A self-controlled death: More thoughts on the language we use

I have read with interest the contributions to the discussion about what words we should use to accurately describe the kind of death or dying experience supported by the Final Exit Network (FEN), Compassion and Choices, the Death With Dignity National Center, and numerous state and local organizations.  Basically, it is the right to die on our own terms.

Many others have pondered this issue and made suggestions, some trying to find just the right word or words to replace the old words suicide and euthanasia, which have linguistic baggage for many of us in the US and do not adequately describe the right as it is practiced in states that have lethal prescription end-of-life laws, and among those who use the training and education provided by FEN to die on their own terms by breathing inert gas.

David Leven and I have explained on this blog here and here why we oppose use of the terms “suicide” and “euthanasia” to describe voluntarily ending one’s own life.

As Derek Humphry has noted, those involved with the Hemlock Society often used the term “self-deliverance” to describe a voluntary planned death.  Jack Kevorkian chose terms like “thanatron” and “mercitron” for two devices he invented to help people end their own lives, and he used “medicide” to describe a planned death with the help of a physician.  

Others writing on Humphry’s ERGO Listserv have noted that “death with dignity” is a common phrase.  I try to avoid the term because of the imprecision of the word “dignity,” which means different qualities to different people and is offensive for good reason to many in the disability community.  Often, people view having personal needs (toileting, feeding, dressing, etc.) cared for by someone else as undignified, yet many disabled people can live only with such personal care.  I know that having a hemorhoidectomy can seem very undignified, for instance, as can having a pelvic exam, a mammogram, a digital rectal exam, or many kinds of surgeries, but we choose to agree to these procedures to protect our lives from disease, so that we can continue to live lives acceptable to ourselves.  From that perspective, the procedures, when experienced, are not as undignified as we may have once thought or when we considered them in the abstract.

Still others, such as Doug Wussler, have pointed to a neologism, “authanasia,” explaining that authanasia is “the self-authored end-of-life when one’s life is at or near its natural end.  Once we have such a word, it then becomes obvious that we no longer need qualifiers such as physician-assisted.”

Erik Slebos discusses the word “Socraticide,” which references ending one’s life to avoid living in agony.  “Deliberate life completion” was suggested by a friend of John Abraham (as noted by Ruth von Fuchs).  Bill Simmons mentions the words “dignicide” and “authenasia” that were the products of a group exercise to find a better expression (preferably one word) to describe the process of taking one’s own life to avoid suffering.  I apologize if I have missed anyone’s suggestions or notes about other words or phrases during this recent discussion on the ERGO Listserv.

Like Bill Simmons, I believe we need to keep working to find better ways to express what we are really talking about when we discuss hastening one’s death to avoid suffering.  I am looking for a short, readily understood phrase (one word seems impossible) that will embrace both receiving a prescription for a lethal drug from a physician and the process of self-deliverance supported by FEN, as well as other methods that may be identified or developed in the future through ERGO or Exit International.  

To this end, I have considered “self-determined death,” “self-arranged death,” “self-managed death,” “self-organized death,” “self-regulated death,” and “self-governed death.”  Finally, I arrived at “self-controlled death.”

When we look at the meaning and connotations associated with the term “self-control,” we find words such as discrete, disciplined, stable, strong, assured, composed, calm, levelheaded, restrained, prepared, orderly, autonomous, temperate, determined, peaceful, dispassionate, cautious–expressions that can apply to the process of ending one’s own life in a peaceful, planned, and determined way, to avoid suffering.  Indeed, “self-controlled” fits in well with our understanding of liberty as that term is used in the 14th Amendment (“. . . nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws”) and as it was understood by our founders, who made the concept central to their call for the freedom to control our own destinies in the Declaration of Independence.

For a while, I will try to use the term “self-controlled death” in place of “hastened death” and the other terms applied heretofore or suggested above.  I can write or say that  “Mr. Jones had a self-controlled death,” or “Mr. Jones’ death was self-controlled.”  Or, “In Oregon, we have the longest-lived law authorizing a person to obtain a lethal prescription to be used for a self-controlled death”; or “FEN members and others may have a self-controlled death using inert gas.”

Some claim that failing to use words like suicide and euthanasia in describing a voluntary hastened death is to resort to using euphemisms.  The English Oxford Living Dictionary defines euphemism as “the substitution of an agreeable or inoffensive expression for one that may offend or suggest something unpleasant.”  However, when I search for a word or phrase to describe the voluntary hastening of death, I am not searching for a less offensive or more agreeable way to describe that circumstance.  I am looking for a more accurate expression, one that conveys the values and purposes that support the decision. I am looking for words or phrases that do not deny the essential differences between a voluntary act grounded in the liberty that all people should have over their lives and their deaths, rather than an act that is driven by irrationality, impulsiveness, or desperation.  I am looking to find words that are not loaded with unredeemable and inaccurate meanings in the context in which they are used.

Suicide is not merely too harsh or blunt or embarrassing or unpleasant or offensive.  It is inaccurate based on its meaning and associations accumulated over time.  We can say about Mr. Jones, for example, that “he had a self-controlled death using Oregon’s DWDA.”  Or we can say that “Mr. Jones from Minnesota had a self-controlled death using inert gas.”  Or we can say that “he had a self-controlled death,” perhaps including a descriptor, such as peaceful, to wit, “he had a peaceful, self-controlled death,” if one feels that extra word is needed.  All these statements are more precise and accurate than “Mr. Jones committed suicide.”

I know this formulation will not satisfy everyone, but that should not be because it is a euphemism–it is not.  It is an attempt at accuracy.  I hope others can do better than I have done to find a more satisfying and accurate way to express what we mean when we acknowledge that someone died peacefully by their own hand in order to avoid a death filled with suffering.