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‘Death with Dignity’ or ‘Assisted Suicide’?

Whether or not Americans support doctors helping terminally ill patients to voluntarily end their lives depends on the words used to describe the issue. Those words also determine the success of such bills.

© David Pollack/CORBIS
What’s in a name? When it comes to “assisted suicide,” it turns out quite a lot. Americans are less likely, according to polls, to support a measure legalizing assisted suicide when that phrase is used. That’s why advocates for such laws are increasingly using what they say is a more humane description: death with dignity.

It’s not just a mushy euphemism, either; it’s a more appropriate description of the act, proponents say. And framing the debate in this way has already helped propel legislation that allows the terminally ill to end their lives with full legal protection. Oregon enacted the first “death with dignity” law when citizens approved it through a 1994 ballot initiative (which the Supreme Court upheld in 2006). Washington followed with another ballot vote in 2008. Montana and Hawaii support professional standards that encourage aid-in-dying practices. And last year, Vermont enacted the first death with dignity law passed by a state legislature.

In 1997, the Supreme Court unanimously ruled that Americans do not have a constitutional right to assisted suicide. But, Chief Justice William H. Rehnquist wrote, “it is widely recognized that the provision of pain medication is ethically and professionally accepted even when the treatment may hasten the patient’s death.” Justice David Souter agreed, stating that terminally ill patients may take medication “to alleviate pain, even when the medication is so powerful as to hasten death and the patient chooses to receive it with that understanding.”

Indeed, the Vermont law protects physicians who prescribe medication to mentally competent, terminally ill patients to help create a peaceful death against any criminal, civil and professional liability. Vermont state Sen. Claire Ayer, the bill’s sponsor, had put it before the legislature in every session for the past 11 years. “It never got out of committee,” she says. But when she rose to the chair of the Senate Health and Welfare Committee, she managed to move it to the Judiciary Committee, which approved it, and then get it attached to another bill that made it to the floor for debate, where it eventually passed—barely. “Probably one-third were philosophically or religiously opposed,” she says, “and the rest didn’t want to vote on it because no matter how you vote, a lot of people will be mad at you.”


The debate drew big crowds to the Senate, which Ayer says was a good thing. “I am a nurse, and I think end-of-life care is a really important part of health care in general,” she says. Proponents expect more states to take up the issue in the years ahead as the baby boomers enter their 70s. Currently the New Jersey and Massachusetts legislatures are debating death with dignity statutes.

And the name game still plays an important role. Vermont’s law jettisoned the “death with dignity” title, Ayer says, because “it was pointed out you don’t have to use this option to still die with dignity. But this is not suicide. That is a desperate act done by people who don’t want to live. These people are already dying, and they are simply trying to control the circumstances of their death.”

The American Public Health Association concurs, stating: “Medical and legal experts have recognized that the term ‘suicide’ or ‘assisted suicide’ is inappropriate when discussing the choice of a mentally competent terminally ill patient to seek medications that he or she could consume to bring about a peaceful and dignified death.”

You could call it “physician aid in dying,” Ayer says, because you are asking for your doctor’s assistance. Perhaps the best name of all is more poetic. “A writer called it being allowed to write the last pages of your life,” she says. “I like that.”

David Levine is a GOVERNING contributor.
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