PORTLAND, Ore. -- Physician-assisted suicide? Doctor-aided dying? Death with dignity? Medical killing?

Oregon's Death With Dignity Act, the only law of its kind in the nation, makes it legal for a doctor to prescribe a fatal drug dose to a terminally ill patient of sound mind who requests it in writing and orally.

But labeling what the Oregon law makes legal has never been easy.

Twice in the past month, under pressure from advocates, the state has switched policy on its terminology and expunged previous wordings from its Web site.

The Oregon law never mentions "physician-assisted suicide," the term used by the state for the past nine years.

Compassion & Choices, an advocacy group that works with about three-fourths of the Oregonians who end their lives with a doctor's prescription, has long lobbied the state to stop using that term.

Kathryn Tucker, the group's legal director, says "suicide" in this context is "inaccurate and inflammatory," because it confuses a rational decision by a dying patient with the desperate, often-violent act of self-killing.

Compassion & Choices leaders met with Department of Human Services officials in August and lobbied -- with hints of a lawsuit -- for a wording change. They suggested three alternatives: "aid in dying," "directed dying" or "assisted dying."

In October, the state agreed to adopt a new term, "physician-assisted death."

But before the state could carry out the change, Compassion & Choices issued a news release applauding the state's move to "value-neutral language."

That provoked fury from critics of the Death With Dignity Act, and the state backed off, reversed field and tried again.

Now, neither "physician-assisted suicide" nor "physician-assisted death" appears on the agency's Web site. They have been replaced by vague references to the Oregon law.

For example, under "Frequently Asked Questions," the question, "Who can request Physician-Assisted Death?" was changed to "Who can participate in the Act?"

The change is "an attempt to maintain our neutrality -- even if people don't see us as neutral," said Dr. Katrina Hedberg, a medical epidemiologist with the state.

But critics accused the state of playing into the hands of proponents.

"DHS is trying to take away those stinging, harsh terms that can lead to guilt," said Dr. Charles Bentz, a Portland internist and president of Physicians for Compassionate Care, which opposes the Death With Dignity Act. "They are backing away from calling it what it is -- a suicide and an act of medical killing."

The Death With Dignity Act states that actions taken under its provisions "shall not, for any purpose, constitute suicide, assisted suicide, mercy killing or homicide." That made it difficult for the state to defend its longtime use of "physician-assisted suicide."

But what to use instead?

"There really aren't any neutral terms out there," Hedberg said. "Even `death with dignity' is perceived by some as one-sided."

The state's decision to try for more neutral wording was made by human services director Dr. Bruce Goldberg after discussion with Hedberg, state epidemiologist Dr. Mel Kohn, state public health officer Dr. Susan Allan and others.

"It's a major change," said George Eighmey, director of Compassion & Choices of Oregon. He said his group hears often from Oregonians who want access to the law but find the term "physician-assisted suicide" offensive. "They don't believe what they are doing is suicide," he said.

Pollsters have found that public support drops sharply when the word "suicide" is included, instead of a term such as "physician-assisted dying."

"We always have a problem when we take politically charged activities and give them simple labels," said Dr. Joanne Lynn, a hospice doctor and former director of the RAND Center to Improve Care of the Dying. "I usually try for whole phrases."

Lynn called "physician-aided dying" a euphemism. "Every nun helping a person in a hospice is aiding the dying -- but that's not what people using the phrase mean."

"What's in a name?" asked Patricia Backlar, a philosopher who teaches bioethics at Portland State University and Oregon Health & Science University. "The terms have political implications."

She compared the phenomenon to the abortion debate, where "pro-choice" and "pro-life" factions face off over language as well as ideology.

"I'm concerned about the word `neutral,"' Backlar said. "This is deeply emotional for everyone. There is nothing neutral about this. You can use whatever words you want, but the nitty-gritty, down to the actual act, is not neutral."

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