"Assisted Suicide," "Euthanasia," and "Depopulation" — What's in a name?

These are are important words, but their definitions — and the policies attached to them — are often scarily squishy

There is a lot of attention being paid to assisted suicide these days, at least in Europe. In the Netherlands, there is the case of Zoraya ter Beek, who plans to kill herself in May with the help of a physician and the permission of the state because of severe and intractable depression in spite of what appears to be a life that many would envy. Over in the UK, forces in favor of voluntary death may be headed in the same direction, though it is unclear exactly where that debate will end up.

What should we do when someone (ostensibly?) wants to die? Of course, traditionally, and actually, still, in most countries, including most of this one, we have made it as hard as possible to choose to die, either with criminal sanctions for anyone who helps out, or with religious visions of eternal damnation. Is it time for that to change?

Even if we believe that people should be allowed, according to certain standards, to decide to die, there are obviously many factors to consider in addition to the necessary prerequisite that the person sincerely wants death. Adolescents, in particular, are famously prone to social contagion, and there is no question that suicide can be “catching.” And what about the folks who go along too easily with the idea that they are a burden that should be erased? Or those who are in a bad situation that perhaps could be changed. In a recent survey, 28% of Canadians thought that homelessness was a legitimate reason for someone to be helped out in their decision to shuffle off this mortal coil. Just a suggestion, but couldn’t we just build more housing?

Assisted suicide is, I guess, a subset of euthanasia, though it is seen as quite different because it is so strongly fortressed by the permission, even eager pursuit, of the one who is going to die. “Euthanasia” usually refers to killing someone else, but for all the right reasons. But they aren’t really that different since the one who is to be euthanized is presumably unable to make the choice to do so, so we are merely substituting our own judgment for theirs in determining that their lives are not worth living. At least, I think that is what we are doing.

In fact, given the stakes, it certainly seems worth carefully considering what exactly we mean when we say “euthanasia.” A dictionary definition is “the act or practice of killing or permitting the death of hopelessly sick or injured individuals (such as persons or domestic animals) in a relatively painless way for reasons of mercy.”

Since euthanasia doesn’t involve the choice of the one who is going to die, it only makes sense that the standards would be higher than those for assisted suicide. Thus, “hopelessly sick or injured” wouldn’t, presumably, include depression, even severe depression. I’m not discounting the pain depression causes but only pointing out that most of us would agree that a depressed person still has the emotional wherewithal to decide for themselves whether it is bad enough to want to die, that many of them would opt to live, and that other people shouldn’t be making that decision for them.

Having had a mother who died at 96 after a long, long time during which she was living with dementia, which ultimately became severe, it’s a topic that has occupied my thoughts. Since assisted suicide is impossible for anyone in that situation since they aren’t in a position to make that decision for themselves, is euthanasia out of the question?

Anyone who glibly talks about the sanctity of life in such situations needs to visit nursing homes on a regular basis and witness the warehouses in which we store the many, many people who are alive but who not only are no longer able to “contribute” in any meaningful way but who also seem to exist in an inaccessible shadow world. What are their lives worth to them? I honestly don’t know how to answer that. With a full and impassioned salute to the work of those caregivers (and they vary considerably) who treat people who seem to be hardly there with kindness and a semblance of dignity, it is hard to come away from such places and then multiply them in your head by the number of nursing homes in the US, then expand that around the globe, and not at least wonder whether we are doing the right thing.

People used to die much more conveniently by way of pneumonia and other afflictions that we now easily cure, even in the most compromised bodies with the most compromised minds. Thus, to pretend that the only thing affecting our willingness to consider euthanasia that has changed since days gone by is our attitude, i.e., that we have become cold and callous and driven solely by utilitarian calculations and fundamentally lost the plot, is, I think, wrong.

But so is killing people. And the fact is that nursing homes, family members, and people who write living wills ahead of time already sort of make those kinds of decisions all the time. Do we keep them alive as long as possible using all of the bells and whistles modern medicine can supply, or do we let them drift away without trying to grab them back? And perhaps with the aid of morphine to “ease the pain”? Withholding care is very different from actively killing someone, they tell us. But is it?

I remember being at work one day and getting a call from my mother’s nursing home saying she had an infection and asking me if I wanted them to withhold antibiotics. So, basically, do you want your mother to die today? I was completely unprepared for this question, and said no. I have never really believed it was the right thing to say, but I don’t think, even if I had the opportunity to think long and hard about it, that I could have said yes. She died not too long after from the flu, which wasn’t treatable. It was a relief, no question, but it was still the day my mother died. For most of us, that is not, under any circumstances, a good day or one that we want to control.

So when do we say yes? Ever? Is saying yes just heading toward an inevitable place where we off everyone with dementia? And how much dementia? Or will we continue to say no and expand the warehousing, keeping everyone alive, sort of, for longer and longer, at greater and greater expense, paid for by Medicare, then savings (unless the financially savvy have protected them), then Medicaid? At the risk of repeating myself, I have no idea.

Of course, the other place that “euthanasia” gets talked about a lot is with animals, and, if you are at all worried about language creep, this should set your hair on fire. It used to annoy me to no end (actually, it still does) that some (not all) animal shelters talk about “euthanizing” dogs and cats who are perfectly healthy but simply unwanted. My point here isn’t whether killing these animals is the right or wrong thing to do in any particular situation. That’s a much bigger question. I’m merely saying that killing someone because you have no satisfactory place to put them is not euthanasia, at least in the way we use it for people.

However, It seems very clear that, when referring to dogs and cats in shelters, the word “euthanasia” is used to mean killing by humane means, such as an injection, rather than using more traditional methods, such as gas chambers or shooting them in the head. But killing someone, even “nicely,” because they have no place to go, is not euthanasia, at least according to the dictionary. Though, I suppose, at some point the dictionaries will catch up and add a new definition.

Of late, when referring to animals, animal use industries have gone further and gotten rid of the idea that “euthanasia” even requires that they be killed nicely. The meat industry now uses the word “euthanasia” to refer to pretty much any means of mass extermination, no matter how brutal, of animals that their business model didn’t plan for, like the pigs stuck in the slaughter pipeline when the slaughterhouses were closed suddenly because of Covid, or the chickens killed by the millions, but nevertheless bought and paid for by taxpayers, because of potential contamination with bird flu. In fact, in addition to “euthanasia,” they are also using a new word, i.e., “depopulate,” which is defined as “to reduce greatly the population of.” So clean, so nicely removed from the horror, so easy to swallow.

These are important words and phrases. Their evolution should not be ignored. For some, “assisted suicide,” or, essentially, self-euthanasia, no longer necessarily requires physical illness or injury to be socially sanctioned. “Euthanasia” of a human still requires illness or injury and humane death, and is still by and large illegal, but the line between killing and allowing to die by withdrawing care and treating pain are fuzzy. “Euthanasia,” when referring to an animal, now means, depending on the animal, either killing by humane means for injury or illness, or killing by humane means because of homelessness or a bad personality or inconvenience, or killing by incredibly brutal means for convenience and economy. “Depopulation” means… honestly, I don’t even know what it means. But it gives me chills.