(Doug Wussler has a graduate certificate in bioethics from Florida State University and a 29-year career in the information technology field.)
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It has been over 10 years since Dr. Margaret P. Battin published the best summary you are ever likely to read about the problems with the word “suicide” in the end-of-life context. Since that time, Medical-Aid-in-Dying (MAiD) has expanded to nine more jurisdictions. More recently, Voluntary Stopping of Eating and Drinking (VSED) has entered the public conversation. And the growing awareness and adoption of VSED has confused us further about the appropriate vocabulary for talking about and classifying death.
If a person lives in a state that offers MAiD, and they have a qualifying terminal diagnosis, and they use MAiD to end their life, the “Manner of Death” on their death certificate will be classified as “Natural.” If their state doesn’t offer MAiD, but they nevertheless hasten their death to end their suffering, their “Manner of Death” will generally be classified as “Suicide.”
But what is the “Manner of Death” if a person dies by VSED? According to an article in the October, 2023, Journal of American Medical Directors Association titled “Challenges in Completing a Death Certificate after Voluntary Stopping of Eating and Drinking (VSED),” there is no consensus on whether a VSED death should be classified as “Natural” or as “Suicide.” The authors call for “debate involving a wide variety of experts” in order to resolve the issue.
A MAiD death is clearly not a “Natural” death, but neither is it a “Suicide.” But instead of creating a new class of death for death certificates, the MAiD legislation codified the “Manner of Death” for a MAiD death as “Natural.” Contrast this with VSED, which is not something that has been legislated. VSED is simply seen as a choice that people are at liberty to make for themselves. Thus, there is no law specifying how to classify VSED on a death certificate. Each jurisdiction is free to decide for themselves how to classify the death. Is it a “Natural” death or is it a “Suicide?”
We are being presented with a false choice here. Both MAiD and VSED belong to what has been hiding in plain sight as a different class of death, a hidden species that comes into view once we consider our longer life spans, last century’s dramatic advances in public health, and the increasing desire for an alternative to a long, painful, expensive, or ugly death.
It’s much closer to the truth to say that people who use MAiD and VSED are euthanizing themselves than to say they died a natural death or committed suicide. Suicide is by definition an act that is ruinous to one’s self-interest. It is also an act society wishes to discourage and prevent. MAiD and VSED are acts of self-compassion and are recognized by society as worthy of support. And, clearly, the death of a competent adult who doesn’t have access to MAiD but chooses to hasten their death by means other than VSED falls into the same class as MAiD and VSED. And yet, we will commonly refer to this death as some sort of suicide, and record it as “Suicide” on the death certificate.
In addition to the harm done to our public discourse by the misuse of the word “suicide” in this context, our suicide statistics are corrupted and we have no way to gather data about this hidden species of death. Society would be well-served to understand what proportion of the population chooses to hasten their death. Only by measuring a phenomenon can we hope to understand it and craft beneficial public policy in response to it.
But to measure it, we have to name it, like we do for every other species we identify or discover. As one example, consider the beginning of a person’s life. When the need arose to talk about a surgical alternative to natural childbirth, we didn’t refer to it as “physician-assisted birth,” “medical-aid-in-birthing,” or “hastened birth.” We gave it a name: “caesarian.” But where death is concerned we fail to make use of clear and simple language. The terminology for a hastened death is wholly inadequate and has become a word salad.
For the time being, let’s name this hidden species “euthanauto,” a word coined by Dr. John Darland. A MAiD death and a VSED death would both be classified as “euthanauto.” So would the death of any competent adult suffering from an irremediable medical condition who choses to hasten their death. And now we can banish the dozens of descriptions, both euphemistic and pejorative, such as “hastened death,” “self-deliverance,” “rational suicide,” and the still extant and execrable “physician-assisted suicide.”
What is needed to make this a reality is for the name to go viral, and for academia to adopt it. The use of the name needs to gain some degree of critical mass in writing and conversation in order to reset the public debate. This process starts with you, dear reader. The next time you discuss the subject, use “euthanauto” instead of the description du jour.
Once this happens, we also have the solution to how to record VSED on a death certificate. “Euthanauto” would be added as an available “Manner of Death” and everyone’s job just got a little easier.
Editors’ note: Final Exit Network acknowledges that individuals may use different words to describe a well-considered, chosen death. The purpose of this blog is to encourage thoughtful discussion and the exchange of ideas related to end-of-life choice. Opinions expressed by contributors are their own, and we welcome respectful dialogue that reflects the diverse perspectives, values, and experiences of those engaged in these important conversations.
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Final Exit Network (FEN) is a network of dedicated professionals and caring, trained volunteers who support mentally competent adults as they navigate their end-of-life journey. Established in 2004, FEN seeks to educate qualified individuals in practical, peaceful ways to end their lives, offer a compassionate bedside presence and defend a person’s right to choose. For more information, go to www.finalexitnetwork.org.
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Thanks, Doug, for raising this vexing issue. Not sure the term “euthanauto” is doing it for me, but I agree that our current terminology doesn’t reflect the important distinction between shortening one’s life via a death of desperation, isolation, and often violence versus someone who may be very ill, infirm, and suffering, who wishes to shorten their death process.
The most recent personal example of this was a friend who wanted to stop her chemotherapy because the side effects were so devastating, but didn’t know whether her oncologist would “allow it” and wanted to make sure her death certificate didn’t say she committed “suicide.” Of course, she was “allowed” to refuse lifesaving medical treatment, and of course, her death certificate did not list “suicide,” but the potent societal pressure regarding the term is reflected in her ambivalence about exercising her very basic rights.
Why not just use the word “chosen.” It seems to me that this word carries no baggage, is simple , uncomplicated, and expresses our right to die.
Manner of Death: Chosen
I really like this simple and succinct term.
I like it too, sort of. But the problem is, violent suicide is chosen, too!
While I agree that terminology is powerful and important, the coinage of “Euthanauto” will not change hearts and minds. This sentence: “MAiD and VSED are acts of self-compassion and are recognized by society as worthy of support.” is simply not true. In a recent example, the End Assisted Suicide coalition earlier this month filed simultaneous federal lawsuits in New York and Illinois, challenging the constitutionality of those states’ assisted suicide [i.e. MAiD] laws. The coalition’s legal efforts to purportedly protect the rights of people with disabilities and other vulnerable populations, follow previous actions in California, Colorado, and Delaware. Religious, medical and legal adversaries will continue to attempt to prevent and dismantle advances by right to die advocates no matter what they’re called.
In Wussler’s proposal for a new word to replace suicide, he lumps all MAiD laws together. This is misleading, since the laws differ. For example, when it comes to what is put on death certificates, in an October 2020 article law professor Thaddeus Pope lists three differences: some states specify the underlying illness; some prohibit use of MAiD as the cause, and one offers no guidance. (The Journal of Health and Life Sciences Law, pp. 52-3.) No state, at least in 2020, used “Natural.” I am not aware that any state has specified “natural.”
As for a new word for suicide, in 2015 an international working group formed at the 2014 conference of the World Federation of Right to Die Societies, proposed dignicide. Other new words have been proposed since then, but none has taken hold. (The working group report is available upon request.)
I also like ‘chosen.’ Yes, that would include violent suicide, but that IS still chosen. Sorry, but euthanauto brings to my mind a vision of death by an intentional single car crash.
Author’s Response to Comments
In response to Bill, a death certificate needs to be filled out with a “Manner of Death” and a “Cause of Death.” All my references are to the “Manner of Death.” Pope is writing about the “Cause of Death,” except in footnote 165 where he cites a New Jersey regulation to “mark the manner of death as ‘natural’”. Pope’s article is available to all and can be found here: https://www.thaddeuspope.com/images/Pope_-_J_HEALTH_LIFE_SCI_LAW_2020_MAID.pdf
Bill is correct, though, that as a matter of convenience I had lumped all the MAiD laws together. I did this because the journal article I referenced in the third paragraph says: “However, in most of these 11 jurisdictions where MAiD has been legalized,
physicians are required to list natural death, instead of suicide, as the manner of death on the death certificate.” Perhaps I erred in taking this shortcut.
Bill is a seasoned veteran in our cause and I am a relative newcomer. I regard Bill as an ally and important contributor. I commented on Bill’s suggestion for a neologism in this blog four years ago. Readers can find that post here: https://thegooddeathsocietyblog.net/2022/07/31/terminology-for-ending-ones-life-at-the-end-of-ones-life/
In response to Jim, who I know as someone with a breadth and depth of knowledge about our cause that far exceeds my own, I had to research his reference to the “End Assisted Suicide” coalition. Their website includes content about the lawsuits Jim refers to. In California, the suit is under appeal after originally being dismissed. In Colorado, the suit has been recommended for dismissal. In Delaware, the suit has been appealed after being dismissed. The suits in Illinois and New York have just been filed.
I concede that there will always be adversaries throwing tacks in the road. But I would dispute that this means that society does not support MAiD and VSED. VSED is legal everywhere, and with a reasonable amount of effort, a person can find or enlist the support they need to use it. MAiD, while moving slowly, nevertheless continues its inexorable march. A quick web search turned up this Gallup poll: https://news.gallup.com/poll/648215/americans-favor-legal-euthanasia.aspx. We can certainly debate the point, but I claim the preponderance of evidence shows that society, in general, supports MAiD and VSED.
I also concede our adversaries will not be swayed by anything we do or say. But I am not trying to appeal to our adversaries. I am trying to appeal to our allies and to the undecided. Uniting behind a common name for the thing we support is step one. That lets us frame the debate and is a big step toward normalization. I claim that a debate over euthanauto allows people to think about the issue differently than a debate over -suicide or -death. Look at that Gallup poll to see for yourself.
To Meg, it’s not clear what you are referring to. What is it you like? “euthanauto” or “chosen.”
To Elizabeth, “chosen” is an adjective and “chosen death” is the description du jour.
To Bev, our wonderful board member, you agree the terminology is inadequate but then you throw up your hands. Any new word requires getting used to. If you are interested in exploring further, review this post from four years ago, and be sure to read through the comments too: https://thegooddeathsocietyblog.net/2022/07/31/terminology-for-ending-ones-life-at-the-end-of-ones-life/
Thank you all for engaging!
Thank you for this thought provoking article, Doug. I agree that we need a term to go viral and I tend to agree with Elizabeth Dillman’s suggestion for the simple term “chosen”. It’s accurate and rolls off the tongue a lot easier than any other suggestions I’ve heard.