Words have power. Language has power.
The words we use may comfort or shock, allay or provoke, sooth or batter. Words often imply layers of meaning that are not explicitly articulated, yet rest beneath the surface:
“I worry that time is short for you” (You are dying) (I care about you)
“I wish we could have done more” (Nothing would have changed her death) (I am on your side)
“I hope with you that you’ll get better, but I think we should prepare in case things don’t go as we hope” (You are not getting better) (I support your hope)
I can think of no situation in which there is greater variation in how our choice of words varies than how we explain cardiopulmonary resuscitation (CPR). Many people, including me, vary the language we use depending on our recommendation for treatment. Some use more drastic language than others. Here are some examples I have encountered, again with possible implied meanings in parentheses:
“Would you like us to restart your heart if it stopped beating?” (Please say yes) (I’m just asking as a formality)
“Would you like to allow us to let you to die naturally?” (Saying no goes against nature) (We have an unnatural power over life and death)
“Would you like us, in what would naturally be your final moments, to press on your chest and break your ribs, shove a tube down your throat and poke you with needles in lots of places in a chaotic attempt that has a very small chance of giving you more time to be technically alive but unlikely to ever return to meaningful communication with others?” (Please say no) (CPR is horrific) (I don’t want to have to do this to you)
“Do not punctuate the end of your life with a senseless act of brutality!” (You’re crazy if you say you want CPR)
Using persuasion to argue for something we believe is in a patient’s best interest is ethically permissible. Coercion – the use of force or threats – is not. Guy Micco, a physician ethicist in the East Bay, talked with a philosopher who preferred the terms “influence” and “undue influence.” “Influence” is, of course, permissible – the line not to cross is the “undue” one.
Where do you see the line with these statements? What language do you use? Do you find yourself varying the language you use based on your recommendation for or against CPR? Does “unbiased” language exist?
Alex Smith is an Assistant Professor of Medicine, Department of Medicine, Division of Geriatrics at the University of California, San Francisco who blogs at GeriPal.
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