“Opening assisted suicide to a minority of patients could worsen the end of life for the greatest number”

by time news

2023-04-03 14:35:19

The end of life is an intimate question that generates a feeling of fear that hinders our reflexive faculties. Our opinion is forged by our personality, culture, experience, then an argument is built in a second time in a process of secondary rationalization. Many French people are in favor of the legalization of administered death. Their belief is based on a painful experience at the death of a loved one, sometimes a source of activism in a process of repairing this intimate wound, or it is a position of intellectuals arguing the “right to choose one’s death”far removed from the reality of the end of life.

For the silent majority, the answer is legitimately cautious and humble to the question of administered death: “Why oppose it since it can only help (me)? » Caregivers are involved in various ways in the management of patients with serious and lethal illness. As oncologists specializing in supportive care and palliative care, we have been able to support several thousand patients. Our professional experience is nourished by the great diversity of situations encountered and gives legitimacy to our expert opinion. However, caregivers find themselves in a paradoxical situation; while they defend the values ​​of accompaniment centered on listening, they say to the French: “Your aspiration to legalize an administered death in order to improve the conditions of their end of life is not a good solution. »

Medical advances

Medical progress has been real in recent years. Pain relief calls for high-performance techniques and complementary care is being developed within the framework of integrative medicine. Early and multidisciplinary palliative care has been developed in oncology, with the aim of improving the quality of life, while allowing anticipated discussions on the prognosis and the evolutionary risks and a preparation of the conditions desired by the patient and his relatives on his end of life.

This accompaniment makes it possible to avoid the therapeutic relentlessness, a concern of many patients and a source of aggressive care at the end of life. The monitoring of certain indicators such as the rate of chemotherapy administered in the last month preceding death could be made compulsory. Public authorities and learned societies should set benchmarks on the proportionality of care, to avoid the trap of a dichotomous choice between intensive therapeutic relentlessness and death administered, in an action aimed at relieving the anguish of patients confronted with their end of life, like that of caregivers confronted with their powerlessness.

No unreasonable stubbornness

The end of life is always a difficult journey, a source of suffering because of the succession of losses it entails, including that of the feeling of control. Some end-of-life patients do present with refractory suffering, even if it is quite rare. Deep and continuous sedation until death is offered to them, permitted by the Claeys-Leonetti law of 2016, which makes it possible to put an end to any unreasonable obstinacy, including that of hydration and artificial feeding.

Some patients express a desire for death, because they fear a certain clinical deterioration whose date and/or modalities are not predictable. They find no meaning in this time left, and they often feel lonely and unsupported. In this context, the expression of the desire to die includes a call for help, a request to enter into a relationship with the person to whom it is addressed and an ambivalence known as a psychological defense mechanism. A care relationship is woven, the care teams will deploy listening, expertise and creativity. The relief provided as well as the psychological journey made possible will allow the patient to find another taste in his life.

A lingering death wish

A few rare patients have always expressed a persistent and irrepressible death wish, due to extreme existential distress. More recently, we observe a request for death of another type: a right demanded because of the individual’s freedom to choose one’s death, and not to face one’s “natural” end of life. Two types of arguments come against it.

First, the right to assisted suicide would encroach on the freedom of caregivers forced into an act of extreme violence. The conscience clause would be inapplicable individually because of the duty of non-abandonment and collectively because of the risk of division within the teams. Secondly, the right to assisted suicide would send the message to society that end-of-life patients have no place in our society; and would take the risk of weighing on the weakest who would see no other way out. In the United States, we note in the motivations for assisted suicide the fact of not being able to assume the financial burden of care, and the cost of care in nursing homes could lead to such abuses in France.

A minority of patients

The experience of caregivers makes them fear that a law allowing a minority of patients to benefit from assisted suicide could worsen the end-of-life conditions of a far greater number. The resources that we observe when the end of life goes well are individual, in the ability to accept their altered medical condition and to be accompanied; and social, in the ability of relatives and caregivers to adopt an attitude that reinforces the feeling of dignity of end-of-life patients. The challenge is there: that of having enough confidence to rely on the other, to know that we will be loved and cared for until the last day. No law on the end of life will avoid being confronted with it, and it may have come the time for society to allow everyone to fully live this last act of our life consubstantial with our human condition.

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