HomeHealthHow Aid in Dying Became Medical, Not Moral

How Aid in Dying Became Medical, Not Moral

In rural Iowa, Peg Sandeen reflects on the challenges she faced living with AIDS, particularly the judgment from her neighbors. Her husband, John, fell ill in 1992, and rumors quickly spread. Despite their efforts to overcome the stigma, their situation only worsened. By 1993, John’s disease had taken a toll on him, and he was running out of options. With the desire to have control over his own fate, John wanted to use life-ending medication to die on his own terms. Unfortunately, he had no way to communicate this to his doctors. The public debate on assisted dying in Oregon at that time was filled with highly charged words such as murder, euthanasia, and suicide, none of which captured John’s true intentions. Peg emphasizes that John did not want to commit suicide, as he cherished his life, his wife, his 2-year-old daughter, and his passion for playing guitar. Peg, now the CEO of Death With Dignity, an organization supporting aid-in-dying laws, believes that using the word “suicide” only added to the already existing judgment surrounding HIV and AIDS. She regrets that John never had the opportunity to discuss his wishes with his physicians, as the societal stigma made it nearly impossible to approach the topic as a medical matter rather than a moral one. John eventually passed away from the virus while the Death With Dignity Act was still pending in Oregon. Since the act’s implementation in 1997, over 3,700 Oregonians have utilized its provisions. Similar laws have been passed in ten other states and Washington, D.C. Alongside these changes, there has been a shift in language. Many health advocates and medical professionals argue that a terminally ill patient choosing to accelerate the end of their life is fundamentally different from suicide. They prefer using terms like “medical aid in dying” to emphasize the fact that these individuals are not deciding whether to die, but rather how to die. The distinction lies in the inevitability of death due to a terminal illness. Dr. Matthew Wynia, director of the University of Colorado’s Center for Bioethics and Humanities, emphasizes the difference between someone ending their life due to mental illness and someone with a terminal diagnosis making a similar choice. In the 1990s, advocates for assisted dying faced an uphill battle, as two bills in California and Washington failed and opponents framed the practice as physician-prescribed death. To overcome this challenge, supporters rebranded and repositioned the movement. The Death With Dignity Act avoided defining the practice itself and instead clarified what it was not, including mercy killing, homicide, suicide, or euthanasia. This ambiguity led to the need for new terminology. In 2004, advocates discussed adopting the phrase “medical aid in dying” to assure patients that the practice was regulated and medically sanctioned. Medical legitimacy was crucial, as patients and their families often felt stigmatized when terms like “suicide” were used. Dr. Anita Hannig, an anthropologist, notes that such language created shame, isolation, and lack of support for grieving families. Patients also concealed their true wishes from doctors out of fear of judgment or because they struggled to reconcile their beliefs about suicide. Unlike the previous term “physician aid in dying,” “medical aid in dying” places the focus on the patient and emphasizes that it is the patient’s decision, not the physician’s. Additionally, the medical community needed a neutral phrase that could be used for research and discussions. Previously, doctors defaulted to terms like “assisted suicide” or “death with dignity.” The lack of agreed-upon terminology prompted the need for a more neutral alternative. While some organizations, such as the Associated Press and the American Medical Association, still prefer terms like “physician-assisted suicide” for precision and clarity, others support the use of “medical aid in dying” to reduce stigma and emphasize patient autonomy. The evolution of medical language, such as the concept of brain death, has historically shaped our understanding of death. The Harvard Medical School’s committee in 1968 introduced the concept of “irreversible coma,” now known as brain death, which established a new criterion for death. This legal definition revolutionized organ transplantation worldwide. Doctors have been assisting patients seeking a more peaceful end throughout history, often in secret or under euphemisms. Terms like “hastening” were briefly used after the enactment of the Death With Dignity law to convey that physicians were simply nudging along an impending fate, but it failed to gain traction. Eventually, the name of the law itself became the preferred term as it allowed patients to raise the topic with their doctors in a less taboo manner. Even after retiring, Dr. David Grube, a former family physician in Oregon, still uses the term “medical aid in dying” to refer to the practice.