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  • Paul Stark

Why assisted suicide advocates say suicide isn't suicide and intentional killing is 'aid in dying'

Several states have made it legal, in specified circumstances, for a doctor to prescribe a lethal drug overdose so that a patient can intentionally cause his or her own death. The term for this kind of act is assisted suicide.

But Compassion and Choices (C&C), the primary organization advocating its legalization, is deeply concerned about language. It vigorously denies that assisted suicide is "suicide" or "assisted suicide." It says that it is, instead, "medical aid in dying."

"Factually, legally and medically speaking," the group claims, "it is inaccurate to equate medical aid in dying with assisted suicide." Really?

Merriam-Webster defines suicide as "the act or an instance of taking one's own life voluntarily and intentionally." A medical dictionary defines suicide as "the act of taking one's own life" and defines physician-assisted suicide as "voluntary termination of one's own life by administration of a lethal substance with the direct or indirect assistance of a physician."

The American Medical Association says physician-assisted suicide is "when a physician facilitates a patient's death by providing the necessary means and/or information to enable the patient to perform the life-ending act (e.g., the physician provides sleeping pills and information about the lethal dose, while aware that the patient may commit suicide)."

Suicide is intentionally ending one's own life. And assisted suicide is when someone else assists. There's no ambiguity here.

So is the practice in question "assisted suicide"? Yes, by definition, unequivocally. Assisting in suicide is assisted suicide. How on earth can C&C claim otherwise?

The group seems to offer two main arguments. First, it notes that laws authorizing assisted suicide expressly state that "actions taken in accordance with [the law] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law."

All this means, though, is that a handful of state laws, through the influence of C&C itself, have declared that the assisted suicide specifically authorized in the law cannot legally be considered "assisted suicide." This exempts it from the legal prohibition on the practice.

That deceptive terminology choice doesn't change reality. But it does make it easier for C&C to get the laws enacted in the first place.

Second, C&C argues that people who die from the practice it advocates are psychologically different from people who die from suicide. Unlike the victims of suicide, C&C says, "people who seek medical aid in dying want to live but are stricken with life-ending illnesses." That's why it's "aid in dying" rather than "suicide."

But is there actually such a difference? With regard to regular (non-assisted) suicide, "most people who seriously consider suicide do not want to die," explains WebMD. "Rather, they see suicide as a solution to a problem and a way to end their pain." The same is true of people who die by assisted suicide.

According to state health department reports, individuals who opt for assisted suicide worry about reduced autonomy, inability to participate in certain activities, perceived loss of "dignity," and feeling like a "burden" on others. (Physical pain is generally not a concern.) Some of them suffer from clinical depression, as a study of Oregon patients in the British Medical Journal found. (Indeed, assisted suicide patients hardly ever undergo a psychiatric evaluation before receiving the lethal prescription.)

In all cases, those who die by assisted suicide—like those who die by non-assisted suicide—feel that self-killing is the solution to a problem.

Even if C&C were correct in its psychological distinction, however, the definition of suicide includes no such qualification. Suicide is simply the taking of one's own life. So C&C is employing a redefinition of suicide. It's not the dictionary definition, or the medical definition, or our society's definition. It's a redefinition that C&C is using so that it can claim it is talking about something other than a type of suicide.

What about C&C's own terminology? In place of assisted suicide, the organization substitutes "aid in dying." This is a textbook euphemism. "Aid in dying" suggests helping someone through the dying process. It does not suggest helping someone intentionally cause his or her own death with poison. It does not suggest killing. Yet that is what C&C uses the term to mean.

"'Physician aid-in-dying' makes it sound like giving someone a lethal drug is an extension of hospice and palliative care. It is not," observes Dr. Ira Byock, a Dartmouth professor and director of the Providence Institute for Human Caring. "As a palliative care physician I aid people in dying by treating their symptoms and supporting them through the difficult practical and emotional tasks of completing their lives. In more than 35 years of practice I have never once had to kill a patient to alleviate the person's suffering."

The unwillingness of C&C to let words mean what they mean should make us very skeptical of its agenda.

There is, after all, an obvious reason why assisted suicide advocates use misleading euphemisms. The reason is that everyone knows suicide is bad. Everyone knows suicide is tragic. It's bad and tragic because the life of a person matters regardless of circumstance and regardless of condition.

There has to be—and there is—a better way than the choice of death.

This article appears in the March 2018 issue of NRL News.

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