Emmanuel Macron announced, Tuesday, September 13, the launch of a citizens’ convention on the end of life, which will be “incorporated in October”. This last will report its conclusions in March 2023, the Elysée Palace said in a press release.
At the same time, the government will initiate a “concerted and cross-partisan work” with the deputies and senators, underlined the presidency. “All of this work will make it possible to consider, if necessary, the clarifications and changes to our legal framework by the end of 2023”added the Elysée.
What does the current end-of-life law allow? What does it prohibit?
Euthanasia, assisted suicide… What the law prohibits
French law prohibits so-called active euthanasia, that is to say the deliberate administration of lethal substances with the intention of causing death, at the request of the patient who wishes to die or without his consent, i.e. that is to say on the decision of a relative or the medical profession. According to the law, it is a murder, a crime punishable by sentences ranging from thirty years of criminal imprisonment to life. The Penal Code also provides for the prohibition to practice the profession for doctors who are guilty of it.
French legislation also prohibits assisted suicide, which consists of a caregiver giving a patient who requests it the means to end his life.
Euthanasia and assisted suicide, on the other hand, are authorized in a handful of countries in Europe. The Netherlands and Belgium were the first two European countries to authorize euthanasia twenty years ago. Luxembourg decriminalized euthanasia and assisted suicide in 2009, as did Spain, which adopted a law to the same effect in March 2021.
Switzerland authorizes assisted suicide, the practice of which is governed by codes of medical ethics and is supported by organizations. Austria has legalized, by a vote of Parliament in December 2021, assisted suicide for people with a serious or incurable disease. This law came into force on 1is January 2022. Finally, in Italy, where the penal code punishes “instigating or assisting in suicide”the Constitutional Court de facto decriminalized in September 2019 assisted suicide in certain cases: for fully conscious patients “Kept alive by treatments (…) and suffering from an irreversible pathology, a source of physical and psychological suffering which they consider intolerable”.
Deep sedation, advance directives… What the law authorizes
For the time being, in France, it is the Claeys-Léonetti law, adopted in 2016, after a first version in 2005, which regulates the end of life of incurable patients. It allows a “deep and continuous sedation until death” for terminally ill patients in very great suffering, whose vital prognosis is engaged ” short term “. This short term, which ranges from a few hours to a few days, has been defined by the High Authority for Health.
The patient is put to sleep, the treatments (hydration and nutrition are considered as such in particular) are stopped and painkillers are administered. Sedation can take place at the patient’s home, if desired, or at the hospital.
The law provides for the cessation of processing in the event of “unreasonable obstinacy” (or relentless treatment): if the patient wishes, the treatments can be “suspended” when they “appear useless, disproportionate or when they have no other effect than the sole artificial maintenance of life”. If the patient cannot express his wishes, the decision must be taken by the doctors in a “collegiate”. In all cases, “the doctor must safeguard the dignity of the dying and ensure the quality of the end of life by providing appropriate palliative care”specifies the text of the law.
The 2016 text reinforces the value of “advance directives” that patients are able to formulate, in anticipation of a situation where they would no longer be able to express their wishes. These directives can be written down on free paper or via the form proposed by the Ministry of Health. The document must be dated and signed, and the patient must identify himself by his surnames, first names, date and place of birth.
The patient can also designate an adult who will represent him if he is no longer able to express himself. The word of this person, whose appointment can be revoked at any time, takes precedence over the wishes of other relatives and the patient’s family.
Access to care, medium-term prognosis… What the law does not regulate
“We never provided the necessary means to put this law in place, we do not have the means to do our job”, slice the doctor Claire Fourcade, doctor in palliative care in Narbonne and president of the French Society of palliative care and support. In France, “two thirds of patients do not have access to palliative care, i.e. 200,000 people each year”, she explains. Otherwise, “twenty-six departments do not have a palliative care service”. Patients then have two options: “Either be taken care of by a less suitable service, or leave far from home. »
The implementation of the law “requires human resources that we do not have and extremely close support for the patient and his relatives, which we do not have the time to provide”insists Claire Fourcade.
“Deep and continuous sedation until death is intended for patients who are dyingexplain to Monde Jonathan Denis, president of the association for the right to die with dignity. We will stop the care, the medicine will withdraw and we will wait for the person to leave. Which can happen quickly or take several weeks. Thus, the law ignores all the people who are not in agony but who have a vital prognosis engaged in the medium term. There is no other solution than to go into exile in Belgium or Switzerland. »