OCT 1997
Therapists Talk 
Shrink Rap 


    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 euthanasia.

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 particularly troubling."



Last messed with November 15, 2001

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.