Kim Leadbeater, the Labour MP in charge of the Terminally Ill Adults (End of Life) Bill currently going through its committee stage, has repeatedly called on Tory MP Danny Kruger not to use the term ‘suicide’ in relation to proposed new laws on assisted dying. This is not the first time proponents of assisted suicide have tried to distance themselves from the ‘s-word’. But just this week, Kruger once again had to reiterate in parliament why clarity of language is so important in this debate.
The dictionary defines suicide as ‘the act or an instance of ending one’s own life intentionally and voluntarily’. Throughout medical school, doctors learn the definitions, assessments, causes, and the various forms this can take, ranging from jumping off high buildings to taking massive medication overdoses. Suicide in people who have a terminal illness happens, rarely, and often around the time of learning the diagnosis, even before disease-modifying treatments have begun.
Definitions in the international classification of diseases – an internationally agreed classification of mental disorders designed to improve diagnoses, treatment, and research – can also be a guide to help with wording. Intentional self harm, or injury and poisoning of undetermined intent are classified as suicidal acts according to the code. Organisations like the World Health Organisation, for instance, rely on these classification codes to identify international trends in suicide incidence.
Leadbeater’s belief appears to revolve around the thinking that these terminally ill people are dying anyway, so by engaging in an assisted death they are merely bringing the inevitable forward. The act of actively taking a lethal medication mix to end one’s life then becomes something else than suicide.
‘They are all dying anyway’ may seem like a benign explanation for the avoidance of using the word suicide. But dig a bit deeper and some eligible people under the current version of the Bill could be years away from the actual natural end to their lives, surprising as that may sound. We doctors know that six-month-or-less prognoses are meaningless and largely guess work, so relying on these as the starting gun for assisted suicide discussions is a risk. Similarly, the mechanisms of how these drugs work, inducing a cardio-respiratory arrest and usually resulting in a death from asphyxiation, make this very different to ordinary dying.
When did ‘suicide’ become such a controversial word to use? Is it really still seen as something that needs to be hidden away from society, a source of terrible shame, to be kept secret and under the radar, and to be dealt with only by the thousands of bereaved families unlucky enough to be affected?
Suicide prevention, whatever the reason for wanting to end one’s life, must not be diminished. The Anscombe Bioethics Centre has indicated in its analysis of assisted dying and suicide prevention in other countries that latter becomes much harder to do when the former is legalised.
Being precise with our language is important. This is especially important given that the probably deliberately vague term of ‘assisted dying’ mistakenly means the right to forgo life prolonging or life-saving interventions to some people. At least assisted suicide adds the clarity that this law is intended to allow for individuals to receive a concoction of lethal medications from the state, and that it is to be ingested or released into a vein by the person themselves in order to end their life.
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