The Constitution does not oblige doctors to respect the will of a person expressed in their advance directives, even if it is their wish to be kept alive at all costs: the Constitutional Council rendered a decision on Thursday 10 November which will make case law. The 2016 Claeys-Leonnetti law provides that any adult can indicate in writing how they want to be accompanied by doctors, if their life is in danger. These wishes must be respected, but only under certain conditions.
The decision of the sages of the rue de Montpensier aimed to decide a priority question of constitutionality (QPC) posed by the family of a man admitted in a coma in July 2022 to the hospital in Valenciennes (Nord), after being crushed by the truck he was repairing. Victim of multiple fractures and cardiorespiratory arrest, the man, then 43 years old, had been taken care of in intensive care. The doctors considered that it was preferable in July 2022 to stop the treatments and the procedures performed. They felt that their pursuit would only have the effect of keeping him artificially alive, allowing him only one “quality of survival (…) catastrophic ». They relied on the Claeys-Léonnetti law, which authorizes the cessation of treatment, “when they result from unreasonable obstinacy”.
But this patient had written advance directives in June 2020 asking to be kept alive “even artificially”, if he was plunged into a coma deemed irreversible. The family, determined to oppose the cessation of care, seized the judge in chambers of the administrative court, who ruled against them. She then appealed to the Council of State, while submitting a QPC sent to the Constitutional Council.
Compliance with the law
Legally, the QPC contests the conformity with the Constitution of paragraph 3 of article L 1111-11 of the public health code which provides for the possibility for a doctor to refuse to execute advance directives if he considers that they are “manifestly inappropriate or not in conformity with the medical situation”.
The family’s lawyer, Ludwig Prigent, argued during the October 25 hearing that these two exceptions left the doctor too much discretion, which could lead to a decision contrary to the principles of the dignity of the person, respect for human life, personal freedom and freedom of conscience, all rights guaranteed by the Constitution.
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