PeterUbel

The Centers for Disease Control and Prevention defines suicide as: “Death caused by self-directed injurious behavior with any intent to die as a result of the behavior .” The Merriam-Webster dictionary defines it as: “the act or an instance of taking one’s own life voluntarily and intentionally especially by a person of years of discretion and of sound mind.” By both of those definitions, the act of a terminally ill person ingesting an overdose of pills with the intention of ending their life would qualify as suicide.
To that extent, Kathryn Tucker, in her response to my earlier post, was wrong to characterize my use of the term “physician assisted suicide” as being “inaccurate.”
Instead of the word “assisted,” she prefers the word “aid.” But logically and technically, I cannot see a difference between “physician assisted suicide” and “physician aid in dying.” Nor do I see a moral difference. As I pointed out in my post, I have been a long time supporter  of people’s rights to end their lives when they are suffering from terminal illnesses, and of the appropriateness of physicians helping them do this.
But Tucker made some outstanding points in her essay, ones I am very grateful to have learned from, and ones that are very much in the spirit of my original post. She points out that the way people perceive words matters, separate from the specific definition of those words. She points out that the word “suicide” is stigmatized. Many, perhaps most, acts of suicide are the acts of people who are not in their right state of mind. Most of us physicians are trained, correctly, to see suicide as a warning that a patient needs help, and to treat suicide as something to prevent rather than assist in.
I cannot dispute when a terminally ill person says that describing them as suicidal is “disrespectful and hurtful.” But I can tell you this. I did not use the word suicide with any intention to be disrespectful or hurtful. The goal of my essay was to point out that it’s a mistake to equate a person ending their own life with the concept of dignity. It can also be dignified not to end one’s life. It can be dignified to fight all the way to the end, with the most aggressive possible care. It can be dignified to enroll in hospice care, and die naturally without taking any substances that hasten one’s end. And yes, it can be dignified for a terminally ill person to take control over their own destiny, and ingest medications that end their life.
Thanks to Kathryn Tucker, I will not use the phrase physician-assisted suicide again, except to make sure people understand that the phrase carries connotations that are unnecessarily pejorative.

The below post is a response to my article Death With Dignity Should Not Be Equated With Physician Assisted Suicide by Kathryn L. Tucker, JD. My own thoughts on her response are here.

In a Forbes.com oped, “Death With Dignity Should Not Be Equated With Physician Assisted Suicide, Duke University physician Peter Ubel writes: “I think it is wrong-headed to equate assisted suicide with the concept of a dignified death.”
Dr. Ubel’s use of the inaccurate, value-laden term “assisted suicide” to describe a terminally ill patient’s choice to shorten a dying process that the patient finds unbearable – as some journalists also wrongly do – is concerning. Words matter.

Medical, health policy and mental health professionals recognize that the term “assisted suicide” is inaccurate, biased and pejorative in this context. Increasingly, these organizations have adopted the more accurate and neutral term “aid in dying” to refer to this choice.
The nation’s largest public health association, theAmerican Public Health Association, adopted a policy supporting aid in dying, recognizing  that: “the term ‘suicide’ or ‘assisted suicide’ is inappropriate when discussing the choice of a mentally competent terminally ill patient to seek medications that he or she could consume to bring about a peaceful and dignified death.” The policy emphasizes: “the importance to public health of using accurate language.” The American Medical Women’s Association has adopted similar policy, as have a number of other national medical organizations.
A growing number of states, including Oregon, Washington, Montana,Vermont and Hawaii, permit mentally competent, terminally ill patients to obtain medications they can ingest to bring about a peaceful death if their suffering becomes unbearable. The Oregon, Washington, and Vermont lawsclearly state: “Actions taken in accordance with [the Act] shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide, under the law.”
Terminally ill patients do not want to die but are facing an imminent death, most after long efforts to cure their illness and heroic efforts to palliate symptoms. Despite excellent pain and symptom management, some find the dying process unbearable and want to achieve a peaceful death. Patients who can choose aid in dying do not consider that they are committing “suicide,” and find the suggestion that they are deeply offensive, stigmatizing and inaccurate. Many have publicly expressed that the term is hurtful and derogatory to them and their loved ones.
“All I am asking for is to have some choice over how I die,” wrote terminally ill patient Louise Schaefer in a letter to The Sacramento Bee. “Portraying me as suicidal is disrespectful and hurtful to me and my loved ones. It adds insult to injury by dismissing all that I have already endured; the failed attempts for a cure, the progressive decline of my physical state and the anguish which has involved exhaustive reflection and contemplation leading me to this very personal and intimate decision about my own life and how I would like it to end.”
Dying patients who choose aid in dying want to live, as evidenced by the fact that more than one-third of these terminally ill patients don’t ingest the medication even after they obtain it.   But they derive great comfort knowing they have that option. For those who do take the medication to achieve a peaceful death, they have been able to cross the threshold to death in a manner consistent with their values and beliefs, and consider this choice to have enabled them to exercise a final act of autonomy consistent with how they have lived their whole life.
As noted philosopher and law professor Ronald Dworkin observed in his book Life’s Dominion (Knopf 1993):  “…we live our whole lives in the shadow of death…we die in the shadow of our whole lives….We worry about the effect of life’s last stage on the character of life as a whole, as we might worry about the effect of a play’s last scene or a poem’s last stanza on the entire creative work.” We ought not insult and diminish this choice by applying an inaccurate, pejorative term. Words matter.
Kathryn L.  Tucker, JD, is the Director of Advocacy & Legal Affairs for the nation’s leading end-of-life advocacy, education and support organization, and teaches Law, Medicine and Ethics at Loyola Law School in Los Angeles.Compassion & Choices