In the Debate Over Physician-Assisted Suicide, Words Matter

On May 10, 2018, noted botanist Dr. David Goodall took his own life as Beethoven’s ninth symphony played in the background. At the age of 104, he was dejected and exhausted, weary of the constraints his advanced age imposed on life. After traveling from Australia to Switzerland, he bade his family goodbye, then fielded questions from the press. When he was ready, he self-administered a lethal dose of barbiturate prepared by a licensed physician.

Headlines called this unsettling case a “physician-assisted suicide” (PAS), and few could argue with the label. Although his impressive age meant death was near, Dr. Goodall died not from disease, but from an infusion triggered with the push of a button, and with medical professionals standing by.

Nicer Word for Death

In the handful of U.S. states where it’s legal, the self-administration of medications to speed death is called “medical aid in dying.” Unlike Dr. Goodall’s Swiss case, these deaths require proof of terminal illness. But the softer language has profound implications. Not only does it normalize an immoral practice, it also muddies the already confusing waters of medical care for those grappling with tough decisions at the end of life.

The choice of terms is deliberate. In 2008, the American Public Health Association released a statement in which they distinguished the term “suicide” from “the choice of a mentally competent terminally ill patient to seek medications to bring about a peaceful and dignified death.”

PAS advocates argue that the label “suicide” is offensive and stigmatizing to those considering “dignity in an already impending exit from this world.” They assert that terminal illness, not suicide, kills people who request a doctor’s assistance to end life.

Unfortunately, studies confirm that gentler terminology sways public opinion. Since 2002, 51 percent to 68 percent of Gallup survey respondents have voiced support for physician-assisted suicide. When the question has excluded the word “suicide,” however, favor consistently increases by up to 15 percentage points. And up to 69 percent of those favoring it self-identify as regular churchgoers.

When a tweak in semantics shifts support for a life-and-death issue, we need to pay attention.

Instrument of Death

Muted language doesn’t change the fact that in cases of physician-assisted death, demise is artificially—and intentionally—hastened. This is true even while terminal illness broils in the background, and even when the death’s purpose is to alleviate suffering.

Anguish afflicts those with terminal illness, and we minister to our dying neighbors in tenderness (Matt. 22:39; John 13:34–35). But when an infusion of barbiturate floods the veins of a dying person, that lethal dose of drug, not disease, is the instrument of death.

Physician-assisted suicide violates our call to love both God and neighbor, and we can’t erase its dangers with a turn of phrase.

The American Medical Association, which opposes PAS, recognizes this distinction, and retains the terminology “physician-assisted suicide” in its code of ethics. Moreover, Scripture points us to the sanctity of mortal life, and to our imperative as God’s image-bearers to protect life and commit our days to his glory (Gen. 1:26; Ex. 20:13; 1 Cor. 10:31; Rom. 14:8; Acts 17:25).

Physician-assisted suicide violates our call to love both God and neighbor, and we can’t erase its dangers with a turn of phrase.

Death by Any Other Name

For years as a critical care surgeon, I “aided in dying.” When medicine couldn’t cure and death crept near, I titrated morphine drips to ameliorate pain and air hunger. I held the hands of the dying, some flushed with infection, others cool, as if their souls were already speeding away.

Few would equate this care with interventions to speed demise. Yet for the layperson, the mangled terminology of PAS worsens confusion surrounding end-of-life care, especially regarding palliative care and hospice.

Palliative care supports people through life-threatening illness, and by definition does not intend to hasten death. Its benefits for patients and families are numerous and include improved quality of life, less post-traumatic stress disorder among loved ones, and in some cases improved survival.

However, stigma already steers many away from palliative care, and the vague phrase “medical aid in dying” threatens to worsen that trend. Advocates of PAS are quick to claim that the practice has improved palliative care in Oregon, but a careful review of research refutes this argument.

Dr. Warren Fong, president of the Medical Oncology Association of Southern California, writes, “There’s a really big misconception about what hospice is, and this whole suicide debate has worsened that misconception. When people go on hospice, they [mistakenly] think, ‘I’m giving up, I’m failing my family. I’m committing suicide.’”

The Canadian Society of Palliative Care Physicians raises similar concerns:

Palliative care physicians provide medical aid in dying every day. The terms “assisted dying,” “physician assisted dying,” and “assisted death” are imprecise and ambiguous, and therefore potentially harmful. The essential concept is that of hastening or accelerating death. If patients believe that assisting in dying is the same as hastening death, then palliative care becomes a threatening option.

True Aid for the Dying

Above all, softening language about PAS ignores the disturbing problem that compels the terminally ill to hasten death. The most common reason that people pursue PAS isn’t intractable pain, but loss of independence.

Diminished autonomy, an inability to engage in cherished activities, and loss of dignity far surpass pain as a motivator to end life. Perhaps, rather than blanketing the issue with innocuous words, we should focus on our neglect of the infirmed.

As believers, we’re called to care for those afflicted with severe illness (Matt. 25:36–40). What’s more, we can point one another to Christ’s promised renewal: one that endures even when our bodies twist and warp, and when crippling disease drains away hope (1 Pet. 1:3).

Christian love mandates that we see physician-assisted suicide for what it is—and isn’t. It requires us to care for the terminally ill, and to reaffirm their dignity as image-bearers of God. We ought to love one another so well that an imposed death, no matter its name, never seems the right answer.