Olivier Falorni has never hidden his support for the legalization of euthanasia. But the ex-socialist who went to the MoDem wanted not to go beyond the scope of the mission entrusted to him: to evaluate the law of February 2, 2016 known as Claeys-Leonetti which fixes the rights of people at the end of life. With his two co-rapporteurs – Caroline Fiat, LFI deputy for Meurthe-et-Moselle, and Didier Martin, Renaissance deputy for Côte-d’Or – he thus classically recommends in a report delivered on Wednesday March 29 to develop the offer of palliative care or encourage the drafting of advance directives.
The difference between “let die” and “let die”
However, certain conclusions and recommendations aimed at extending the use of deep and continuous sedation until death risk reviving old controversies. This medical practice consists of numbing the consciousness of the patient by means of drugs most often associated with analgesics. It is strictly reserved for patients whose vital prognosis is committed in the short term – a few hours or a few days – and is only applied after a collegial decision by the healthcare team.
The objective is to avoid refractory suffering and painful agonies, even if it means assuming the risk of shortening the patient’s life. In this sense, it differs from euthanasia, which is practiced with the intention of causing death. The difference may seem slight, and the inclusion in the law of this form of sedation had also aroused misunderstanding, some likening it to passive or hidden euthanasia. But for caregivers in palliative services, the distinction between “let die” and “make die” is essential.
A still “very rare” practice
However, if the Falorni mission recognizes that this device “contributes to the strengthening of patients’ rights and in particular the right not to suffer she also notes that the use of this practice is still ” very rare “ et “Very variable depending on the pick-up location” – in a palliative care unit, in a hospital service, in nursing homes or at home.
It remains to understand the reasons for this situation. Is it because palliative doctors only use this deep and continuous sedation sparingly, when the situation really requires it, as explained by those who were interviewed by the mission? Or because there is a form of reluctance on the part of caregivers vis-à-vis this device, which is not always easy to set up?
In the absence of precise data on the subject – the decision to perform such an act is recorded in the patient’s medical file, but there is no centralized register – the mission was careful not to decide. Without refraining from making several recommendations to develop its use, advocating in particular to make it possible to accelerate the process when the agony lasts too long.
A concrete but exceptional case
To support this proposal, Olivier Falorni and his co-rapporteurs evoked the concrete, but exceptional case, observed during a visit to a neonatology unit, of an infant suffering from a disease that condemned him but having survived more than eight days. despite his placement under deep and continuous sedation and the withdrawal of food and artificial hydration.
“An unbearable situation for the family as well as for the healthcare team. It is to avoid these painful situations that we wish to specify the conditions of use of deep sedation, in order to prevent it from lasting an unreasonable time.pleaded Olivier Falorni. “As Jean Leonetti said himself: if after three days the patient is still alive, we accelerate”clarified more clearly Didier Martin.
A way to bring in the“active assistance in dying” through the window when the Claeys-Leonetti law had closed the door? Oliver Falorni denies it: “We have tried to assess this law in the most complete and lucid way possible and have made concrete proposals to improve its implementation. It is true that the issue of active assistance in dying has often been raised by almost all of the actors interviewed – doctors, lawyers, philosophers, religious – but we have refrained from taking a position in this report since it was not not its object. »
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Conclusions of the evaluation mission
Inadequate access to palliative care. To develop them, the mission recommends making the sector more attractive, developing training and reviewing hospital pricing.
Poor knowledge of advance directives and designation of trustworthy persons. Hence the need to engage in awareness campaigns.
Deep and continuous sedation considered too little used.
In conclusion, the mission considers that the Claeys-Leonetti law responds to “the vast majority of end-of-life situations” more “does not provide an answer to all”.