Aid in dying or physician-assisted suicide? As MN lawmakers weigh bill, advocates and opponents choose different terms.

Minnesota lawmakers are once again weighing a bill that would allow terminally ill patients to end their lives with medication provided by a doctor.

The “End of Life Options Act,” which would allow an earlier death for patients with six months or less to live, has seen renewed discussion at the Capitol this year, where on Thursday it passed through its second committee in the House.

“Medical aid in dying” or “physician-assisted suicide” is an emotional issue for many, with a January House hearing on the bill drawing an audience of hundreds on either side. Lawmakers heard hours of testimony from cancer patients with only months to live, and families of people who suffered painful deaths from disease. There also were people concerned legal elective death could eventually become an option for people with disabilities and negatively affect care.

But it isn’t just a debate on medical ethics. There’s also an ongoing discussion in medicine, academia, journalism and law over what society should call the practice. And sometimes — but not always — it can provide clues on which side of the debate someone falls.

Terms

Advocates mostly prefer the term “medical aid in dying” and balk at the use of “physician-assisted suicide.” They argue when patients are already expected to die, they are choosing the timing of the inevitable.

But opponents, and even some supporters, say the terms physician- or medically-assisted suicide are more transparent and help prevent confusion with other terms, such as euthanasia. At the end of the day, they argue, patients are engaging in the dictionary definition of suicide, and calling it “aid” is a euphemism that obfuscates the seriousness of the choice.

Groups such as the American Medical Association say it also helps distinguish a patient taking medicine to die from euthanasia, where a third party, typically a doctor, ends the life a patient to prevent suffering.

The semantic debate came up during the bill’s second House hearing Thursday, when advocates told members of the Public Safety Committee why they felt the term suicide is an inaccurate word for terminally ill patients choosing when to die.

“Suicide occurs as a result of a mental health crisis that drives individuals to take or try to take their own lives, usually impulsively and often by violent means,” said Eric Bergh, a retired psychologist who has worked in suicide prevention.

“They are self-destructive and not in a rational state of mind,” added Bergh, who lost his brother to suicide more than 20 years ago.

‘Suicide’ vs. ‘medical aid in dying’

Opponents pushed to continue calling the practice suicide and argued legalization could undermine suicide prevention efforts. However, there’s no evidence that this has been an issue in the 10 states that have legalized the practice so far, Bergh said.

Dr. Rebecca Thoman, with Compassion & Choices, a group that backs bills like Minnesota’s End of Life Options Act, said the term “suicide” carries negative connotations, potential legal implications, and lacks the nuance to describe the choices patients are making when they chose to end their lives.

“In suicide, if you even look at some of the synonyms, it’s self-destruction,” she said. “Medical aid in dying is self-preservation. The goal is peaceful, the goal is to relieve.”

Thoman pointed to other instances where terminally ill patients make choices that hasten death that are not necessarily thought of as suicide. Patients in hospice care die sooner when they choose not to eat or drink, and people with kidney failure can end dialysis.

Descriptive language

Some medical ethicists don’t buy those arguments. Dr. Daniel Sulmasy, who heads the Kennedy Institute of Ethics at Georgetown University, said advocates know using terms like “aid in dying” are more palatable to voters, but using those words ultimately obscures the nature of the act.

“Terms like medical aid in dying are incredibly ambiguous,” said Sulmasy. “I mean, I’m opposed to physician-assisted suicide, but all in favor actually of medical aid in dying. When (patients) are dying, I give them drugs to help with symptoms like pain and nausea and make sure that their psychosocial and spiritual needs are attended to.”

The American Medical Association continues to use the term physician-assisted suicide for similar reasons.

“In the absence of a perfect option, the AMA believes ethical guidance to physicians is best served by using plainly descriptive language,” the association said in a statement.

Most importantly, the AMA said, calling the act “suicide” clearly distinguishes it from euthanasia. Other medical groups have changed their language. It’s worth noting: The American Academy of Family Physicians and Minnesota Medical Association no longer use the term suicide.

It’s not just opponents who prefer to use the term suicide. Sulmasy pointed to ethicists who advocate for patients ending their lives, such as Princeton bioethics professor Peter Singer, who use the term suicide because it is the simplest and most transparent language to describe the act.

And news organizations reporting on the issue from a neutral stance often prefer the term physician-assisted suicide, too. The Associated Press Stylebook continues to recommend terms like medically assisted suicide and physician-assisted suicide, though advocates have approached the AP about changing its word choice.

Terminology continues to evolve as more states allow patients to choose to die. So far 10 states have done so — often under different names, such as the “Death with Dignity Act” in Oregon. California’s is called the “End of Life Option Act.”

Minnesota legislation

Minnesota’s end-of-life bill passed out of the House Public Safety Committee on Thursday. Its next stop is the House Judiciary Finance and Civil Law Committee, with a hearing possible as early as next week.

There’s a companion bill in the Senate, though it hasn’t yet gotten a hearing.

It’s not clear if the bill could pass in that chamber as Democratic-Farmer-Labor lawmakers who generally favor it only have a one-seat majority, and at least one DFLer has voiced opposition to elective death for patients in the past.