Euphemisms or Lies?

Stephen M. Perle, DC, MS

Sometimes we use euphemisms to make the uncomfortable more palatable. For example, animals in research studies are euthanized, which is the nice way of saying that they are killed. Likewise, we talk about the death of humans by saying that they have passed or have gone to their eternal rest. Rather than being confronted with the harsh reality of what has occurred, we sugarcoat the event with a euphemism.

People who are uncomfortable with bodily functions and anything related to sex will go to extremes to hide words related to these issues behind euphemisms. Almost anything taken to its extreme is cannon fodder for the humorist and satirist. In the news recently was a story about a religious homophobic group whose members did not like using the term “gay.” They thought it made homosexuality sound acceptable. As a result, they used the “search and replace” function on news items, replacing the word “gay” with “homosexual.” Unfortunately, this meant that the U.S. 100-meter runner Tyson Gay became Tyson Homosexual.1

Euphemisms in Health Care
Euphemisms may be seen as white lies when replacing a distasteful term with a gentler one. In health care, however, euphemisms are nothing short of violations of our veracity duty to patients.

Take, for example, the euphemism I see in my newspaper daily: non-surgical spinal decompression. This is a euphemism for traction—nothing more, nothing less. Now, usually euphemisms are supposed to replace a distasteful word (“died”) with a less distasteful one (“passed on”). In the case of “traction,” however, the euphemism is meant to replace a common word with one that sounds fancier and, therefore, clinically more effective. The lie is to make it sound better than it is.

I understand that Madison Avenue uses this kind of advertising all the time. But once again, let’s keep in mind that although our practices are businesses, we do not operate under the same ethical rules as Main Street. Other small businesses can use euphemisms and not violate the letter of the law; we have a moral duty to uphold the spirit of the social contract: to act in the patient’s best interest first.

There is no way that getting a patient to believe that a treatment is new and different, or is based upon NASA technology, or has a phenomenal success rate is consistent with the spirit of our moral duty of veracity.2 Despite what some might say, the fact that a particular device costs more doesn’t mean that the service to the patient should cost more.3 Does one pay five times the price of a cab ride because the cab driver chose to buy a Mercedes-Benz, rather than a Honda?

Informed Consent?
It is another story if the clients know that when they call for a cab ride, they have the choice of getting to the same location in a Honda or a Benz. Both will get you there the same way, but one might have a nicer ride. That choice to pick the luxury of the ride represents an informed decision.

Choosing between a chiropractic office that offers traction and one that offers “nonsurgical spinal decompression,” which both lead to the same clinical outcome, but at a significant difference in cost, isn’t in the advertisements. Where’s the informed consent? It’s hidden in the euphemism “decompression,” rather than “traction.”

Dr. Perle is a professor of clinical sciences at the University of Bridgeport College of Chiropractic, where he has taught an ethics course for more than 15 years. To read ACA’s code of ethics, visit www.acatoday.org/ethics. Send questions to ethics@acatoday.org.

References:

1. Right Wing Watch Blog. The Dangers of Auto-Replace. Www.rightwingwatch.org/2008/06/the_dangers_of_1.html.

2. AG stops out-of-state companies from using “junk science” to promote chiropractic devices. Www.doj.state.or.us/releases/2007/rel062907.shtml.

3. Edwards J, Vaughn C. Decompression Facts, Myths and Hyperbole, Part 5. Accept Insurance or Collect Cash? Dynamic Chiropr 2009;27(6). Www.dynamicchiropractic.com/mpacms/dc/article.php?id=53678.

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