Over the past few years, proponents of physician-assisted suicide (PAS) have been pushing the American Medical Association (AMA) to amend its Code of Ethics as it pertains to the practice.
In 2016, a delegation from Oregon asked the AMA’s Council on Ethical and Judicial Affairs (CEJA) to recommend that the AMA adopt a neutral stance on physician “aid in dying.” In 2017, Dr. Zuhdi Jasser approached the Council recommending that it develop a distinction between suicide and “aid in dying.” Many were concerned that amending the AMA’s Code of Ethics would be a major step for those advancing a progressive end-of-life agenda.
But after considering these recommendations, the Council on Ethical and Judicial Affairs recently released report 5-A-18, and the answer from the Council was a resounding “no.” While the Council’s refusal to take a neutral stance on PAS was pleasantly surprising, perhaps the most noteworthy takeaway from the report was the forthright way the questions of linguistic engineering were answered.
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Through and through, the report called out and rejected attempts to alter the terminology made by proponents to make PAS more palatable to the American people. The report says:
Proponents of physician participation often use language that casts the practice in a positive light. “Death with dignity” foregrounds patients’ values and goals, while “aid in dying” invokes physicians’ commitment to succor and support.
Using softer euphemisms for PAS is one thing that proponents have done quite well in the public square. And it’s no wonder why proponents of PAS would want to alter the language. It was George Orwell who first articulated the importance of controlling the language when attempting to manipulate or change the mind of the masses. The idea is simple. The language we use to discuss certain issues is critical. It shapes the conversation, and thus those who control the language control the conversation. If a person in a dispute can get his opponent to use language of his choosing, he has already effectively won the argument because his opponent has conceded linguistic ground.
In his autobiography, former abortionist Bernard Nathanson, founder of the National Association for the Repeal of Abortion Laws (NARAL, later renamed the National Abortion Rights Action League) and architect of abortion laws in the United States, repeatedly mentions how abortion proponents used confusing and misleading language in order to obfuscate the public conversation. By replacing “unborn child” or “baby” with more unfamiliar or meaningless terms such as “fetus,” “blob of tissue,” or “clump of cells,” abortion proponents were able to steer the conversation away from the fact that abortion takes the life of an unborn human being.
In the same way, proponents of PAS in the United States have been working overtime to obscure and change the language around this issue. Oregon, the first state to legalize PAS, titled its law “The Death With Dignity Act.” Other states have used different names, but the goal is the same: make the practice more palatable. Here in Nebraska, for example, the bill to legalize PAS was titled “The Patient Choice at the End of Life Act.” The language shift has happened in other areas as well. One of the leading advocacy groups promoting national legalization of PAS is Compassion and Choices. By using words such as “choice,” “dignity” and “compassion,” proponents steer the conversation away from the fact that the practice involves doctors helping patients commit suicide.
But no matter how a person dresses it up, suicide is suicide, and doctor participation is doctor participation. Changing the language may get more Americans on board, but it does not change the nature of the practice. Thankfully, the Council saw through these deceptive efforts:
In the council’s view, despite its negative connotations… the term “physician assisted suicide” describes the practice with the greatest precision. Most importantly, it clearly distinguishes the practice from euthanasia. The terms “aid in dying” or “death with dignity” could be used to describe either euthanasia or palliative/ hospice care at the end of life and this degree of ambiguity is unacceptable for providing ethical guidance.
Perfect. This excerpt is important for a number of reasons.
First of all, it recognizes the importance of using honest language in deliberations. It’s very difficult to have an intelligible conversation when two individuals think the words used mean two different things. Confusing language surrounding any issue only serves to impede honest debate.
In addition, it recognizes that no matter the language used, PAS is still the best way to describe the practice of doctors writing lethal prescriptions for patients. This shows that while the linguistic engineering used by proponents of PAS may be affecting the way Americans view the practice, it is not having the desired effect on those who set the ethical standards used by physicians in the United States.
Lastly, it affirms that different people can and do have different values regarding end-of-life issues and decisions. For one person, “death with dignity” might include hospice care, courage in the face of a terminal illness, and accepting death when it comes. Yet for another person, “death with dignity” might include giving a patient the opportunity to have complete control over the time and manner of his passing. We might have different opinions on which of those is more dignified or morally upright, but the point is that different people have different values when it comes to end-of-life decision-making.
Further, if we call PAS “death with dignity,” what does it say about those who do not choose it? Is a person who faces pain and death with courage and perseverance less dignified than someone who ingests a lethal concoction to avoid further suffering? Absolutely not. Allowing proponents of PAS the latitude to usurp the phrase “death with dignity” would have been a disastrous development for medical ethics and how we think about end-of-life issues in this country.
The report delineates the reasoning used in the determination, and concludes by stating that the AMA’s Code of Ethics will not be amended in regards to PAS. It would be difficult to overstate the importance of this decision in regard to the national conversation on end-of-life issues. Many individuals, myself included, believe that when it comes to moral issues such as PAS, a neutral stance is effectively the same as a supportive stance. If you’re not against it, you’re for it. Adopting a neutral stance would have been the first step toward full-on embrace of the practice. Obscuring the language through the changing of definitions would have been a hindrance to honest public discourse.
But the CEJA’s rejection of these recommendations is a reminder that the battle against PAS and euthanasia is not yet lost even though many local AMA chapters have gone in the opposite direction. The AMA has offered a reprieve giving opponents of PAS an opportunity to build up a culture of life within the medical profession. While the public conversation rages on, it’s good to know that there are many individuals setting the ethical standards in this country who still believe that doctors have no business facilitating the suicides of their patients.
Renowned bioethicist Wesley J. Smith sums up this report quite nicely: “Good. A doctor’s role is to heal, palliate, counsel, and treat. It should never be to help kill.”