Article

The Need for More Accurate Terminology in Discussing End-of-Life Options

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Abstract

The letter by Dr Workman1 in response to the article “Health Care Costs in the Last Week of Life: Associations With End-of-Life Conversations,”2 as well as the reply from that article's authors,3 clearly points out the need for the use of more accurate terminology when discussing end-of-life care and interventions. I suggest that the dialogue include accurate value-neutral terminology when discussing the choice of a mentally competent, terminally ill patient to consume medication prescribed for the purpose of bringing about a peaceful death. This medical practice is increasingly referred to as aid in dying; this term has been adopted by the American Public Health Association, the American Medical Women's Association, and the American Medical Student Association. Those opposed to the practice intentionally use inaccurate, pejorative terms such as “assisted suicide” despite the widespread recognition that the choice of a dying patient for a peaceful death and “suicide” are starkly and fundamentally different. We applaud the discussion of the need to be sensitive in the use of terminology in the end-of-life arena and hope it extends to this medical practice as well.

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Article
Zhang et al1(p480) introduce their study about communication at the end of life by observing that “Life-sustaining medical care of patients with advanced cancer at the end of life (EOL) is costly.” However, their data suggest that such “life-sustaining” treatments do not prolong life, although they clearly show that such suffering-inducing treatments result in a poorer quality of death.If treatment at the end of life is to be appropriate to the context, linguistic changes are required. So long as treatments are invariably conceived of and offered to such patient groups as “life sustaining,” physicians will have the very difficult task of convincing people that death is preferable to life. How many patients with terminal cancer would prefer suffering-inducing treatments over life-sustaining ones?