By Jonathan Blackwell^1,2

1. Edinburgh Inflammatory Bowel Disease Unit, Western General Hospital, Edinburgh, UK
2. Deanery of Molecular, Genetic & Population Health Sciences, University of Edinburgh Western General Hospital, Edinburgh, UK

I cannot forget a Sunday night from when I was 17. I cannot forget it. Waiting on the platform at Wandsworth Common, laughing, joking, waiting for the train. And then it hit us. Not the train but the news. Adam was dead, he had thrown himself off the heights of Beachy Head.

Suicide is defined in the Oxford English Dictionary as “The action of killing yourself deliberately”.¹ Its definition is unequivocal yet the act of suicide breeds endless questions. Why? What could I have done? Why couldn’t they have lived for me? How could they feel so unloved?

The latest question is – what is the best phrase to describe “The action of killing yourself deliberately… with the legal assistance of one’s doctor”?

Kim Leadbeater’s Terminally Ill Adults Bill, a document over 47,000 words long, whose purpose is to legalise exactly this act, mentions the word “suicide” just four times – where it modifies the 1961 Suicide Act.² The avoidance of the word “suicide” is even more conspicuous in Liam McArthur’s Assisted Dying For Terminally Ill Adults (Scotland) Bill, as it is not mentioned even once.³

As these two pieces of legislation progress through Westminster and Holyrood there has been heated debate about whether the term “Assisted Dying” or “Assisted Suicide” is more appropriate. In other jurisdictions a variety of nomenclature are used including Medical Assistance in Dying in Canada, Death with Dignity in Oregon, and Assisted Suicide (hulp bij zelfdoding) in the Netherlands. The American Medical Association prefers Physician-Assisted Suicide as it “describes the practice with greatest precision”.⁴

Proponents of the bills have denounced the use of the word “suicide”, with Kim Leadbeater claiming terminally ill people choosing to end their lives are not “suicidal” and “want to live”.⁵ Such linguistic contortions might be expected from a politician however as clinicians we are perhaps just as guilty.

Kathryn Mannix’s With the End in Mind details how we have lost the vocabulary to describe death, relying on euphemisms to shield ourselves from its painful reality.⁶ Unfortunately, while euphemisms may soften the blow, they can also obscure the truth—sometimes with tragic consequences.

I was reminded of this recently after one of my patients died. When I met with his mother, devastated by her son’s death, what struck me most was how our communication with her during his final days had fallen short. It became painfully clear that the language we had used had not prepared her for what was coming. I had told my patient he was dying. He understood. My team had told his mother “this will be his final admission to hospital” and she heard he would be cured. Such misunderstandings are common and tragic and ultimately very painful.

Great efforts have been made to reclaim the language of death but I fear we are simultaneously losing the language to describe suicide. The phrase “assisted dying” creates confusion and is poorly understood. A UK poll found just 43% of respondents thought “assisted dying” involved the provision of lethal drugs to end somebody’s life. The majority believed the term meant withdrawing life-prolonging treatment or providing hospice-type care.⁷

Much of the discourse has centred on autonomy. Laudable. But autonomy is only respected when people are given the facts. Without accurate information, informed consent cannot exist. The starting point must be to use plain and honest language. Adam, who jumped off Beachy Head, did not die from “unassisted dying”. It was suicide and what is being proposed in England, Wales, and Scotland is “assisted suicide”.

The dictionary is currently being rewritten in order to distance “assisted dying” from the stigma of suicide. However taboos do not reduce stigma, in the long run they perpetuate it and I feel deeply uncomfortable with the suggestion assisted dying is morally distinct from suicide because the people who might avail themselves of it are terminally ill and suffering. There has never been a person who killed themselves who was not suffering intensely and in need of love and support. I am sure Adam was. The problem with suicide is not that it is somehow shameful, I reject that entirely. Yet suicide is always a shame. Life lost. Opportunities lost. The chance to recover from devastating news – lost. Time with loved ones – lost. Those long unspoken words of reconciliation or declarations of love – lost.

Rebranding assisted suicide with the euphemism assisted dying may be well intentioned, wanting to spare patients any shame in choosing such a path. However the truth it obscures, as I have learned from painful personal experience, is that suicide is a fundamentally destructive act and many of us who are left behind will never fully heal. Legalisation, societal approval, friendly doctors, and clean and private rooms will not change that one iota.

I hope neither bill passes but if they do I hope we can at least be honest with our patients about what is really on offer.

References:

1. Waite M, ed. Paperback Oxford English Dictionary. 7th ed. Oxford University Press; 2012.
2. Parliament of the United Kingdom. Terminally Ill Adults (End of Life) Bill [Bill 012 2024–25]. Introduced in Commons by Kim Leadbeater MP, House of Lords by Lord Falconer of Thoroton; first reading 16 October 2024; second reading passed 29 November 2024; passed Commons on third reading 20 June 2025; now in House of Lords. Accessed July 27, 2025. https://bills.parliament.uk/publications/61635/documents/6735
3. Scottish Parliamentary Corporate Body. Assisted Dying for Terminally Ill Adults (Scotland) Bill [SP Bill 46, Session 6 (2024)]. Introduced by Liam McArthur MSP; introduced 27 March 2024; at Stage 2 (Scottish Parliament). Accessed July 27, 2025. https://www.parliament.scot/-/media/files/legislation/bills/s6‑bills/assisted‑dying‑for‑terminally‑ill‑adults‑scotland‑bill/introduction/bill‑as‑introduced.pdf
4. American Medical Association Council on Ethical and Judicial Affairs. Physician-Assisted Suicide. CEJA Report 2-A-19. Presented at: American Medical Association Annual Meeting; June 2019; Chicago, IL. Accessed July 27, 2025. https://www.ama-assn.org/system/files/2019-05/a19-ceja2.pdf
5. Kim Leadbeater MP. Terminally Ill Adults (End of Life) Bill (Fifth Sitting). House of Commons Debates (Hansard). January 29, 2025. Accessed July 27, 2025. https://hansard.parliament.uk/commons/2025-01-29/debates/4405bcb6-13b3-4c86-b804-403a3d21b9d1/TerminallyIllAdults%28EndOfLife%29Bill%28FifthSitting%29
6. Mannix K. With the End in Mind: Dying, Death and Wisdom in an Age of Denial. 1st ed. William Collins; 2017.
7. Assisted Dying Survey July 2021 Summary. Conducted on behalf of the All-Party Parliamentary Group for Dying Well. July 2021. Accessed July 27, 2025. https://www.dyingwell.co.uk/wp-content/uploads/2021/09/Survation-Assisted-Dying-Survey-July-2021-Summary-3.pdf

Names and sex may have been altered to protect individuals’ identities.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Jonathan Blackwell has received a research grant from Crohn’s and Colitis UK. He has received speaker fees from Dr Falk, Pfizer, Takeda, Thermo Fisher Scientific, Johnson and Johnson, and Ferring. He has received travel grants from Takeda, Ferring, and Johnson and Johnson. He has provided consultancy to Takeda..