Should We Stop Using the Phrase 'Assisted Suicide'?

A few days ago, the non-profit Compassion & Choices, which advocates for the rights of terminally-ill patients near the end of life, launched a new website: itsnotassistedsuicide.org. The website was created as a way to reach out to people who might be supportive of the group's mission that look up the term "assisted suicide," but don't find Compassion & Choices.

Currently, the organization's main website doesn't show up for searches on this term because the group uses it very sparingly—and mostly to distance themselves from it. A search for their preferred phrase "aid in dying" will reliably bring up the site, but isn't as popular as "assisted suicide." Compassion & Choices digital director Bill Gordon told me the organization is "fairly confident" many people Googling "assisted suicide" are "searching for what we're offering." With itsnotassistedsuicide.org, they hope to get their message out to these people.

But if the term "assisted suicide" is used by large amounts of people who are supportive, why do organizations like Compassion & Choices want to run away from it? As it turns out, public support for delicate issues like the right to die depends largely on the language used to talk about those issues.

Historically, Gallup polling has shown a wide variation when people are asked what doctors should be allowed to do if "a person has a disease that cannot be cured and is living in severe pain." Gordon cited a 2013 survey that support for "assisting the patient to commit suicide" was 51 percent, but went up to 70 percent when the words were changed to "end the patient's life by some painless means."

The other reason is that terminal patients who wish to obtain life-ending medication under Death With Dignity statutes resent the notion that they are "suicidal." According to one of Compassion & Choices's recently updated media resource bulletins, "Adults who choose the option of medical aid in dying find the suggestion that they are committing 'suicide' deeply offensive, stigmatizing, and inaccurate. Many of them have publicly expressed that the term is hurtful and derogatory to them and their loved ones."

Brittany Maynard, the 29-year-old California resident who moved to Oregon after she was diagnosed with brain cancer to make use of the state's law, echoed this sentiment in a CNN op-ed: "I've had the medication for weeks. I am not suicidal. If I were, I would have consumed that medication long ago. I do not want to die. But I am dying. And I want to die on my own terms."

Perhaps the most substantive reason why advocates have rejected the "assisted suicide" label has to do with legal strategy. Anne Singer, Compassion & Choices's campaigns communications manager, told me that about 40 states already have laws on the books prohibiting assisted suicide. Rather than fighting to repeal those laws, the group works to interpret existing legislation to fit Compassion & Choices' goals. This is done not only by drafting state specific Death With Dignity legislation, but also by filing lawsuits on behalf of terminally ill patients and their doctors.

This is the case in California, where several terminally ill plaintiffs are arguing that the law shouldn't treat their request for lethal medication any differently than it would someone's uncontested ability to request removal of a ventilator or feeding tube. The issue is also being taken up by the California legislature, where the End of Life Option Act is currently stalled in the state legislature after passing the state Senate, thanks to lobbying by the Catholic Church.

Existing Death with Dignity laws in Washington, Oregon, and Vermont ensure that death certificates of participants state the terminal illness as the cause of death and list "natural" as the manner of death—not "suicide." Singer told me that the legislation is significant because most insurance policies will not pay out in the event of suicide.

What this all means is that the push to replace "assisted suicide" with "aid in dying"—or "assisted dying," the phrase preferred by the Death With Dignity National Center—isn't merely a rebranding effort. It's an attempt to create a new category based on the circumstances of the patient's illness.

Up until now, a doctor providing the means for a patient to die has been considered either "assisted suicide"—giving patients a lethal substancethat they ingest on their own—or "euthanasia," or having the doctor physically administer the substance.

In essence, "death with dignity" advocates are saying that their constituency of mentally-competent, terminally-ill patients have unique needs that require different consideration. The fact that the they are taking the lethal substance themselves secondary, in the same way that removing a feeding tube has very different ramifications depending on a patient's chance for meaningful recovery.

For the time being, there does seem to be significant momentum at the state level towards enacting more Death with Dignity laws, in line with Oregon's model legislation. In the 2015 legislative session, bills have been introduced in 25 legislatures plus the District of Columbia, in many cases for the first time. Canada's Supreme Court recently ruled that a universal ban on assisted suicide was unconstitutional in the case of an adult who "(1) clearly consents to the termination of life; and (2) has a grievous and irremediable medical condition (including an illness, disease, or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." The language of the decision referenced the experience of US states where the practice was legalized and generally refrained from using the word "suicide" to describe the conditions under which it should be allowed.

Outside the US, the "aid in dying" distinction is not usually made (an exception being Quebec's legislation from 2014, which carefully defines the term "medical aid in dying"). Other countries also don't limit the scope to the terminally ill, but instead provide access for anyone with severe suffering. This is the case in Luxembourg and the Netherlands, both of which allow physician-assisted suicide and euthanasia; Belgium's law has a similar scope but only explicitly states euthanasia (in practice assisted suicide is allowed in the presence of a doctor). Switzerland allows assistance with suicide for anyone—including non-residents—as long as it is for "unselfish reasons," even by non-medical professionals.

But in the US, it remains to be seen if a credible movement will emerge to explicitly advocate for legalizing physician-assisted suicide or even euthanasia. Jack Kevorkian certainly achieved great notoriety with his efforts 20 years ago. However, more concerted activism will likely be needed to mount legal challenges and fight for the repeal of legislation banning the practice. In addition, there has been a restriction on using federal funds for assisted suicide or euthanasia in place since 1997.

In the past several years, support for the right to die has increased—especially among younger people. In a May Gallup poll, support for a doctor to "assist the patient to commit suicide" climbed from 51 to 68 percent (support for the phrase "end[ing] the patient's life by some painless means" held steady at 70 percent). Another 56 percent also considered "doctor-assisted suicide" to be morally acceptable, a [record high and an increase of 7 percent](http://www.gallup.com/file/poll/183416/MoralAcceptabilityI_150526 .pdf) since Gallup started including that option in 2001.

The largest increase in support for "doctor-assisted suicide" in the past year was among 18- to 34-year olds with a 19 percent increase, though all age and political groups saw gains. Gallup cited the widely-publicized case of Maynard as a likely catalyst for this shift.

In news reports, Maynard's case was often reported as an "assisted suicide." Together with widespread sympathy for her story, this may have had its own effect on rebranding the term. Will this lead supporters to keep equating "aid in dying" or "assisted dying" for terminally ill patients with "assisted suicide" in a way that advocates would prefer they didn't? Or will it lead to broader conversations about the ethics of end of life decisions?

If you are struggling with suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.

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