The Impact of Language in Discourses on Physician Assisted Dying: Untangling Threads of Discord in the Case of Brittany Maynard

Background:Physician assisted dying for the terminally ill is permitted in only a handful of places in the United States. However, locales continue to actively consider the issue through legislation or legal action. The year 2015 saw physician-assisted death legalized by a Supreme Court decision in Canada, and by legislative action in the State of California. Prior to this legislation, in 2014, 29 year-old California native and Oregon transplant Brittany Maynard became an outspoken activist in the Death-with-Dignity movement at the national level. During the course of her advocacy for terminal patients’ rights to hasten their deaths, she identified use of the word “suicide” as “inflammatory”. Polemic internet communication surrounding Maynard’s case constitutes a salient case study in the most recent chapter of this ethical and moral debate. As hastened death is increasingly discussed and legalized, social work and other disciplines providing services to persons and families facing the end of life should actively consider ways to think and talk about physician assisted dying.

Method: This study uses discourse analysis to examine publically available internet texts focusing on individuals contesting the ‘best terminology’ to use in debates focusing on Maynard’s story and advocacy. Internet articles were selected for inclusion if they contained contestations about correct terminology in both the article itself and in comment threads related to the article. These articles and qualifying comments, totaling­­­­ 173 pages of text, were coded for major themes, then recoded and labeled based on fitness with three major themes emerging from expressed meaning behind contestations of correct terminology.

Findings: I argue that reasoning offered in declarations of ‘correct’ or ‘best’ terminology within these texts gives a candid view of what is important to individuals taking part in the debate. Three major themes emerging from the data include defending agency, relation, and moral acts; seeking an objective truth; and concerns about sociocultural morality. For those defending agency, relation, and moral acts, it was important to feel like their death choice, or the choice of their loved ones, was a moral choice that they indeed had the right to make. Individuals appealing to some objective truth often argued that there was only one correct and objective name for physician assisted dying. Finally, concerns of sociocultural morality often hypothesized that what physician assisted dying is called could have serious effects on a national morality.

Conclusion: Linguistic and medical anthropology offer useful theory for helping social work consider cultural beliefs about terminal illness and meaning in language disagreements surrounding physician assisted dying. Using these theories and emergent themes, discussion focuses on how social workers might approach language and dialogue surrounding death choices in thoughtful, respectful, and productive ways to both enhance resource access and build sound therapeutic alliances in end-of-life care. Finally, this analysis helps to inform future social work research about communication and values at the end of life as physician assisted dying becomes more widely accepted and available. Whether in a national debate, social work research, or at our clients’ bedside, language matters in death choice discourses.