In his essay on the death of words, Charles Morgan writes ‘for want of a common speech, the learned are, in a sense, trapped within their special areas of knowledge’ (Morgan, 1948), noting that knowledge itself, in its technical development, has grown farther away from language. Yet, over 50 years later, the gap between knowledge and language continues to widen. Perhaps it is because we continue to fish from an increasingly stagnant pool of stock linguistic expressions, while failing to notice not only that language changes over time, but also that the way we think determines how we speak.
In a midwifery context, Thomson (1999) expressed concern over the use – rather, misuse – of a range of words and phrases. For example, although ‘perinatal’ refers to the health of the baby during the latter third of pregnancy and the first week of life, she detected it ‘creeping into the literature and everyday practice, in particular when referring to postnatal depression’. The phrase ‘teenage pregnancy’ should apply only to weeks 13–19 of gestation, otherwise ‘pregnant teenagers’ is preferred; and Thomson professed amazement ‘that in the literature the term “ethnic minorities” is used repeatedly’, when the term ‘people from ethnic minority groups’ should be used (Thomson, 1999).
The need for a delicacy of communication when health professionals confer with patients and their families cannot be understated. So, why might health professionals deliberately use language that could be misunderstood by patients? Shaw et al (2021) have considered this during their exploration of the way in which medical terms elicit different meanings, depending on how they are viewed. They suggest that motivating factors for health professionals choosing unclear language include a wish to disguise ethical issues, that jargon may reaffirm a physician's standing, that clever semantics help disguise discomfort or poor training in breaking bad news and euphemisms could protect patients from unpleasant connotations – although this ‘nonetheless carries the risk of diminishing patient autonomy’ (Shaw et al, 2021).
An important example cited by Shaw et al (2021) is using two terms to describe the same thing, namely the unborn baby and the fetus. While the technical term is ‘fetus’, ‘baby’ may be used when talking to the pregnant woman. However, context is important. On the one hand, a woman who wishes to give birth may refer to her baby, and if she were to have a miscarriage she might say ‘I've lost my baby’; but on the other hand, ‘women who seek abortions may tend to use “fetus”, and not “aborted baby”’ (Shaw et al, 2021). The choice of words, say the authors, is freighted with moral significance and not just a matter of semantics, and they comment that ‘[p]regnant women and healthcare professionals who use “fetus” rather than “baby” may be engaging in psychological distancing to avoid confronting the potential moral significance of having an abortion’ (Shaw et al, 2021).
But even when discussing certain issues among themselves, health professionals may opt for obfuscation, and possibly some semantic sleight of hand, to cloud an issue where clarity is demanded. For example, in the context of heritable human genome editing, Baylis (2021) addresses revisions made to the Guidelines for Stem Cell Research and Clinical Translation, issued by the International Society for Stem Cell Research. Two significant revisions include first, the splitting of ‘category 3 prohibited research activities’ in the 2016 guidelines into ‘category 3A research activities currently not permitted’ and ‘category 3B prohibited research activities’ in the 2021 guidelines, and second, the transfer of heritable human genome editing research from the ‘prohibited’ category to the ‘currently not permitted’ category. These changes, states Baylis (2021) ‘are noteworthy because of the absence of a clear demarcation line between the two categories insofar as, by definition, that which is “prohibited” is “currently not permitted”, and vice versa’. Baylis (2021) points out that permanence is not part of the definition of ‘prohibition’, since a prohibition can be rescinded at any time, and asks ‘why make a policy change that has no apparent practical effect?’ One suggestion that she offers is that by re-categorising specific ‘prohibited’ research activities as ‘currently not permitted’, it raises possibilities and seeds ‘intuitions about which prohibited research activities should “soon” be permitted subject to specialised scientific and ethics review and approval’ (Baylis, 2021)
Language is essential for transactions of information, knowledge, and wisdom, but if language is to be used in a meaningful way, we must be critical of how we, and others, use it.