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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.