Belief

When Words Kill: A Health Care Glossary

Euthanasia, end-of-life, death with dignity, assisted suicide: The meaning depends on whom you ask. In a high-stakes health care debate, we can’t even agree on the terms.

"Our goal," Randall Terry wrote last week, "is to keep child-killing and euthanasia in the center of this debate until any vestige of taxpayers' paying for murder is gone."

For once I'd have to agree with the inflammatory and dramatic director of Operation Rescue; at least with his literal words.

The killing of children, or for that matter, state-sponsored killing of anyone, is not something I want my tax dollars to pay for. (Taxpayers continue to pay for capital punishment, the sad irony and injustice of which I will leave to another time.)

Terry's statement, taken from a press release announcing a five-state speaking tour, isn't really about child-killing or euthanasia or murder. It's about using language to scare the uninformed, the fearful, the religious, the elderly; and (one could say when viewing the demographic of town hall disrupters) the white, the male, the racist, the libertarian, the NRA member, the fiscal conservative (whatever that means, exactly, when crossed with Nazi-accusers).

Terry knows his demographic well, and they know exactly what he's getting at with words like "killer" and "murder" and "tax dollars." Even though, well, it's all lies.

Last week, Sen. Chuck Grassley of Iowa (the leading Republican member of the Senate Finance Committee currently tasked with writing a bipartisan health care reform bill) announced that end-of-life care has been dropped from their agenda.

It was a clear capitulation to the sound and fury that opponents to reform have mustered since July 24, when [Ohio GOP Rep. John] Boehner suggested that the bill could lead to "government-encouraged euthanasia."

In the intervening three long weeks, the public has been barraged with a host of "death" terms, more often than not used by opponents, like Terry, to derail the reform effort; but also by a struggling administration forced to address the last great frontier in terms that aren't inaccurate, misleading or scary.

To this word mix, "pro-life" and end-of-life care advocates have added their own history of debate over terms. Tracking this usage and teasing out words' actual and implied meanings gives us a glimpse of not only the political implications of a bill in formation, but also at how we as a society engage the discourse of death.

Sticks and Stones ...

Assisted suicide, euthanasia and aid-in-dying are not interchangeable terms. While "assisted suicide" is the common term for what is legal in Oregon, Washington and Montana (and, in some form, in Belgium, Colombia, Germany, Japan, Switzerland and Great Britain), advocates resist use of "suicide" and prefer "aid in dying" or "Death with Dignity," the names of the bills in Oregon and Washington (Montana's law was established by the court and not by vote, and is being challenged).

As one affiliate of Compassion & Choices, the country's largest end-of-life advocacy organization, told me, "Suicide is for those who want to die. Death with Dignity is for those who want to live but can't."

It's a fine distinction of terms; one contested even by those within the movement. As Compassion & Choices interprets assisted suicide, it means helping someone to end their life prematurely. So does euthanasia. Both are, under this definition, illegal in the United States. The Death with Dignity laws require that the patient administer his or her own medicine; the prescribing doctor, or anyone else, cannot legally "assist" with the "suicide." To receive lethal medication under the Death with Dignity law is not easy.

Among other restrictions, it is illegal for doctors to suggest death with dignity to their patients. A patient must also have less than six months to live, must be determined to be of sound mind, and might require a consulting doctor.

For this reason, those who select Death with Dignity tend to be white, upper-middle class, well-educated and well-informed; not the poor and disadvantaged that Republicans claim are at risk under these laws.

The political right's preferred term for aid in dying -- "euthanasia" -- has clearly contributed to the "death panel"/death camp rhetoric we've heard these past two weeks (and echoes Glenn Beck and Michelle Bachmann's internment camp lies of a few months ago).

Euthanasia, although defined as "good death," summons up the concentration camps of Nazi Germany and has served as a source of unnecessary fear for the elderly, who are unable to distinguish between implied state-sponsored killings and elective assisted suicide, hospice or palliative care (or even end-of-life counseling).

The "death panel" scare has unfortunately overshadowed the real panels that govern insurance companies' decisions and are used to regulate treatment and cost. Euthanasia, in right-speak, has become synonymous with health care reform -- and yet no one has bothered to define either clearly.

This destructive conflation of terms is nothing new; conservative commentator Betsy McCaughey used euthanasia in 1994 to help defeat Hillary Rodham Clinton's health care reform; and to launch her own political career.

The best recent example we have of national discourse on end-of-life issues was the case of Terri Schiavo in 2005, when the George W. Bush administration attempted to intervene on behalf of Schiavo's parents and siblings after her husband, Michael, received court approval to remove her feeding and hydration tubes.

Public disapproval of Republican "overreaching" in the Schiavo case -- and accusations of euthanasia -- was profound, and the party quickly learned a lesson that has proved helpful this time around.

Polls then showed resounding rejection of government involvement in issues of health care (although how general this opinion was at the time was difficult to discern from the immediate situation). Thanks in part to talking points (PDF) devised by conservative consultant Frank Luntz, Senate and House Republicans have successfully framed President Barack Obama's health care reform as a government takeover or socialism.

Point four of Luntz's "10 Rules for Stopping the ‘Washington Takeover' of Health Care" in the memo "The Language of Healthcare" reads: "The arguments against the Democrats' health care plan must center around ‘politicians,' ‘bureaucrats' and ‘Washington.' "

What winning statement did Luntz get from polled citizens that would make them oppose Obama's plans? 

It could lead to the government rationing care, making people stand in line and denying treatment like they do in other countries with national health care.

While rationing of services is a legitimate concern in any health care system (even in a wealthy country like our own), budget allowances for health care and other "entitlements" tend to be harder to secure than, say, for the Pentagon: We currently have a private health care system that denies services to 47 million Americans.

Opponents of the current legislation claim that services would be denied by age and disability, yet they fail to note that health care is now rationed by class. It seems that some varieties of rationing are better than others.

... Words Will Never Hurt Me

The erroneous conflation of "euthanasia" and "end-of-life planning" has consequences. In a poll published by MSNBC on Wednesday, 45 percent said they believe the administration's reforms will allow the government to stop providing care to the elderly; 75 percent of self-identified Fox News viewers believe the same.

This is no coincidence. It is the result of a deliberate attempt to scare the most vulnerable, the poor, the elderly, the uninsured, the less-informed, the religious.

From Rush Limbaugh to Sarah Palin to Newt Gingrich, Republicans have lined up to propel the euthanasia scare into a health care reform defeat.

All three have supported end-of-life planning in the past. All three are now working to parlay misunderstood terms and conditions into a political win, regardless of the damage unreformed health care causes millions of Americans each day.

Since July 1, 50,000 to 60,000 seniors have left the AARP, the nation's largest senior organization, because it has endorsed the Obama administration's health care reform. That is still only a small percentage of AARP's 40 million members. Many have switched to the so-called conservative alternative, American Seniors Association.

How this trend will develop as baby boomers approach retirement, and how it will affect end-of-life planning and elder advocacy is hard to predict.

A 2005 Pew Research Poll, reported again last week by Kim Parker, shows that only 29 percent of Americans have living wills, up from 12 percent in 1990. She writes that while most Americans know what a living will (or an advance directive) is, they fail to create one.

Another interesting fact to come out of the poll, which may help explain Republican efforts to conflate euthanasia, assisted suicide and end-of-life planning:

Race and religious affiliation are much more strongly linked to attitudes about the right to die. Among whites, 75 percent say that there are some circumstances where a patient should be allowed to die. Only 40 percent of blacks agree. Catholics and white evangelical Protestants are less likely than non-evangelical Protestants and seculars to say patients should sometimes be allowed to die.

Now that the euthanasia claim in Section 1233 of the proposed bill has been thoroughly debunked and dropped from the bill, "pro-life" doctors have come out this week to say that end-of-life counseling is a necessary part of medical care; but that they are opposed to such discussions, including assisted suicide where it is legal, in Oregon, Washington and Montana. In other words, opposition is not necessarily to patient-elected, government-paid counseling sessions, but to legal assisted suicide in three states.

"Will it include a presentation of assisted suicide as an option in states where it is legal -- or perhaps in all states?" asks Senior Vice President of the Christian Medical and Dental Association, Gene Rudd, M.D.

It is a disingenuous question. Death with Dignity laws state that a physician may not mention aid in dying; the patient must bring it up him or herself.

Their position, and the recent false rumor that Compassion & Choices is responsible for drafting the "euthanasia" article, misleads seniors and deprives them of vital services -- services that could prevent them and their families from suffering undue stress, services that could lengthen their lives.

A recent study of cancer patients in the Northeast shows that end-of-life planning improves quality of life for the terminally ill.

In addition to a better mood, patients also lived about five months longer (although that finding was not statistically significant) and spent less time in the hospital.

Last Wednesday, Sen. Grassley made the "intellectually dishonest" statement that government policy should not "treat life at age 85 different than we do life at 35."

And yet, until we find a cure for death, to medically treat an 85-year-old and a 35-year-old in the same manner would be akin, in Randall Terry's words, to murder.

Ann Neumann is writing a book about death, grief and travel. She lives in Red Hook, Brooklyn in New York City.
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