Michael E. Holtby, LCSW, BCD
Death by Euphemism
First published in Colorado's AIDS Newsletter, Resolute!, September, 1997
Not to be reproduced with permission of the author.
Euphemism: 1. the substitution of a mild, indirect, or vague expression for one thought to be offensive, harsh or blunt. 2. The expression so substituted: "to pass away" is a euphemism. for "to die".
Random House Dictionary
of the English Language
This July I traveled to England to talk to a group of experienced nurses
taking an intensive continuing education course on HIV/AIDS. My co-presenter was
Russel Ogden, a Ph.D. graduate student at the University of Exeter whose
research has already received international recognition in the area of HIV and
It is my impression that the British are experts in the expression of the
indirect. As one nurse described, she could have helped her patient die if only
she had not said, "I'm ready to die now." If only she had said she needed more
pain medication, but no, when asked she said she was comfortable and not in
pain. The nurse looked at her patient's son, and knew that if she gave her more
morphine she would be crossing a prohibited line. In England there is the
Suicide Act of 1991 which carries a 14 year prison sentence for assisting
someone to die. Yet she confessed to us, and the assembled group of nurses, that
if the son had not been there she would have helped this woman to die. That
appeared to be the prevalent opinion of the class.
In fact, the impression I was left with in England was that euthanasia (which
differs from assisted suicide in that the helper does the deed rather than the
patient) is actually quite common. It is cloaked, however, in secrecy and
euphemism. Patients are "helped to be more comfortable" with a wink and a nod.
Caregiving partners may be given a large mixture of morphine, ostensibly
administered for pain relief yet there are no questions asked when the next day
it is all gone -- as is the patient.
Doctors hide behind the principal of "double effect". This is the idea that
it is legally and ethically permissible to give a patient medication to relieve
pain at the risk of death -- so long as the intent was not to cause death.
Coincidentally, England is now reeling from the revelations of two of their
Country's doctors who, in July, publicly stated that between them, they have
helped 200 people to die over the course of their careers. Dr. Michael Irwin, a
former medical director of the United Nations, and David Moor, a GP from
Newcastle. The police are investigating, but they are contending they can't be
convicted for relieving pain. They are, however, trying to bring out the
hypocrisy of the principal of double effect. They contend that the difference
between themselves and other British doctors is not what they do, but what they
say about what they do.
The subject in England is heating up, not only due to Drs. Irwin and Moor,
but also due to a popular television soap opera, Brookside. In a recent
episode a woman dying of cancer was smothered with a pillow by her daughter and
son-in-law after her doctor refused to prescribe more morphine for her pain.
The British Medical Association suggested Dr. Moor "executed" his patients,
and his response was that this was "thunderous twaddle". "I am not in the least
bit interested in the views of a bureaucrat sitting in the BMA offices in
London," added Dr. Moor. Where Dr. Moor seems to differ from his colleagues is
that he is not indirect in dealing with death. He has a discussion with the
patient and their immediate family, and "If I and the patient with, as far as
possible, informed consent, decide this is the way forward, so be it."
Russel Ogden, had just returned from the International Summit on Promoting
Standards of Care for PWA's Around End-of-Life Decisions, sponsored by
Glaxo-Welcome in Madrid, Spain. They resolved that a PWA has the right to "make
deeply personal decisions concerning their bodies, including decisions regarding
the manner and timing of death."
A key portion of their position paper stated, "We agree that when a person
dies in a manner that might be acceptable to others, but is inconsistent with
the dying person's values, it is an affront to human dignity." The implication
is that if an individual wants to have their death hastened, to not
assist them is wrong.
The U.S. Supreme Court also rendered a rather fuzzy decision on assisted
suicide this July. They contended it is not a constitutional right. Yet Chief
Justice William H. Rehnquist insisted that the ruling did not decide the
narrower question of "whether a mentally competent person who is experiencing
great suffering has a constitutionally cognizable interest in controlling the
circumstances of his or her imminent death."
As in England, we are currently encouraging a death by euphemism. Justice
Sandra Day O'Conner stressed that in the future the Court could recognize an
individual's right to pain control at the risk of death, the principal of double
effect, as constitutionally protected.
Dr. Joanne Lynne, Director of the Center to Improve Care of the Dying at
George Washington University School of Medicine observes, "Many of the decisions
may be ambiguously articulated. They may be as much as a nod, something brought
up in conversation, 'How do you feel about staying here?'" Margaret P. Battin,
Ph.D. at the University of Utah finds "That the lack of candor about how the
patient's death will occur and under what conditions is the thing that's
Last messed with November 15, 2001
Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.