Nancy Valko
May 2007
Reproduced with Permission

Last year, I attended a lovely wedding where the bridesmaids wore an unusual shade of dark brown. Many people were perplexed by the color choice but one of the bridesmaids solved the mystery with one word: chocolate. Everyone smiled and nodded.

This is a rather benign example of the power of words to change perceptions. In ethics, however, such semantics are often employed for a more disturbing purpose - to disguise reality by changing words in order to define the debate.

Here are some examples.

Blastocyst or Preembryo vs. Embryo

Creative semantics is particularly obvious in the debate over government funding of embryonic stem cell research. While the term embryo does not evoke quite the same emotions as the term baby, embryo at least does recognize a unique human entity in the eyes of probably most people. The terms blastocyst or preembryo, however, connote more of an unformed mass of cells.

Ironically, the term preembryo (also sometimes called proembryo) was originally created "with the development of in vitro fertilization (IVF) to describe egg cells (ova) that have been fertilized but not yet implanted into a uterus".1 The problem with calling IVF embryos embryos became clear when couples started custody battles over their own frozen embryos. Since the Association of Obstetricians and Gynecologists (ACOG) had redefined the beginning of life from actual conception to implantation of the fertilized egg (embryo) back in the 1960s, this left the poor embryo in a virtual no man's land, according to some ethicists. Renaming the embryo a preembryo or blastocyst for the first 14 days after conception or until implantation in the uterus gave both embryonic stem cell research and IVF supporters a mechanism for drawing an arbitrary ethical line on the scale of human personhood. According to this theory, the blastocyst or preembryo could then be denied even the minimal ethical respect given to embryos.

Of course, these terms also serve to confuse the average person about the reality of the newly conceived human being, which, unfortunately, is a tremendous political bonus to both the embryonic stem cell research and IVF supporters.

Artificial Nutrition and Hydration vs. Food and Water

Before he died, I had a chance to speak personally with the late Dr. Ron Cranford at a pediatrics conference in St. Louis in 1994. Dr. Cranford is the infamous neurologist used in such high profile "right to die" cases such as Nancy Cruzan's and Terri Schiavo's.

Dr. Cranford had just finished one of his presentations about withdrawing food and water from so-called "vegetative state" patients and he particularly emphasized the term "artificial nutrition and hydration".

I asked him to first explain how water was artificial and then to comment on tube feedings using regular, pureed food. He stammered a bit for a while but ultimately admitted that is was a bit misleading to describe food and water supplied through a feeding tube as "artificial".

Then, he went to talk to the media and, of course, once again used the phrase "artificial nutrition and hydration".

I've spoken to groups many times about this issue and I often hear from people who, in their words, don't want to be "artificially kept alive". But I have yet to hear anyone willing to give up their safe, processed water or other food items. Only the argument itself is actually artificial.

Donation after Cardiac Death vs. Non-Heartbeating Organ Donation

When I first started investigating non-heartbeating organ donation (NHBD) in the early 1990s, I was appalled. This new rationale for taking organs from people who were not even considered "brain dead" really seemed to be an unholy marriage between the "right to die" groups promoting withdrawal of treatment decisions and the aggressive push for more organs to transplant.

But I found that the term "non-heartbeating organ donation" even confused many ethicists when I first told them about my concerns. In the late 1990s, I attended a conference on NHBD at St. Louis University's Center for Health Care Ethics and the majority of the doctors and nurses seemed to be confused and/or skeptical about the whole idea. But proponents continued to quietly work to increase NHBD's acceptance as an ethical way to increase the number of organs harvested.

But I noticed that when NHBD became better known and organ-harvesting protocols were being rewritten, there was a major language change. NHBD became donation after cardiac death (DCD) and the few news articles calling attention to this sea change in organ donation ethics started mentioning patients who were "imminently dying". Apparently, people were already conditioned to the term brain death and thus some kind of phrase using death was needed and donation after cardiac death seemed to work better than NHBD. And the term "imminently dying" seemed immensely more reassuring than the description of the potential NHBD donor by a Wisconsin organ procurement organization as "a severely neurologically injured patient who is expected to expire within 120 minutes following extubation".2 (emphasis added)

Physician-assisted Death vs. Physician-assisted Suicide

More than 10 years ago, Oregon became the first - and so far the only - state to implement a law legalizing physician-assisted suicide. Over the years, several other states came close to enacting similar laws but despite initial polling showing widespread support, those proposed measures ultimately went down in defeat. Euthanasia supporters were baffled.

According to Wesley Smith and Rita Marker in their March 2007 National Review Online article,3 the group Compassion and Choices (formerly know as The Hemlock Society) commissioned research and polling that showed the term suicide gave people a negative impression.

In an effort to get the word suicide out, Compassion and Choices sent a formal request to The Oregon Department of Human Services suggesting such name changes as "aid-in-dying," "directed dying", or "assisted dying". (Future litigation to affect the change was apparently implied.)

Oregon blinked and on October 16, state officials announced that the new term would be "physician-assisted death".

However, some objected to the phrase because of its ambiguity and Oregon finally settled on using the cumbersome and ultimately silly phrase "persons who use the Oregon Death with Dignity Act". But euthanasia supporters were thrilled and Compassion and Choices' director of legal affairs, Kathryn Tucker, was quoted as saying "This will be a sea change because how you speak of things strongly influences how you think of them."

The old cliché "The pen is mightier than the sword" is proving true in the realms of political spin and death rhetoric. It is up to all of us to educate ourselves and use our own words and pens to publicize the truth and expose the deceptive language utilized by the culture of death.


1 "Proembryo" from Wikipedia, the free encyclopedia. Online at: http://en.wikipedia.org/wiki/Proembryo [Back]

2 "Development of the University of Wisconsin Donation After Cardiac Death Evaluation Tool", Progress in Transplantation, Dec. 2003 by Lewis, Jonathan, Peltier, James, Nelson, Helen, Snyder, William, et al. Online at: http://www.findarticles.com/ p/articles/mi_qa4117/is_200312/ai_n9306068 [Back]

3 "When Killing Yourself Isn't Suicide - Word games may win the day in the battle of physician-assisted suicide" By Rita L. Marker and Wesley J. Smith. National Review Online, March 5, 2007. online at: http://article.nationalreview.com/?q=NGYwNWM4Y2EwODRjOTViZjI4ZTJjZTQ0M2Q4NWRhZjI%20= [Back]