The XX Factor

Why Is It Always “Pulling the Plug on Grandma”?

The ugliest period of the health reform wars was the summer of 2009, when Sen. Chuck Grassley and others held out the scary specter of “pulling the plug” on Grandma . Now the Republicans are trying to repeal “Obamacare,” and the Granny wars have reignited. Once again, Grandpa is nowhere to be seen.

“I can report that Granny is safe,” President Obama told a health care advocacy group recently. “She may not feel that way,” retorted Karl Rove, in a Wall Street Journal op-ed headlined ” The Politics of Saving Granny .”

What did happen to Grandpa?  Is anybody pulling the plug on him? Do we care?

Grandpas get old and sick, too. They get Medicare, and they run up bills, and they go in and out of hospitals, and they (and their families) face the same tough decisions about end-of life care. But Grandpa is not part of the never-ending rhetorical war on health reform.  I don’t think that’s an accident. I called a couple of experts on language, gender, and medicine. They don’t think it’s an accident, either.

The “granny” phraseology strikes a whole symphony full of chords about vulnerability and powerlessness in a way that “granny and grandpa” don’t.  “Granny evokes sympathy, nurturing, warmth. Granny Smith apples. Food. Cookies. All the association with warmth and family,” said Sylvia Chou, a sociolinguist who did doctoral research on how hospice patients, their families, and physicians discuss end of life.  (Chou now works at the National Cancer Institute on health communication, not on health reform policy.)

Grandpa doesn’t have such clear and universal imagery, Chou noted. Maybe we’ll think of an old man and a young boy and fishing poles. Maybe we’ll think “jolly.”  Some might think “grumpy.”  We don’t think apple pie. Then layer on “pulling the plug.” That phrase connotes, and denotes, a loss of power, coupled with a dehumanizing image of a machine.

“That ‘pull the plug’ phrase. It’s very technological. You pull the plug ON someone,” Chou said.  Conversations between patients and doctors about end of life care are supposed to enhance autonomy.  Plug-pulling distorts that, turning the patient into a powerless (literally) victim who could be switched off.  Feminizing the language adds punch.  Women, more than men, become  “nonpeople” as they grow old, added linguist Deborah Tannen.  Decisions are made about them, not by them.

Marcelline Block, co-editor of a new anthology called Gender Scripts in Medicine and Narrative , recalled other subtle and not so subtle threads in health reform about women’s bodies-a lot more fighting about mammograms than  prostate tests. Abortion, too. But that’s not what shaped the public debate or fueled the town meetings that helped give rise to the Tea Party.  It was Granny, the death panels, the plug.  The end of life. The end of apple pie. But not, so far at least, the end of health reform.