Battles of terminology in bioethics

Back in 2008, Michigan voters were asked to approve the use of embryos in stem cell research. The names of the two opposing advocacy groups give a flavor for the strategic maneuvering by both sides: the opposition group called itself the Michigan Citizens Against Unrestricted Science & Experimentation and the pro-research group called itself CureMichigan.

This is of course just one example of many we can name where those on opposite sides try to influence the debate by labeling it in their favor.  (I am going to be lazy and not put quotes around the terms as I should in what follows).  Pro-choice vs pro-life. Research participants vs research subjects.  Patients vs clients (or, as in UK, service users).  And of course physician assisted suicide vs physician aid in dying (among others, the latest being simply ‘hastening death‘).  I’m trying very hard not to use the term _olitical _orrectness as that sets people off in different directions too.

Two things are certain about these battles. One, at some meeting or other in which one of the above issues is being debated, someone will insist on a certain terminology because the opposing party’s term is ‘offensive.’  Two, once the discussion about terminology starts, there is rarely a resolution, only occasional cowed acquiescence and more often many rolling of the eyes. (I must admit I have done my share of eye rolling.  I can happily report, however, that in my experience the tendency to eye roll seems to be one of temperament rather than ideology, as people on all sides seem to engage in it).

I think the following are true and widely accepted:

1. Terms used in bioethics discussions and debates are often, or even usually, not neutral.
2. Not all people, even on the same side of the debate, insist on terminological correctness.  This is true in assisted death debates in some places where, for example, in Belgium and Netherlands, assisted suicide and euthanasia are terms built into the laws.  In contrast, US laws permitting the practice usually reject the term assisted suicide.

The following premise may or may not be acceptable to all.

3.  An ethical issue should be something that should be resolved through, well…, reason, and not simply by asserting and manipulating power and influence.  The final terminology should be the result of a reasoned debate, not a means to wield power.

To insist on a universal use of one’s own preferred term while the debate is in progress therefore seems unreasonable (if you accept 3) since it is asking one’s opponent to adopt a position that is still being debated.  In fact, it is unclear, if you accept 3, that insisting on neutral (people who have not taken sides yet) parties using the preferred terms is a reasonable request either.

But doesn’t this ‘privilege’ the status quo position?  Not necessarily.

The most fair conclusion, it seems to me, is that we should respect the use of terms of each side’s own choosing, to the same extent that we should respect each side’s attempts to explain and persuade.  To insist that the other side, or even neutral parties, start using one’s own preferred term is to put the conclusion ahead of the premise. Or as logicians put it, it is begging the question.

Some implications:

1. Academic journals should refrain from imposing on authors a specific terminology in an ongoing debate. It would be an unnecessary ideological intrusion to insist on a particular terminology while the debate is in progress.  For example, editors should not insist on either “research subject” or “research participant”–they should let the authors choose.
2. It does not help to say that the other side’s terms are ‘offensive.’ This assertion is true only if the other side is wrong. But that is precisely what is being debated. Practically speaking, such a claim should be supported by an argument rather than simply insisted on; otherwise, it is a form of intellectual bullying.  Academics’ opinions and views are regarded with special weight because they are seen as objective arbiters (at least to some degree).  The duty to refrain from trying to win a debate by insisting on a more friendly terminology is therefore especially pertinent for academics.

 

 

JAMA special issue ‘Death, Dying, and End of Life’

This week’s JAMA has several articles and an editorial on various issues in end-of-life care, including assisted suicide/dying and euthanasia.  Here’s the editors’ summary of the issue.  There are excellent articles for and against assisted suicide, a commentary by a prominent Canadian doctor on recent events in Canada, a masterful summary of key end-of-life care issues by Atul Gawande (free to anyone), among others.  The issue addresses not just the assisted death controversy but puts it in a broader context of what it’s like to die in modern society, and factors that so sadly work against helping people achieve a good death in these modern health care systems.