What should we call the physician-assisted act of intentionally killing oneself near the end of life

By: Eric Widera (@ewidera)

It was a big day in California today. The California Senate passed SB 128 which would permit a doctor to provide a terminally ill patient a lethal dose of a drug with the explicit intention that the terminally ill patient make take this drug to shorten his or her life.

So here is the problem that I have when trying to put my head around this issue and write about this for GeriPal. It all starts with what to call it when a physician prescribes a lethal dose of a drug for a terminally ill patient with the intent that the patient may choose to self-administer this drug to bring about his or her death. For obvious reasons, it would be hard to say this over and over again in a paragraph (as I just did), so what should we call it when we right or talk about it?

Here are the leading options:

• Death with Dignity: I know what I’m about to say will be taken as a great offense to some who read this blog, but come on. This is just pandering. The term is vague and value laden that offers nothing to the debate over the topic except spin. It also makes it seem like this is the only road to go if you want dignity at death.
• Physician-aid in dying (PAD): I’m not loving this one either mainly because of a loss of specificity. Are we providing people aid that are dying by focusing on their comfort or are we aiding them to die by giving them medications with the intent to end their lives? Only the latter is correct but people may confuse the former with it
• Aid in Dying: I’m not even sure what to do with this one. Who is aiding who with what again
• Physician Assisted Death (another PAD): I’ll talk more about this below, but this makes it unclear if we are including euthanasia
• Physician Assisted Suicide (PAS): this is probably the most specific term for the physician assisted act of killing oneself intentionally. However I do realize that many criticize this definition as suicide is linked with mental illness and lack of decision-making capacity (both of which may I add shouldn’t be stigmatized either)

With all of this said, I feel the most technically correct phrase to use is Physician Assisted Suicide (sui: of oneself + caedere: kill).

Physician Assisted Death probably comes in at a close second for best term to use, although another worry is that it is vague enough that I don’t know if it encompasses euthanasia and/or assisted suicide (this is also true of aid-in-dying as it doesn’t state who is doing what to whom). For example,a recent NEJM article defined Physician Assisted Death as the administration of drugs with the explicit intention of shorting of life that both encompassed euthanasia or PAS. As I don’t think most people would argue for endorsing euthanasia, I think specificity is important.

So with that said, I’d love to know what term you use and why. Take my poll and leave comments below.

What should the physician-assisted act of killing oneself intentionally near the end of life be called?