Language and professional power

This tweet came across my timeline some time ago. The tweet and the thread are about whether ‘die’ or ‘pass away’ should be used in palliative care. It’s another of a zillion tweets telling people how to speak and how they should be spoken to. In this blog, I want to make the point that it serves little point apart from the exercising professional power. It serves only those who discuss and not those in their care.

Before I continue, I’d like to share a story about my father’s death. My mother and I were in hospital a few days before his death and were told that he was in severe pain but nothing could be done.

“Why, I asked. Why can’t you give him morphine?”, to which the attending doctor said he couldn’t as my father might get addicted. I opened my mouth in bewilderment. A brief conversation ensued in which the doctor told us to prepare ourselves for my father’s death which was imminent, he would die within 48 hours or so. During the conversation, I said something like; “Are you for real (I started shouting), so, he will die bloody addicted!”. The doctor was not to be persuaded. Addiction for him was a real worry, even if it was to last 48 hours.

Today, when I think about it, I am still angry. Not so much with the doctor. I think he was following his training or the hospital practice. Still, I continue to be shocked by the ease with which they could tolerate a patient’s suffering and do nothing about it. And I continue to be shocked by the idiocy of the argument. Yes, perhaps my father would have been an addict for the remaining two or three days of his life. He never regained consciousness, he died a couple of days later. I don’t think he would have cared all that much about being an opioid addict.

I have no idea whether medical practices in Poland have changed since then. I do hope, however, that if I am in a such a position, I have enough friends and contacts in the medical world that they will let me die pain-free. I am genuinely scared of a cretinous idiot of a doctor who will be protecting me from opioid addiction in the last week of my life.

But the reason why I am telling the story is that I honestly cannot remember whether the doctors used the word umierać (‘die’) or odejść (‘pass away’). It didn’t register then, it doesn’t register now. Moreover, as much as I could not care less what words they were using then, I can’t give a flying….today. What I was interested in was whether they would alleviate my father’s pain. I was interested in their empathy not in the words they were using.

Let me put it differently, they could have used all the right words, as prescribed by the participants of the thread and I still would not have cared, and I still would have considered and would continue to consider the care my father received as dreadful. This is because the words medics use do not offer analgesia, morphine does. And you can put your bloody ‘die’ on a loop and it will do nothing to the suffering patient.

I also have significant difficulties in believing that anyone in a situation when their close one is dying gives a tertiary thought to whether a medic uses that or another word. Yes, possibly, after the event, you might have a view. In the situation – it’s irrelevant. And I find it extraordinary that people who care for those dying and those bereaved by their death have serious conversations about two words. It’s beyond my ken.

And here we come to the point of the thread. Almost unanimously (a few people suggested that context is important), the participants decided that when faced with ‘die’ and ‘pass away’, it is the former word which should be used. They offered a number of reasons. Here they are, I hope I got them all here:

  • ‘we’ should not be afraid to use the word ‘die’
  • ‘die’ offers more clarity than ‘pass away’
  • ‘die’ more clearly sets the scene.
  • ‘die’ is the preferred word
  • euphemisms are bad

The problems with those reasons are that they are offered without any reference to the context in which conversations happen. For example, I find the claim that people will not understand ‘pass away’ suspicious. Wouldn’t the conversation about their relative’s death not have reference to the cause of death, earlier expectations that the person is in a critical condition, funeral arrangements? Surely, it would, which in turn would dispel any doubt about what was meant. The argument is unconvincing. Indeed, I actually asked how the people referred to understood ‘pass away’  but got no answer.

Is ’pass away’ a euphemism? Yes, technically, it is. But given that the only meaning it has is ‘to die’, it’s  a very conventional euphemism, much like ‘kick the bucket’, which also has one possible meaning.  Furthermore, euphemisms have important social functions. Among others, they are used and perceived as taking care of people’s feelings and sensitivities. Life without euphemisms would be nigh unbearable. No one seems to give a hoot about hurting people or not.

No one has offered any explanation as to who ‘prefers’ the word. And as a relative of a patient who died, I can quite adamantly say that it’s not my preference – I don’t care. The thread in its entirety is really about professionals telling us, minions, what words we should use and hear. They decided that one word is better than another and now they started policing the profession and patient population. If you don’t you the word, you’re uninformed, unprofessional or just plain stupid. They created another shibboleth. Well done!

So, you might ask, which word should they use? To which I continue to answer: I don’t care. There is much, much more to a conversation about someone’s death than the choice between ‘die’ and ‘pass away’. But, it seems, that this is unimportant – as long as you say ‘die’, you’re fine. Incidentally, you must say the word ‘die’, as a number of thread participants said “with compassion and care” and I have no idea what it means. Indeed, no one explained it and I suspect that no one can explain it. It’s no more, I think, than professional posturing, display behaviour, saying what must be said, even though it’s devoid of any meaning.

So, let me end with two reflections. First, I continue to be disappointed by a group of professionals who are hell-bent on policing language. It’s not for you, me, or anyone else to tell people how to speak. Let’s imagine that I do use the verb ‘pass away’, who are you to ‘correct’ me? What gives you the right or, indeed, the inclination to inflict a change on how I speak.

As a matter of fact, I myself tend to use the word ‘die’ but I don’t know whether my mother would today use ‘die’ or ‘pass away’. However, out courtesy and respect, I would adapt my vocabulary to hers. And I would offer a few brief soldierly words (in Polish it’s a euphemism for, among others, to eff off) to anyone attempting to change this.

The second reflection is about the discussion itself. As I suggested earlier, it is not and it cannot be for the people in care. It’s exclusively for exercising professional power and stamping authority on how minions like me talk. Be under no illusion whatsoever: the source of any discussion on how people talk and should talk is in attempting to control them. In other words, it is not for my benefit that you have such a conversation. It is only for yours. And that’s precisely why I completely reject it.

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