Words matter. They convey thoughts and emotions. Words allow us to express ourselves and connect with others. They’re important. The language we use around death and dying not only tells us what we’re thinking, it tells us who we are. Especially when we discuss adversity. When we use fighting language around disease and death, are we accurately describing the experience? Or are we missing an opportunity to convey what’s happening?
Can we use analogies in a way that illuminates rather than obscures?
Looking at illness through a military lens
Using war analogies for disease began a long time ago. Old medical journals written in the early 1600s contain this language. They grew in popularity over the centuries and became normalized in the 1970s.
This was when President Nixon declared war on cancer. Then the National Cancer Institute was formed, codifying this fighting language. It quickly caught on in the general public and continues today.
- “He beat cancer.”
- “I’m fighting this.”
- “She’s battling COVID.”
- “A breakthrough has been discovered in the fight against heart disease.”
Not everyone believes these comparisons are accurate. For instance, author and cancer patient Lisa Adams put it this way:
“When I die don’t say I ‘fought a battle.’ Or ‘lost a battle.’” Or ‘succumbed.’ Don’t make it sound like I didn’t try hard enough, or have the right attitude, or that I simply gave up. When I die tell the world what happened. Plain and simple. No euphemisms, no flowery language, no metaphors.”
From my vantage point as an end-of-life doula, illnesses don’t resemble battles or war. Rather, they are processes our bodies go through and our families endure. Sometimes illnesses are naturally occurring. And clients aren’t soldiers. They’re living life the best way they can, talking to doctors and taking medication in various forms to continue for as long as they can.
There is an understandable desire to frame health issues in a way that people can understand. Unfortunately, medical terminology is often devoid of emotion. It might also be confusing. Therefore, metaphors make things easier to understand. However, the medical community doesn’t seem united behind one specific type.
We’re all so different
Some prefer to use words associated with war and battles, while others worry their use is counterproductive. In the end, each person should use language that feels right to them. If war metaphors pump you up and motivate, then by all means continue with that.
But others, including children, might find war imagery distracting and scary.
Another concern is that some might take these ideas to the extreme and, if treatment doesn’t work, feel somehow responsible. Like they’re giving up. No one should blame themselves for something as complex as a medical condition. Outcomes rely on so many different factors to be successful.
Life, and death, are hard enough. People don’t need to feel judged or blamed on top of everything else.
Our use of certain words has other consequences, too
When we say, “There’s nothing more to do so we called hospice,” it contributes to the false narrative that palliative or hospice care are only for people who’ve given up.
This is not accurate or fair.
Palliative care and hospice do a lot for patients. Quality of life is better, and pain is more effectively controlled when these options are included early on rather than excluded. And yet people believe the opposite and only call hospice in someone’s final days. Are faulty analogies to blame?
Let’s find new ways to describe this phase of life.
We should stop using words that suggest dying people are “surrendering.” Because when we think of it this way, doctors are afraid to mention palliative care and patients don’t benefit from this important treatment option.
We must convey to people that hospice and palliative patients report a higher quality of life, feel more empowered and are better informed about their conditions. They are more likely to die at home rather than hooked up to tubes in a hospital setting. Hospice families also experience less grief and distress. When palliative care is utilized early on, people live longer and happier lives.
How can our death and disease language reflect that reality?
If people feel like they’re surrendering a battle, they experience despair and guilt at a time when those negative emotions are least helpful.
Additionally, this becomes almost a self-fulfilling prophecy. Believing that illness is a war and sick people are losing that war, families won’t talk about hospice or palliative care until death is imminent. Then when dying occurs, death becomes even more associated with palliative care and hospice. So people continue to avoid bringing it up.
And so on and so on the cycle continues.
When we feel like we’re to blame for what’s happened to us, death becomes a missed opportunity. That sorrow robs dying people of the chance to make amends, leave behind messages of love for friends and family, or consider treatment options that might allow for a special trip or goal.
It also robs patients of effective pain management.
All of this is unnecessary.
What other metaphors can we use?
Some figures of speech do help us better conceptualize the world around us. So might it be more helpful to use, as bioethicist George Annas suggests, ecology-based analogies instead? They would emphasize ideas of balance, sustainability, conservation, and responsibility.
That’s just one suggestion. There are others. Perhaps we can better describe illness as…
- an unwelcome guest.
- a scary rollercoaster.
- jail time.
- a marathon.
- a journey.
In short, the power of language is never more evident than when clinicians discuss death and disease. Unfortunately, using the wrong words can lead to misunderstandings, confusion and suffering.
So let’s sit with the uncomfortable nature of what we’re experiencing, rather than inaccurately describe it. Patients deserve sensitivity, honesty and words that reflect the sacredness of the experience. Leave fighting language on the battlefield where it belongs.