Euphemistic Codes and Tell-Tale Hearts: Human Assistance in End-of-Life Cases

A euphemism is defined as the substitution of an agreeable or inoffensive word or expression for one that is harsh, indelicate, or otherwise unpleasant taboo; allusion to an offensive thing by an inoffensive expression. This article deals with medical euphemisms used commonly through medical codes in hospitals for end-of-life patient care. It examines the extent to which fear shapes decision making in critical care units - fear of medical failure, and fear of litigation if not everything is done to prolong life, no matter how agonizing. Furthermore, being trained to save lives, health care providers often lack the courage to let a patient die - especially when care has been provided for an extended period of time. This article demonstrates that if autonomy or self-determination is to be more than a poetic principle, with clinical application to patients in end-of-life illnesses, it must be validated by closer levels of communication between patients and their health care providers before serious debilitating illnesses occur which all too often block rational thinking by the patient, his family or surrogate decision makers. Such forthright communication and ultimate decision making before a medical crisis is a simple and direct solution. There is no need whatsoever to deal with euphemistic coding or, for example, tests of substituted judgment or other artifices if patients articulate their life goals and medical wishes through execution of advance directives. Sadly, absent this, patient autonomy must yield to physician autonomy - yet, an autonomy shaped hopefully by compassion and by standards of sound professional judgment regarding futile treatment and - when challenged - submitted to review ideally by hospital ethics committees or, failing that, the courts