The language of death – new column #MAID

We all know the power of language within public debates. In such debates, most participants will use language that aligns their point of view with that of the wider culture. And most will try to distance themselves, lexically, from attitudes and actions that have negative connotations. In the abortion debate, for example, both sides describe their own position in positive terms – as either pro-life or pro-choice. We know that our language shapes public perceptions, and will shape the debate, and so we respond accordingly.

The question of this column is how to describe a certain kind of death. The death I’m referring to is that of a person who has a serious sickness that causes her substantial pain and suffering – and that pain and suffering cannot be relieved to her satisfaction. Her natural death is reasonably foreseeable and, at her request and with her consent, a medical practitioner gives her a series of injections that kill her cause her to die.

Within the Canadian context there is now agreement that this kind of death should be called “medical aid in dying.” This is the language now used in legislative frameworks, by most medical practitioners, and in public discourse generally.

However, in a recent report to the General Assembly of The Presbyterian Church in Canada, the denomination’s Committee on Church Doctrine chose different language to characterize this kind of death. That report used the older language of “physician-assisted suicide.” And it was curious to me that at the very moment the report was presented, a colleague leaned over and whispered to me: “But that’s not what the practice is called, now.”

The Presbyterian Church in Canada is, we know, a Christendom institution – historically, our religious identity has been assimilated to our national or civic identity. To be a good Presbyterian also meant being a good Canadian. The flip side of that coin is that we are terribly uncomfortable when there is dissonance between our identity as Christians and our identity as Canadians. So much so that there is a palpable relief when we discover that we are, in fact, in line with majority opinion. Hence my colleague’s preference for “medical aid in dying.”

The passive voice
Given the limits of space, let me simply raise two objections to that phrase. The first objection comes from Dr. Balfour Mount, who is known as father of palliative care in Quebec and in Canada. When the National Assembly in this province began using the language of “medical aid in dying,” Dr. Mount responded angrily that he had been providing medical aid in dying for 50 years, since that’s what palliative care is! He added that the new bill was “not talking about ending the suffering, but instead, ending the sufferer.”

The use of the phrase “medical aid in dying” represents an attempt to align this medical practice with actions and attitudes that are appreciated within the culture; to associate the practice with medical care and with support for the dying. However, it is a powerful argument against this phrase and this language that it has been appropriated from the palliative care context. Further, that there is nothing in “medical aid in dying” that distinguishes it from palliative care.

A related, problematic aspect of this phrase is the fact that it doesn’t involve anyone doing anything – the language is almost entirely passive. In “medical aid in dying” what has become of the patient who asks to have her life ended? And what has become of the medical practitioner who gives the injection that kills her or ends her life? Neither is anywhere to be found in “medical aid in dying.” Perhaps it is fair to ask whether every active agent has disappeared from this phrase because it allows advocates to avoid mention of something we are all uncomfortable with – namely, with doctors terminating patients’ lives.

We all know the power of language in public debates – we know how language is used, and sometimes abused, to shape public opinion. Perhaps what the Presbyterian church needs today (and perhaps other denominations as well) is a good dose of confident sectarianism, if only to provide us with a moment to pause and ask ourselves “What on earth are we saying, anyway?!”

*cover image (main page) is a detail from Riopelle’s piece “Mitchikanabikong” (1975)

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