In Part II, we will examine the paper “Safety of Aspiration Abortion Performed by Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants Under a California Legal Waiver” in the American Journal of Public Health (2013 March; 103(3): 454–461) by Tracy A. Weitz and others (link).
That work makes a number of claims which we’ll investigate, but more importantly for us today is the language it uses, which has to be dealt with first. This is a “hot-button” topic, difficult to discuss without lapsing into euphemism. Now euphemism, unless it is used humorously, obscures and obfuscates. And this is especially harmful in a work which discusses statistical evidence.
Take, for example, the words physician or doctor, used synonymously, and which previously meant a person trained and pledged to heal; one who took the Hippocratic Oath, a portion of which reads:
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
I will give no deadly medicine to any one if asked, nor suggest any such counsel; and similarly I will not give a woman a pessary to cause an abortion.
These days the meaning of physician or doctor is not quite opposite of the ancient definition as much as it is orthogonal, for doctors are now people who both save and actively take lives. Whereas before a doctor would do no harm, now one kill you or lop of your leg or other body part on request (yes, yes, and yes). We even use doctor for those who provide no medical service, like for chiropractors. The best modern definition, and the one used here, might be those certified by government to perform certain procedures and prescribe certain drugs.
This does not differ much from the definitions of nurse practitioner, certified nurse midwife, and physician assistant, and indeed the differences between these professions are narrowing. The idea is doctors are given more leeway in their ministrations than the others: government allows them to perform a greater range of procedures and prescribe from a larger portion of the pharmacopoeia.
The differences are narrowing because it is thought “unfair” that doctors have greater privileges and because doctors charge more for their services, and money trumps all (or most) in this culture. Now the other professions also have different training than doctors. The argument is that the differences in training are not important for some procedures and prescriptions. The paper we’ll investigate makes that very assertion.
The procedure is abortion, specifically aspiration abortion, sometimes called vacuum or suction abortion whereby a simple vacuum is used to kill the life which is growing inside a woman’s uterus (Wikipedia has helpful diagrams). Now the “material” removed via suction abortion is alive—it has life—and so the proper, non-euphemistic verb is to kill, that being the willful intent of both the practitioner and the woman undergoing the procedure. Unemotional scientific definitions are always best, and that is the guideline followed here.
But not followed in the paper. The authors curiously label the killing abortion care, health care, public health need, etc., and call the people doing the killing health care professionals and the like. This is curious because care in ordinary English means solicitude, concern, caution, regard, ministration and so forth, none of which are applicable. No civilian hearing care would take it to mean to kill.
Therefore care, when used in this context and by our authors is jargon and euphemism, so when it appears we must mentally swap it with the verb. I do this everywhere I quote the paper, putting my substitutions in brackets to indicate the “surgery.”
Lastly, there is the unusual appearance of health as given in the examples above and in instances like women’s health needs. Again, in plain English, health means (Webster) The state of being hale, sound, or whole, in body, mind, or soul; especially, the state of being free from physical disease or pain. But the authors take the precise opposite of this: health care, to them, means killing, death, pain, bodies in “pieces”.
This is very strange, but we mustn’t judge them harshly because every profession has it quirks and peculiarities of language. Take statistics: where likelihood does not mean what civilians take it to be, and where confidence (as in confidence interval) means something like the opposite of its appearance. In any case, to avoid confusion, the word health will be avoided unless it takes its English meaning.
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Thanks to reader Joseph Reierson for brining this article to our attention.
RE: “Now euphemism, unless it is used humorously, obscures and obfuscates. And this is especially harmful in a work which discusses statistical evidence.”
GOOD TIP! But a clarification may be in order–does a “humorous” (whatever that means) euphemism merely not obscure & not obfuscate, or, does it enhance clarity?
RE: “The argument is that the differences in training are not important for some procedures and prescriptions.”
NO DOUBT THAT’s GOTTA BE TRUE for “SOME” things:
Consider athletes foot or jock itch — if one happens to visit their Doctor Of Physick (as once upon a time used in Old English vernacular) one can get a prescription for Clotrimazole in the concentrated 2% strength. Going to the local drug store one is limited to only 1% strength over-the-counter. OR, one can get, over-the-counter, the same prescription-strength 2% ointment from the next aisle…if one doesn’t mind the label identifying this for treating vaginal yeast infections instead of foot, or jock, infections.
Think about that — where a guy will use that stuff the recipient area is pretty robust against irritating side effects…but a prescription is warranted for the stronger & faster-acting version. And exactly the opposite applies for females ….
Go figure, eh? (“eh?” — that’s Canadian, for practice…). This is one data point illustrating where our society’s priorities are focused.
Ken–that’s a bit disturbing!
Briggs,
Actually, if you want modern definitions of Doctor and Physician that are clear and distinct, I would use the following.
Doctor: A holder of a doctoral degree. An MD (Medical Doctor) is one who holds a doctorate in the field of medicine. This is independent of any licensing.
Physician: An MD licensed to practice medicine.
MattS,
These are fine in their way, but you never hear somebody say, “I’m going to my physician’s” or “Good morning, physician!” And don’t forget our goal is to interpret the results of the study in terms of a woman wanting to kill the life inside her asking herself, “Should I go to a doctor of a nurse practitioner?” Or similar questions.
There’s a section in the paper headed, “Human Participant Protection”. The authors are presumably immune to irony.
(I didn’t understand the paper. It seemed to say, “If we don’t count differences less than 2% then statistically there’s no difference”.)
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Jaynes devotes a few paragraphs to logic and language. Here we are dealing with particularly blatant substitution of meanings. By extension one may postulate that Syrian government undertook some action in the field of public healthcare.