Let‘s Talk Inclusive Language: Who Failed?
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Who failed?
CW: children with cancer
This month, we’ve got a question from a pediatric oncology nurse who wrote in to get advice on a phrase that really bothers him.
There’s a thing we say here at the hospital that makes me so angry. You can sum it up as “Patient X failed Therapy Y,” like yesterday someone said, “Juanita failed induction therapy.” No, the six-year-old didn’t fail induction therapy—induction therapy failed her!
I’ve tried to model “Induction therapy failed Juanita,” but I just get blank looks or eyerolls. Any advice for addressing this wildly problematic language?
This is a great question and ties in with some points I made in the March 2023 edition of Worthwhile Insights. In that newsletter, I talked about contributions made by disability activist Judy Heumann. One major contribution she made was telling us again and again that we needed to shift our focus away from individuals and towards systems.
Here in the US, our language is endlessly individualistic and relentlessly credits, blames, and gives responsibility to individual people—even at times when the credit, blame, or responsibility really goes to a group of people. Or an institution. Or a system.
A very common workplace example: I talk to a lot of people in internal services or back office work who feel like no one understands the contributions they make to their business. That sales people get lots of credit (and big bonuses). Or individual developers or engineers who come up with a new feature. But they feel (and I think, rightly so) that their leadership doesn’t understand or recognize their value and how, without their work, their product would fail.
And in my book, I talk about this briefly from a disability perspective. For example, in the sentence “She can’t get inside the building because of her wheelchair,” the focus is individual—the person and her wheelchair are at fault.
But the focus should shift. All public buildings should be accessible to wheelchair users. Full stop. And if we start from that perspective, who now has responsibility (or blame)? People who create buildings, people who own older buildings, and people who check on buildings to make sure they’re compliant.
Photo credit: CDC via Unsplash
Let’s get back to children with cancer who are “failing” therapies and treatments. I know it’s probably rough to think about, but the fact that we’re talking about children here really highlights the issue.
In linguistics, one way we analyze a sentence is to look at the scenario and the roles that the sentence invokes—along with the roles that it leaves out. So let’s do that here.
Juanita failed induction therapy.
Here, Juanita is playing the semantic role of agent. The agent is the role that carries out the action of the verb. In the scenario invoked by this sentence, Juanita is carrying out the action of trying to do induction therapy and then failing at it.
Now let’s look at our nurse’s proposed rephrase:
Induction therapy failed Juanita.
Here, Juanita is playing the semantic role of patient. (She is literally a patient in the real world and also a patient in the world of semantic analysis.) The semantic patient is a person or thing who is acted on or affected by the action of the verb.
In this scenario, it becomes a lot clearer that Juanita doesn’t have agency when it comes to the therapy. She doesn’t have control over her cancer. It’s not like she’s not doing enough, doesn’t care, isn’t fighting hard enough.
She is the patient. And the treatment is failing her.
Note that in both of these sentences, the real agents of the action aren’t even mentioned—the medical practitioners choosing therapies and treating Juanita.
So what can our nurse do? And what can you do?
It turns out that if you want to reframe things, just shifting your phrasing usually isn’t enough. (As we can see with the blank looks or eyerolls our nurse is encountering when he changes the wording.)
Reframing usually requires a discussion about language. And that’s why I’ve taken the time to lay out what’s going on, so you can discuss things using clear and scientific terminology.
Here’s a suggested script, maybe for a meeting or other time that isn’t urgent, so people can take the time to sit and consider:
“Can we pause a minute and talk about the problem with phrasing when we talk about a patient failing a therapy?
This kind of phrasing suggests a scenario where the patient is in control, is the one with agency. But that’s not how it actually works. It’s not like they’re trying and failing, it’s that the treatments are failing them. We’re the ones taking action. They’re just experiencing things and hoping for the best.
So I’m going to stop saying that patients failed a therapy. And from now on, I’m going to say the therapy failed patients. I like to be precise, and I think this language gives a more accurate picture of what’s going on.”
For those of us who aren’t in the medical field, we can also be more careful with our language and how it presents someone’s agency.
She lost her battle with cancer.
He’s fighting cancer.
“Be brave! Keep up the good fight!”
Many people dealing with cancer don’t like this framing at all. “Am I not fighting hard enough?” they might think. “Am I not brave enough?”
So let’s try to avoid language that suggests that someone has control over something that they don’t. And make sure that we’re using words that accurately reflect who has agency—and who doesn’t.
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