By Chris Haring
Authors of the research article “Medical aid in dying: Clinical considerations” note the importance of using accurate terms to describe physician-assisted death
What’s in a name? The aid-in-dying movement has established that terms such as “medical aid in dying,” “physician-assisted dying/death” and “Death with Dignity” are the accurate and preferred phrases to describe the practice for which we advocate.
However, as more states pass aid-in-dying bills and refine existing laws, even some otherwise movement-friendly sources still utilize phrases like “assisted suicide” and “euthanasia” when they’re really referring to physician-assisted death.
Using appropriate language is so important that in the opening portions of a July 2023 research article published by UptoDate (a prestigious online medical journal) titled “Medical aid in dying: Clinical considerations,” its authors (Lonny Shavelson, MD, Margaret P Battin, MFA, Ph.D., and Thaddeus M Pope, JD, Ph.D., HEC-C), take care to accurately describe aid in dying, as well as to distinguish it/physician-assisted death from “assisted suicide.”
In the piece, the authors define medical aid in dying as “the legal practice where a clinician cares for a terminally ill patient who considers and potentially follows through with hastening their imminent death through the use of medications prescribed for that purpose.”
The most notable distinction in this definition is that while the physician is responsible for prescribing the patient’s end-of-life medication at their request, they do not physically administer it. That’s why the authors say that to use “assisted suicide” when referring to aid in dying is “misleading.”
(They further noted that even the American Association of Suicidology ‘…recognizes that the practice of physician aid in dying… is distinct from the behavior that has been traditionally and ordinarily described as ‘suicide’… legal physician-assisted deaths should not be considered to be cases of suicide.”)
Whether as an advocate or provider, accuracy is critical when discussing such sensitive and emotionally-charged topics as end-of-life options. The authors are clear in their recommendation: “The clinician must consider carefully what terminology is appropriate to use, ideally reflecting (and understanding) the terminology used by the patient” Here at Death with Dignity, we couldn’t agree more!
Read the entire terminology section below:
AUTHORS: Lonny Shavelson, MD, Margaret P Battin, MFA, PhD, Thaddeus M Pope, JD, PhD, HEC-C
Published: July 31, 2023
Many parts of the world have seen the emergence of discussions regarding end-of-life care, with increasing pressure for the legalization of varying forms of medical aid in dying (sometimes abbreviated as MAID). Although there remains variation in legal status internationally, as well as within in the United States, a substantial population of patients have access to legal medical aid in dying. Information on US state laws is available on the Death with Dignity website.
As a result, many clinicians, particularly those in the fields of oncology palliative care, and hospice, will care for patients considering a hastened death. Clinicians, no matter where they stand ethically and morally on the permissibility of this practice, must carefully consider how they will respond to their patients’ requests. Given the advances in the bedside practice of medical aid in dying, those clinicians who choose to participate must be well educated in the clinical details to provide their patients with appropriate care.
This topic describes the clinical practice of self-administered medical aid in dying, which is the only form allowed in those parts of the United States where medical aid in dying is legal. Self-administration is also an option in all other countries where medical aid in dying is permitted, although clinician administration is far more common. Ethical and legal considerations, including those outside of the United States, are discussed in further detail elsewhere. (See “Medical aid in dying: Ethical and legal issues”.)
DEFINITION AND TERMINOLOGY
Definition — Medical aid in dying refers to the legal practice where a clinician cares for a terminally ill patient who considers and potentially follows through with hastening their imminent death through the use of medications prescribed for that purpose. Earlier descriptions of medical aid in dying have characterized it as writing a prescription, at the patient’s request, for a lethal medication. Clinical best practices have since discouraged this limited focus and now emphasize the evaluation and care of terminally ill patients considering the option of a physician-assisted death.
Terminology – Medical aid in dying is one of the most commonly used expressions for the practice. Other terms include aid in dying, physician aid in dying, medically assisted deaths, physician-assisted deaths, and hastened deaths. The term “assisted suicide” is misleading. The American Association of Suicidology “…recognizes that the practice of physician aid in dying… is distinct from the behavior that has been traditionally and ordinarily described as ‘suicide’… legal physician assisted deaths should not be considered to be cases of suicide” . Similar policy statements have been presented by the American Academy of Hospice and Palliative Medicine , the American Public Health Association , the American Psychiatric Association , the American Medical Women’s Association , and the American Academy of Family Physicians [6,7], although these organizations’ policy statements vary in their support of medical aid in dying.