This is an unprecedented dilemma that arises in the debate on the end of life. Can doctors, in the name of refusing unreasonable obstinacy, stop the care given to a patient who has clearly expressed, through his advance directives, the wish to be kept alive at all costs?
The question opposes, since June, the hospital center of Valenciennes (North) to a part of the family of Abdelhadi M.. This one decided to bring the dispute before the Constitutional Council which will have to decide, on November 10, a question priority of constitutionality (QPC) on which is played, in part, the fate of this man.
Why was the Constitutional Council seized?
To enter into this complex file, we must go back to May 18, the date on which Abdelhadi M., 43, was placed in a coma by the hospital’s intensive care unit. It is a question of stabilizing a state judged critical following the serious accident which it has just undergone – the crushing by a truck which it repaired. Ten days later, the team decides collectively – as the Claeys-Leonetti law on the end of life provides – to set June 9 for the suspension of treatments deemed “unnecessary and disproportionate”with no effect other than “artificial life support” of the patient.
A decision to which his wife and two sisters oppose by seizing the judge in chambers of the administrative court of Lille. Their shock argument: a letter dated June 5, 2020 in which their parent expresses his desire to be kept alive, even in the event of a coma deemed irreversible. However, on July 15, the medical team confirmed its decision to stop the care – mechanical respiration, artificial feeding, transfusions – which only ensured the patient a quality of survival judged “catastrophic”.
What is the legal problem?
The hospital relies on article 1111-11, paragraph 3, of the public health code which provides for exceptions to strict compliance with advance directives. Especially when they “appear manifestly inappropriate or not consistent with the medical situation”. Is this the case here? This is disputed by the family who, after the rejection of their request by the judge in chambers, appealed to the Council of State, raising on this occasion a QPC which the Constitutional Council seized on August 22.
Tuesday, October 25, a hearing allowed the lawyers of the two parties to make their observations. Me Ludwig Prigent, for the family, argued that denying care against a patient’s will violates personal freedom, freedom of conscience and respect for human dignity. According to him, the doctors’ decision contravenes the spirit of the law, which above all wanted to guarantee caregivers not to be bound by advance directives leading to the practice of euthanasia which would not say its name.
For the hospital lawyer, Me Claire Waquet, the law is completely in conformity with the Constitution and it is respected here by the refusal to “unreasonable obstinacy” which preserves the dignity of the patient. “Finally, can we keep a person in artificial life indefinitely without asking the question of the burden on the health system? I’m not afraid to ask it”she points out.
What can be the outcome of the case?
The Constitutional Council must decide on November 10. Three possibilities remain open. Either he considers that article 1111-11 is in conformity with the Constitution, which will reinforce the hospital in its decision to stop the care. Either he decides that this article is unconstitutional and it will be repealed. Either it emits “interpretive reservations” which will provide the keys to reading the article.
In any case, the decision will be binding on the Council of State, which must decide the fate of Abdelhadi M. A case which demonstrates, if need be, the extreme complexity of the debate on the end of life in which the country engages.