Bioethics Forum Essay
Ethics, Advocacy, and Euphemisms
Choosing the right words to express what we want to say is a basic part of our communication with other people. Yet we also choose words not just for their precision in expressing what is on our mind, but also to reflect what we value or disvalue, to reveal shades of emotions, to persuade or dissuade.
I want to talk about one common use of words that has a special bearing on ethical discourse and debate. It is the use of euphemisms, defined in the dictionary as “a mild or less direct word used rather than one that is blunt or may be considered offensive.” My interest focuses on a deliberate choice of words (or phrases) designed to advance an ethical or political position, or a no less deliberate aim of extirpating words from ordinary discourse thought to be harmful to one’s convictions or political cause.
A number of us who believe serious health reform will require cutting Medicare benefits together with raising taxes have been urged not to use the word “rationing” in or around Washington or in the hinterlands. It is considered a politically toxic word by right and left in Congress though common by now in the medical and policy literature. Sarah Palin’s “death panels” was an obnoxiously brilliant way of enhancing the long-standing political phobia about the government making decisions that could potentially limit life-extending treatment.
It is not, however, easy to come up with a good euphemism for rationing, though “setting limits” and “resource allocation” are the common code words. The argument, in short, is not whether rationing will be necessary– that is taken for granted– but how prudently to talk about it in the public square. I favor using the word openly, hoping the public and their legislators become accustomed to and, to some extent at least, comfortable saying it out loud. Many people whose prudence and political sensitivities I respect disagree with me.
I will move on to some uses of euphemisms which go well beyond prudence, to outright deceit: “ethnic cleansing” to remove undesirable ethnic groups from areas or countries, and sometimes sliding into genocide; “collateral damage,” a military euphemism for the killing of innocent civilians; the historical “removal and resettlement” of American Indians in the 19th century, verbally covering up a ruthless theft of their traditional tribal areas.
Moving back to medicine and health policy, I can do no better than to recall the early debates in the 1960s and 1970s that I was caught up in as I moved to a pro-choice position on abortion. Clearly, many of my fellow advocates sought euphemisms for the actual procedure, any phrase or word that would avoid acknowledging that abortion is the outright killing of fetuses, often by chopping them up, crushing their skulls, and otherwise destroying them. Better to talk about “emptying the uterine content” or “terminating pregnancy.” A recent and notable addition to the list is to speak not of infanticide but of “post-birth abortion.”
Another example that comes to mind is the phrase “sex workers.” It emerged as part of the sexual revolution–what’s wrong with turning sex into legitimate market product?–but it also covers up the fact the fact of widespread abuses and subjugation of women, usually poor and uneducated. If whores are just sex workers, then their pimps are, I would judge, just managerial facilitators, doing their entrepreneurial bit for prostitution capitalism.
Recall as well the recent history of the euthanasia/physician-assisted suicide (PAS) debate. When ballot initiatives to legalize euthanasia in California failed in the mid-1990s, advocates for it decided that it would be wiser to go for PAS, and that strategy was successfully used in Oregon and Washington. I call that shift, however, a tactical and not euphemistic move. Yet the next stage of advocacy has been to get rid of the word “suicide” altogether, thought (no doubt correctly) to be harmful to the cause. And not only that, but to argue that a patient asking a physician for drugs to kill himself is not suicide at all. Instead, as the advocacy organization Compassion and Choices likes to put it, it is just a “choice,” not to be confused I suppose with jumping off a bridge or shooting oneself, which is, well, something else. That strategy may well work with those not addicted to the dictionary and traditional legal definitions of suicide, looking less inflammatory formulations.
The concept of “choice” as an advocacy tool requires an even closer look. It has typically been deployed when the legal status quo is that of an inability to make a choice. Obvious examples are the situation of prohibition laws in the 1920s denying the legal possibility of buying alcohol beverages, or that of a right to purchase contraceptives (overturned by the 1965 Griswold Supreme Court decision), or the 1973 decision ofRow v. Wadeto legalize of abortion. In each case, the aim was to empower people to make choices where none had earlier been legally possible. The word choice was used as an apparently neutral term whose aim was designed to legitimate the desired change. Politically it is less charged than the phrase pro-abortion, but in the hands of those favorable to abortion that is exactly the meaning they intend to convey. And it has worked.
I note that rhetorical effectiveness as one who is pro-choice on abortion, but I do not kid myself that killing fetuses is nothing more than “emptying the uterine content.” I no less oppose the use of choice as a way to redefine, and semantically hide, the fact that the aim is to empower patients, with the aid of their doctors, to commit suicide. I am thus not pro-choice on PAS. But then I am not pro-choice on the right of citizens to carry concealed weapons, on the right of patients to choose futile and expensive care from their doctors, or the right of mothers to choose genital mutilation for their daughters to uphold some cultural traditions. Choice is not a neutral word.
George Orwell made part of his reputation by underscoring the government manipulation of language to serve totalitarian causes. But euphemisms can also be used as smoke screens to serve good causes in the name of prudence, in the name of expanding the range of freedom, and for moral and political causes that can only be fully judged in the sunshine of straight language.
A final example. Doctors of late have been urged to be more open with patients in presenting a candidly unfavorable prognosis in a critical illness. Euphemisms based on the obligation of physicians to inspire hope in their patients have been taken as a long-standing, serious moral duty. Should the naked truth always be spoken to anxious patients and their families? No, sometimes it is prudent not to do so. But then neither should hope be offered in a way that seductively leads patients and families to want aggressive life-sustaining treatment continued that will be all but useless. The ethical problem is that of discerning the lines between prudential, seductive, and manipulative language. I do not claim they are always easy to see.
Daniel Callahan is cofounder and President Emeritus of The Hastings Center. His memoir will be published this year.
Posted by Susan Gilbert at 04/04/2012 11:04:48 AM |