I'm a medical resident in Canada. I'm not sure that I remember specific instruction in medical school on how to talk with or about patients who are very sick or near death, at least until starting my palliative care rotation 3 weeks ago. For this reason, this rotation has been an instructive and helpful experience. However, it's been complicated by the fact that Canada has, in the past 5 years or so, liberalized its laws regarding euthanasia to an extent that truly beggars belief. It's strange to be currently working in a discipline (palliative care) that, from its origins, has been bravely and humanely committed to extending personhood and respect to all people, regardless of level of function or disease, while simultaneously being expected to act like it's a normal and good thing for people to be classified by legislation and physician assessment into a group deserving suicide prevention, and a group whose condition is such that suicide assistance is seen as a good idea. So many of my patients are driven to consideration of euthanasia by worry about "being a burden". In this cultural and legislative environment, the "dignity of dependence" really is such foreign vocabulary. Instead, we have "Dying With Dignity", a group committed to universalizing and enshrining in law the fears and prejudices of the rich, able and educated (don't even get me started!).
During medical school, we did have a fair amount of teaching during our "professionalism" classes (which were so well-intentioned, but bland, milquetoast, lowest-common-denominator stuff - but that's a rant for another time!) where we were told to refer to our patients by name, rather than room number, and to use 'person-first language': ie "a 62-year-old man with diabetes" rather than "a 62-year-old diabetic". This was useful, as far as it goes, but that's just it: it doesn't go very far. Because of the inability to assume any substantive shared moral commitments, we were fed a sort of thin, watery moral gruel, which was unable to really open our eyes to the true value and dignity of all people, (visibly) dependent and suffering or not. You can call someone a "person with diabetes" rather than a "diabetic" all you want (and more power to you!), but if you go ahead and offer them medically sanctioned suicide, you are saying that their life and other lives like them are, in your professional judgement, not worth preserving.
I recently had a very positive experience around this topic. We had our first ever miscarriage last month. I reached out to our deacon to celebrate a funeral rite for an unbaptized child. He told me he would be honored and asked if we had chosen a name and if we knew the baby’s sex. My napro doctor, who had been monitoring my hormones, called me to offer her condolences. I hadn’t seen my secular midwives yet, since it was so early, and I ended up being grateful I only had to interact with them over the phone, having heard stories like yours in the past.
Oh my goodness this is so powerful. My mother has dementia and I’m now thinking and watching for this. Thank you so much for sharing all you have here. ❤️
The fact is that the word “baby” has no meaning in science. Our high school bio teacher dinged us if we used “baby” rather than “young” for nursing young mammals. She was staunchly Christian and against abortion but she was also a scientist.
There are stages in the development of “babies.” Blastocyst, embryo, fetus. None of those accurate terms make this being les worthy of life and dignity. Be accurate and insist that fetuses have the same right to life as “babies.”
I don't have experience with this personally, but a close friend of mine worked as medical scribe at an ER for about a year-- simply standing in the room, taking down the details of the patients, any procedures undertaken, and so forth. That sort of depersonalizing language is exactly what he was trained to use, and he found himself having to fight off that sort of mindset in himself. He noticed that the ER docs, while generally capable and professional when working with patients, could be extremely irreverent behind closed doors. While I don't know for sure, I suspect that there's two things going on: 1, it's important that medical language be very specific, in that every term have a clear and precise meaning that's not easily confused; and 2, in tense or high-stakes situations it's typically an immense advantage to be able to emotionally remove yourself from what's going on so you can focus on the material details. And at least in the ER (and likely elsewheres) I think this is exactly what doctors are trained to do, so that they don't crack in the middle of a lifesaving operation or let their emotions get in the way of solving the problem at hand. The flipside, unfortunately, is that thinking in this way for an extended period of time makes it easy to actually embrace that depersonalization, not as a defensive mechanism or temporary way of thinking, but rather as how they actually think about people. Furthermore, it seems that this way of thinking has spread to situations or positions where it's less warranted, like the OB office.
In a way, it strikes me as something of a catch-22, in that by wanting doctors to be as effective as they can be at saving lives, they in turn adopt a depersonalizing way of thinking and speaking which leads them to devalue those very lives we want them to save. I don't really have any good ideas to solve this dilemma off the top of my head, but I think it's important. It probably doesn't help that many doctors are likely "no feelings, just facts" sort of people to begin with (think of the media trope of the brilliant-but-extremely-rude doctor).
I really appreciate hearing from medical professionals about why this type of language is used. I have noticed communitarian or pro-life feminists challenging various practices of the medical profession, including depersonalizing language, and that worries me amid our society's current trend to undermine and diminish expertise. It seems to me that communitarians, and everyone concerned with the common good, wants doctors and nurses to be respected and taken seriously by the public, and that demands at least some good-faith effort to understand why they do things in ways that might seem strange (and certainly this discussion is an example of that good-faith effort.)
In the same vein, I think the pro-life movement looks silly when they insist that one can have a heartbeat before one has a heart. This position challenges medical expertise on embryology while paradoxically ceding philosophical/religious expertise on a much greater question: what confers life. To insist that a six-week-old fetus whose heart has not yet developed has a "heartbeat" tacitly accepts the medical claim that a heartbeat is necessary for life and thus for concern. Leah has often advocated for a different position: vulnerability and dependency are key to humanity. That understanding is sitting right there waiting for someone to apply it to a preborn human possessed, not of a heart and a heartbeat, but of a fetal pole and its electrical impulses.
This is super-inside baseball, but as a Catholic I would point out that priests don't apply medical declaration of death (heartbeat or brain activity cessation) when deciding whether they can anoint someone who may have recently died. The Catholic philosophical understanding of death is when the soul separates from the body, and it's possible that takes place shortly after the heartbeat has stopped, not at the exact moment. When it comes to death, we don't use heartbeat as proof of life, so we could quite consistently claim that even a very early-stage embryo is a living person without needing to pretend it has a heart and a heartbeat.
The challenging of medical expertise when doctors and nurses use the language of their training also sits uneasily with me seeing that pro-lifers are happy to appropriate the medical expertise that allows us to confirm pregnancy before the next period and view fetal development at very early stages. For most of human history, many women would have experienced something like a ten-week miscarriage as one missed period followed by a heavy one. She may well never have known she was pregnant. Now, parents have the technology to know about and grieve losses that earlier generations may never even have known about. The burden there is mainly on the parents. But (and I apologize for straying so far from your original post) some of the more strident corners of the pro-life movement use pictures of fetal development, etc, which the medical profession has given us, while acting like doctors are ghouls for pointing out that you need a heart to have a heartbeat.
it's a bit hard to pinpoint exactly what all of your anger is about - the actual events of your loss or the words used to describe or to fail to describe the losses. you have a lot of anger. 40 years ago, i had a miscarriage at 12 weeks followed by years of infertility. i was angry at being dismissed about the infertility because i had a 2 year old when i lost the second pregnancy. finally, i took myself to a specialist and within 3 years had 2 more children. i was very fortunate given my situation. i found that the 'cluelessness' was equal across genders and ages of caregivers. my own mother (an RN) was highly dismissive of my miscarriage. a good female friend who is an OB/GYN summed it up fairly well when she told me that many male OB's are more sympathetic to women than other women are - the women OB's figure that if they got thru it (childbirth), other women can get through it without complaining too much. as for the OB or med student recording the name of one's children, i'm quite sure that none of my physicians or caregivers has ever asked or recorded my childrens' names. why should they? the children are not their patients. i believe you might be asking too much when it comes to that. as for caregivers referring to patients by something other than their names, this is a common occurrence. i worked in hospitals most of my adult life. adult patients in the hospital were and are routinely referred to by their room/bed assignment.. some of that is merely logistics and some of it is a need for an emotional spacing from fragile (especially pediatric) patients. the emotional well being of caregivers is part of the overall picture of healthcare. we've become especially aware of that during COVID - or it's been written about a great deal. people are still dismissing it. doctors and nurses, technicians and aides are not robots. i have known and worked with literally thousands of them since 1967. only a handful would fall into the category of uncaring. the vast majority are deeply caring and work hard for their patients. they are balancing the art and science of medicine every time they greet a patient. some are better at the science than the art. i have known some that were downright cantankerous but whose hands i would gladly place my well being in. kind words are great - knowledge, skill, and a desire to do the best for the patient even greater.
I think it's worth pulling this out: "The first time I became pregnant, the intake nurse asked, “And how do you feel about being pregnant?” only using “baby” once I’d dignified the child by clarifying I didn’t want an abortion."
This is one of those questions that doctors use to start a conversation (and assessment) of other factors that can impact a pregnancy - worries about finances, a physical job, domestic violence, childcare, degree of ambivalence toward the pregnancy. Staff will use this question and the follow up to connect their patient to more resources where appropriate. That's a good thing!
I do think you make a good point about when medical professionals use (inaccurate) language that has an emotional resonance vs (accurate) clinical language that feels impersonal/less kind. But I do wonder if we shouldn't strive for a delight in accuracy? I personally do believe a fetus has dignity, whether or not it becomes or can become a baby or a child. I also believe there should absolutely not be any legal restrictions on abortion. As the fetal pole cardiac activity post you linked to points out - there are real and horrific consequences for the perpetuation of inaccuracies (ex: pregnant folks being denied real and life saving care by politicians who think pregnancy complications don't exist).
I'm a medical resident in Canada. I'm not sure that I remember specific instruction in medical school on how to talk with or about patients who are very sick or near death, at least until starting my palliative care rotation 3 weeks ago. For this reason, this rotation has been an instructive and helpful experience. However, it's been complicated by the fact that Canada has, in the past 5 years or so, liberalized its laws regarding euthanasia to an extent that truly beggars belief. It's strange to be currently working in a discipline (palliative care) that, from its origins, has been bravely and humanely committed to extending personhood and respect to all people, regardless of level of function or disease, while simultaneously being expected to act like it's a normal and good thing for people to be classified by legislation and physician assessment into a group deserving suicide prevention, and a group whose condition is such that suicide assistance is seen as a good idea. So many of my patients are driven to consideration of euthanasia by worry about "being a burden". In this cultural and legislative environment, the "dignity of dependence" really is such foreign vocabulary. Instead, we have "Dying With Dignity", a group committed to universalizing and enshrining in law the fears and prejudices of the rich, able and educated (don't even get me started!).
During medical school, we did have a fair amount of teaching during our "professionalism" classes (which were so well-intentioned, but bland, milquetoast, lowest-common-denominator stuff - but that's a rant for another time!) where we were told to refer to our patients by name, rather than room number, and to use 'person-first language': ie "a 62-year-old man with diabetes" rather than "a 62-year-old diabetic". This was useful, as far as it goes, but that's just it: it doesn't go very far. Because of the inability to assume any substantive shared moral commitments, we were fed a sort of thin, watery moral gruel, which was unable to really open our eyes to the true value and dignity of all people, (visibly) dependent and suffering or not. You can call someone a "person with diabetes" rather than a "diabetic" all you want (and more power to you!), but if you go ahead and offer them medically sanctioned suicide, you are saying that their life and other lives like them are, in your professional judgement, not worth preserving.
I recently had a very positive experience around this topic. We had our first ever miscarriage last month. I reached out to our deacon to celebrate a funeral rite for an unbaptized child. He told me he would be honored and asked if we had chosen a name and if we knew the baby’s sex. My napro doctor, who had been monitoring my hormones, called me to offer her condolences. I hadn’t seen my secular midwives yet, since it was so early, and I ended up being grateful I only had to interact with them over the phone, having heard stories like yours in the past.
Oh my goodness this is so powerful. My mother has dementia and I’m now thinking and watching for this. Thank you so much for sharing all you have here. ❤️
The fact is that the word “baby” has no meaning in science. Our high school bio teacher dinged us if we used “baby” rather than “young” for nursing young mammals. She was staunchly Christian and against abortion but she was also a scientist.
There are stages in the development of “babies.” Blastocyst, embryo, fetus. None of those accurate terms make this being les worthy of life and dignity. Be accurate and insist that fetuses have the same right to life as “babies.”
I don't have experience with this personally, but a close friend of mine worked as medical scribe at an ER for about a year-- simply standing in the room, taking down the details of the patients, any procedures undertaken, and so forth. That sort of depersonalizing language is exactly what he was trained to use, and he found himself having to fight off that sort of mindset in himself. He noticed that the ER docs, while generally capable and professional when working with patients, could be extremely irreverent behind closed doors. While I don't know for sure, I suspect that there's two things going on: 1, it's important that medical language be very specific, in that every term have a clear and precise meaning that's not easily confused; and 2, in tense or high-stakes situations it's typically an immense advantage to be able to emotionally remove yourself from what's going on so you can focus on the material details. And at least in the ER (and likely elsewheres) I think this is exactly what doctors are trained to do, so that they don't crack in the middle of a lifesaving operation or let their emotions get in the way of solving the problem at hand. The flipside, unfortunately, is that thinking in this way for an extended period of time makes it easy to actually embrace that depersonalization, not as a defensive mechanism or temporary way of thinking, but rather as how they actually think about people. Furthermore, it seems that this way of thinking has spread to situations or positions where it's less warranted, like the OB office.
In a way, it strikes me as something of a catch-22, in that by wanting doctors to be as effective as they can be at saving lives, they in turn adopt a depersonalizing way of thinking and speaking which leads them to devalue those very lives we want them to save. I don't really have any good ideas to solve this dilemma off the top of my head, but I think it's important. It probably doesn't help that many doctors are likely "no feelings, just facts" sort of people to begin with (think of the media trope of the brilliant-but-extremely-rude doctor).
I really appreciate hearing from medical professionals about why this type of language is used. I have noticed communitarian or pro-life feminists challenging various practices of the medical profession, including depersonalizing language, and that worries me amid our society's current trend to undermine and diminish expertise. It seems to me that communitarians, and everyone concerned with the common good, wants doctors and nurses to be respected and taken seriously by the public, and that demands at least some good-faith effort to understand why they do things in ways that might seem strange (and certainly this discussion is an example of that good-faith effort.)
In the same vein, I think the pro-life movement looks silly when they insist that one can have a heartbeat before one has a heart. This position challenges medical expertise on embryology while paradoxically ceding philosophical/religious expertise on a much greater question: what confers life. To insist that a six-week-old fetus whose heart has not yet developed has a "heartbeat" tacitly accepts the medical claim that a heartbeat is necessary for life and thus for concern. Leah has often advocated for a different position: vulnerability and dependency are key to humanity. That understanding is sitting right there waiting for someone to apply it to a preborn human possessed, not of a heart and a heartbeat, but of a fetal pole and its electrical impulses.
This is super-inside baseball, but as a Catholic I would point out that priests don't apply medical declaration of death (heartbeat or brain activity cessation) when deciding whether they can anoint someone who may have recently died. The Catholic philosophical understanding of death is when the soul separates from the body, and it's possible that takes place shortly after the heartbeat has stopped, not at the exact moment. When it comes to death, we don't use heartbeat as proof of life, so we could quite consistently claim that even a very early-stage embryo is a living person without needing to pretend it has a heart and a heartbeat.
The challenging of medical expertise when doctors and nurses use the language of their training also sits uneasily with me seeing that pro-lifers are happy to appropriate the medical expertise that allows us to confirm pregnancy before the next period and view fetal development at very early stages. For most of human history, many women would have experienced something like a ten-week miscarriage as one missed period followed by a heavy one. She may well never have known she was pregnant. Now, parents have the technology to know about and grieve losses that earlier generations may never even have known about. The burden there is mainly on the parents. But (and I apologize for straying so far from your original post) some of the more strident corners of the pro-life movement use pictures of fetal development, etc, which the medical profession has given us, while acting like doctors are ghouls for pointing out that you need a heart to have a heartbeat.
it's a bit hard to pinpoint exactly what all of your anger is about - the actual events of your loss or the words used to describe or to fail to describe the losses. you have a lot of anger. 40 years ago, i had a miscarriage at 12 weeks followed by years of infertility. i was angry at being dismissed about the infertility because i had a 2 year old when i lost the second pregnancy. finally, i took myself to a specialist and within 3 years had 2 more children. i was very fortunate given my situation. i found that the 'cluelessness' was equal across genders and ages of caregivers. my own mother (an RN) was highly dismissive of my miscarriage. a good female friend who is an OB/GYN summed it up fairly well when she told me that many male OB's are more sympathetic to women than other women are - the women OB's figure that if they got thru it (childbirth), other women can get through it without complaining too much. as for the OB or med student recording the name of one's children, i'm quite sure that none of my physicians or caregivers has ever asked or recorded my childrens' names. why should they? the children are not their patients. i believe you might be asking too much when it comes to that. as for caregivers referring to patients by something other than their names, this is a common occurrence. i worked in hospitals most of my adult life. adult patients in the hospital were and are routinely referred to by their room/bed assignment.. some of that is merely logistics and some of it is a need for an emotional spacing from fragile (especially pediatric) patients. the emotional well being of caregivers is part of the overall picture of healthcare. we've become especially aware of that during COVID - or it's been written about a great deal. people are still dismissing it. doctors and nurses, technicians and aides are not robots. i have known and worked with literally thousands of them since 1967. only a handful would fall into the category of uncaring. the vast majority are deeply caring and work hard for their patients. they are balancing the art and science of medicine every time they greet a patient. some are better at the science than the art. i have known some that were downright cantankerous but whose hands i would gladly place my well being in. kind words are great - knowledge, skill, and a desire to do the best for the patient even greater.
I think it's worth pulling this out: "The first time I became pregnant, the intake nurse asked, “And how do you feel about being pregnant?” only using “baby” once I’d dignified the child by clarifying I didn’t want an abortion."
This is one of those questions that doctors use to start a conversation (and assessment) of other factors that can impact a pregnancy - worries about finances, a physical job, domestic violence, childcare, degree of ambivalence toward the pregnancy. Staff will use this question and the follow up to connect their patient to more resources where appropriate. That's a good thing!
I do think you make a good point about when medical professionals use (inaccurate) language that has an emotional resonance vs (accurate) clinical language that feels impersonal/less kind. But I do wonder if we shouldn't strive for a delight in accuracy? I personally do believe a fetus has dignity, whether or not it becomes or can become a baby or a child. I also believe there should absolutely not be any legal restrictions on abortion. As the fetal pole cardiac activity post you linked to points out - there are real and horrific consequences for the perpetuation of inaccuracies (ex: pregnant folks being denied real and life saving care by politicians who think pregnancy complications don't exist).