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Don't Call It Suicide: What Words To Use In Right To Die Debate

Someone who is terminally ill and wants to die faster does not 'commit suicide,' says this German palliative medicine physician. Words matter.

The term 'suicide' is offensive to those who seek medical aid for dying
The term "suicide" is offensive to those who seek medical aid for dying
Gian Domenico Borasio


The Federal Constitutional Court held hearings in April about complaints against paragraph 217 of the German Penal Code, introduced in 2015. This law created the new offense of "business promotion of suicide", which is supposed to only prevent the activities of assisted suicide groups, but effectively prevents any possibility of medically assisted suicide. The law is in sharp contrast with the wishes of the vast majority of the population and is regarded by many legal experts as out of touch and unconstitutional.

Behind the sober legal text hides a world view that has much to do with the language used in this debate, which is in part downright inhuman. This can best be illustrated by the widespread use of the term "suicide" in Germany, whose intellectual origin is shown in the following story from the not-so-distant year of 2006.

An Italian named Piergiorgio Welby suffered from muscular dystrophy for many years. He was paralyzed and dependent on mechanical ventilation to breathe. He repeatedly asked to be unplugged and allowed to die. Finally, when a doctor followed his request, the then president of the Italian Episcopal Conference, Cardinal Camillo Ruini, denied the deceased a church funeral.

Those who commit suicide are no longer denied the Catholic burial because they are held to have committed the sin of "suicide" in a state of mental derangement. But the Cardinal declared that Welby could not be allowed a religious burial in this "attenuating circumstance" because he had asked for years to stop the ventilator. It was only marginally noted that this was not a suicide but a withholding of treatment, which is completely legal in Italy and Germany.

Old words still haunt our heads and influence our thinking.

In German criminal law, the term "murder" is defined as "manslaughter with motives' — thus one of the most despicable acts ever. As we have seen, the term "suicide" comes from a time when suicide was considered a mortal sin and those who had committed it could not be buried in consecrated grounds. Even though the gaze of society has changed fundamentally (thank God), the old words still haunt our heads and influence our thinking.

We should never forget that what we are discussing here is human suffering in some of its most extreme forms. On the one hand, there are mentally ill people who see no other way out of their desperation than suicide. On the other hand, there are people who are facing long, painful, inevitable deaths because of a physical illness and seek medical help for suicide. Stigmatizing these suffering people with the term "suicide" should be forbidden out of respect. From today's perspective, the term "suicide" used in such cases is downright grotesquely discriminatory, hurtful and unfair. It should be banished from the language.

But the issue doesn't just lie with the word on its own. Many more terms used in connection with the discussion about assisted suicide reinforce, more or less subtly, the impression that this is a reprehensible and fundamentally punishable act. In the explanatory statement to paragraph 217 (in which, thankfully, the word "suicide" does not appear), there is a lot of talk about "organized suicide assistance." The word "assistance" in German criminal law refers exclusively to the support of criminal offenses. The word "organized" in this context immediately resonates with the word "crime."

Piergiorgio Welby was denied a church funeral because he asked his doctor to unplug him — Photo: Luca Coscioni

In addition, one commits suicide. You can commit many things, but above all: mistakes, sins or crimes. Which brings us back to the linguistic connotations of "suicide."

Incidentally, the notion of "suicide" often used by suicide support advocates is problematic for another reason: here, there is a heroization of this act, behind which in turn hides a certain ideological position. We should, therefore, stick to the neutral term "self-death." As I said, the words we use shape our thinking.

Finally, a somewhat provocative thought in relation to the debate on suicide assistance. The word "suicide" goes back to the Latin sui caedere, which refers to suicide as the abrupt termination of a usually physically healthy life. The majority of suicides in Germany fall under this definition, most of which are due to potentially treatable psychiatric causes and must be prevented. It is in this domain that psychiatry, which is not always gotten praise, has made a lot of progress in recent years.

But what about those people who are suffering from an incurable physical illness and who are seeking medical help to cut short a period of dying that is considered distressing or unworthy? Is the word "suicide assistance" really appropriate in view of the stigmatization that goes along with the term "suicide"?

In some Anglo-Saxon countries, such as Canada, the term "medical aid in dying" is used in this context. This is not considered as an alternative to palliative medicine, but as necessary additional assistance in the few but unfortunately unquestionably existing cases in which even the best palliative medicine cannot alleviate suffering — both physical and existential.

Separating these extreme situations from suicidal thoughts could help create a discourse that is also free of any prejudice about how, as a society, we can best do justice to these suffering fellow human beings — it could be us one day, after all. To pursue this idea could well be worthwhile for the Federal Constitutional Court and perhaps also for the enlightened lawmakers.

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