Noreen O’Carroll
mercatornet.com
Dr Noreen O’Carroll is a lecturer in medical ethics at RCSI University of Medicine and Health Sciences.
The lower house of the Irish Parliament, the Dáil Éireann is currently considering the “Dying with Dignity Bill 2020”. The most striking feature of this bill is that it does not mention the words “assisted suicide” or “euthanasia” in any of its qualifying criteria or provisions but instead uses expressions and phrases such “assistance in dying”; “the prescription of substances which can be orally ingested”; “prescribing and providing the means of self-administration”; and “the substance or substances may be administered”.
Language matters. It can persuade us to buy products when they are labelled and packaged attractively. It can also shape people’s attitudes and approaches to controversial issues and questions. Assisted suicide and euthanasia are labelled and packaged attractively in the Dying with Dignity Bill through the use of euphemistic terms that obscure important ethical and empirical distinctions. But they are very influential in swaying public opinion in favour of assisted suicide and euthanasia.
Euphemisms designate something unpleasant by a milder term. In the bill euphemisms operate by dissociating language from the experience of reality and putting something illusory in its place instead.
What’s in a Name?
This can be seen in the title and provisions of the bill. The title is quite misleading. By using the euphemism “dying with dignity” it dissociates the choice to take one’s life intentionally, or have one’s life ended deliberately by a healthcare professional, from the experience of “suicide” or “euthanasia”, which is what the bill’s provisions are about.
This is a cause of considerable distress to all who have lost a loved one who died naturally with dignity, because it implies that a death with dignity is only achieved by assisted suicide or euthanasia.
It has been suggested that the rationale for using euphemistic language in the bill is to better reflect the wishes of patients with terminal illness whose desire is for a death with dignity. However, legislation doesn’t apply to patients only; it also affects others – doctors, nurses, families, communities and society as a whole.
A more linguistically appropriate title for the bill is, arguably, the “Assisted Suicide and Euthanasia Bill”.
The provision for assisted suicide in Section 11 of the bill is expressed in language stating that a medical practitioner may prescribe or provide a substance or substances which can be orally ingested or self-administered by a person; or prepare a device which will enable that person to self-administer the medicine, “with the purpose of enabling that person to end his or her own life”.
The euphemisms “orally ingesting” and “self-administration” dissociate the idea from the reality of the experience of committing suicide by ingesting or self-administering lethal medication prescribed or provided by a doctor or nurse; the definition of terms in Part 1 of the bill states that an “assisting healthcare professional means a registered medical practitioner or a registered nurse who has been authorised by the attending medical practitioner to deliver any substance or substances prescribed”. In this situation, the patient is the direct causal agent ending his or her own life.
Absent Words
The absence of the words “suicide” and “assisted suicide” is striking. The provision for euthanasia in Section 11 of the bill is also expressed euphemistically, stating that in the case that it is not possible for a person to self-administer, “then the substance or substances may be administered” – and this too is qualified by the phrase “with the intention of enabling the person to end his or her own life”.
This is less than honest. Obviously, if the patient is unable to self-administer and the substances may be administered, then clearly someone else is involved. Who? The identity of the healthcare professional who euthanises the patient is disclosed in Section 11 (6) as either “the attending medical practitioner or the assisting healthcare professional”, who can be either a doctor or a nurse. The doctor or nurse is legally obliged to remain with the person “until the person has self-administered the substance or substances or have it or them administered”. This situation is one where the doctor or nurse is the direct causal agent who ends the patient’s life.
Couched in euphemistic language, this is euthanasia and specifically voluntary euthanasia when it is done at the request of the patient. The idea conveyed in the words “the attending medical practitioner or assisting healthcare professional must remain with the person until the person has self-administered the substance or substances or have it or them administered” (my emphasis) is dissociated from the experience it is intended to convey – of one’s life being ended deliberately through the administration of a lethal substance by a doctor or a nurse. The absence of the words “euthanasia” and “voluntary euthanasia” is striking.
Conscientious Objection
The provision for conscientious objection in Section 13 of the bill obliges medical practitioners who do not want to participate in ending the life of a patient to make arrangements “for the transfer of care” of the patient to another medical practitioner.
“The transfer of care” is a euphemism for compelling a doctor who does not want to co-operate in ending a patient’s life intentionally to send the patient to another doctor who will do so. This is a travesty of genuine conscientious objection, because it compels doctors to be complicit in acts they believe to be morally wrong and unjustifiable.
When Is Suicide Not Suicide?
When he introduced the bill in the Dáil, Mr Kenny argued that “assisted dying” should not be conflated with suicide and that a terminally ill, mentally competent patient who wants to end their life is not suicidal. He said: “I take exception to conflating this with suicide. People with a terminal illness are not suicidal”.
At the second stage, when the government proposed referring the Dying with Dignity Bill 2020 to a special Oireachtas committee to consider the legislation and report back within a year, he referred to “assisted suicide” but that it was irresponsible to conflate assisted dying with suicide, which had very different connotations.
However, it is a distortion of language to suggest that someone who takes their own life with assistance from a doctor is not suicidal.
The word “suicide” means to kill oneself, derived from Latin, sui (of oneself), and caedo (to kill). The words infanticide, homicide, parricide and gendercide derive from the same root. To suggest that someone is not committing suicide when they take their own life with assistance from a doctor flies in the face of the word’s meaning.
Ireland has a national suicide prevention strategy, Connecting for Life, published jointly by the Department of Health, the HSE, the National Suicide Prevention Office and Health Ireland. This defines the word “suicide” and its cognates in fidelity to its root meaning of “to kill oneself”: “Suicide is death resulting from an intentional, self-inflicted act”. The foreword to the strategy states: “Suicide prevention is everybody’s concern. This national strategy sets out what we must do as a government and society to protect and save lives. Since suicide is a ‘whole-of-society’ issue, we’re taking a ‘whole-of-government’ approach….”
One wonders whether the 81 TDs who voted to progress the Dying with Dignity Bill 2020 have ever heard of, or read, Ireland’s national suicide prevention strategy.
Remarkably, in his Dáil speech Mr Kenny did not make any reference to the bill’s provision for voluntary euthanasia. Yet there is a world of difference between a person committing suicide with assistance from a doctor or nurse, and that person having his or her life ended by a doctor or nurse following a request to do so. The World Medical Association defines the former as “assisted suicide” and the latter as “voluntary euthanasia”.
The use of euphemistic language in the Dying with Dignity Bill 2020 is in line with what is happening in other jurisdictions.
In the United States, where assisted suicide has been legalised in some individual states, the legislation is given titles such as Death with Dignity Act (Oregon, Washington State, Washington DC, and Maine); Patient Choice and Control at the End of Life (Vermont); End of Life Option Act (California), Our Care Our Choice Act (Hawaii); Aid in Dying for the Terminally Ill Act (New Jersey). In Canada the criminal code was amended to include “Medical Assistance in Dying (MAID)”, legalising assisted suicide and euthanasia. In Australia the states of Victoria, Western Australia and Tasmania have all passed Voluntary Assisted Dying laws making assisted suicide and euthanasia available.
This article is an excerpt from “Assisted Suicide, Euthanasia and the Dying with Dignity Bill 2020” by Noreen O’Carroll, an article published in the Summer issue of the Irish journal Studies.
