial when those words are found in written texts of law.

When two words are assumed to refer to the same object, but actually point to different things, we have a problem. And when one key word is legally enshrined, and charged with marking the limits of stable policy --but is none-the-less in a state of dynamic flux-- we have another.

Sadly, with "Assisted Suicide" and "Medical Aid in Dying" (and indeed with all of the terms surrounding the assisted death debate) we have both of these problems in spades.

Voluntary euthanasia drops its defining adjective

All the way back to the beginnings of modern euthanasia discussion (1870)[1] it has been commonly understood that our subject is the voluntary death, of a dying patient in unbearable suffering, at the hands (or with the help) of his or her doctor. This is what the public believes, and this is the basis on which the results of polls and votes have been consistently returned.

However, recent changes in vocabulary are by no means accidental, and by no means innocent. The new words do not have the same meaning. Most importantly, without any widespread understanding, the "thing" we are discussing has changed dramatically. And the most dramatic change lies in the progressive removal of the requirement that any such death be "voluntary".

To demonstrate this change, one common theme in the semantic component of the assisted death debate concerns a vigorous (even indignant) rejection of the word "suicide", under the charge that it's use is pejorative and disrespectful to those who avail themselves of a doctor's assistance to die.

And yet the most common definition of suicide ("an instance of taking one's own life voluntarily and intentionally") is no more than a technical description of fact.

Similarly, the time honoured term "voluntary euthanasia", is no longer anywhere in use at this time. The last instance I am aware of occurred in the pivotal Canadian Supreme Court "Carter" case, where it was decided that a complete ban on all forms of assisted death was not compatible with Canada's Charter of Rights and Freedoms. During that trial, counsel representing the litigants used the then novel term "Medical Aid in Dying".

When challenged to show how the meaning of that phrase (as defined in that trial) differed from the old term "voluntary euthanasia", it was grudgingly admitted that there was no difference.

However, in hindsight, that answer was either disingenuous, or ill informed. For the practice of "Medical Aid in Dying" has now departed considerably from "voluntary euthanasia", not in detail, but in the fundamental character of its voluntary nature. For MAID, if rigorously admitted as a true medical procedure, can not be fundamentally voluntary. And, indeed, MAID as currently practised, does not (necessarily) require even capacity to consent, let alone voluntary intention.

For that is the true meaning of "medical aid in dying" as it is now evolving in practice: not an "option" to autonomously request and self-administer lethal substances, exercised by fully competent individuals at the extreme end of life (as the context is still so carefully delimited to this day), but entirely differently... a standard medical response to suffering in virtually any circumstance whatsoever.

Certainly the practice in Canada, Belgium and the Netherlands, where patients are now euthanized as infants or young children, as demented adults (with advance directives), and for mental illness as sole underlying condition (including even for drug addiction),[2] would suggest this as the logical direction of policy.

It would appear, then, that the abandonment of assisted (or physician assisted) "suicide" and "voluntary euthanasia" for the umbrella term "medical aid in dying" is simply the linguistic component of what remains (for many) an unsuspected --but radical-- shift in real policy.

This, to be clear, is precisely the meaning of claims that ingesting poisons under a doctor's supervision is "not suicide". The affirmation is that there is something else, "something" requiring a different name, which is neither "assisted suicide" (where the voluntary nature of the act is inherent to the definition) or "voluntary euthanasia" where the word "voluntary" is actually part of the literal term employed.

It is, in sum, precisely the excision of this voluntary component which is the key to substituting the term "medical aid in dying".

Endnotes:

[1] Popular Science Monthly/Volume 3/May 1873/Euthanasia https://en.wikisource.org/wiki/Popular_Science_Monthly/Volume_3/May_1873/Euthanasia accessed Nov 10, 2023

[2] Canada Will Legalize Medically Assisted Dying For Eligible People Addicted to Drugs, vice.com, Manisha Krishnan,October 19, 2023 https://www.vice.com/en/article/4a3bdm/canada-will-legalize-medically-assisted-dying-for-people-addicted-to-drugs accessed Nov 10, 2023