A doctor is not necessarily obliged to respect the “advance directives” by which a patient expresses his wish or not to be kept alive. The principle was confirmed Thursday, November 10 by the Constitutional Council, which validates the legislation in force. The law, which provides that the doctor can override these directives if they are “inappropriate” to the patient’s situation, complies with the “safeguarding the dignity of the person” as at his “personal freedom”believes the Council.
This decision is taken at a time when debates on the end of life are returning to the public domain. President Emmanuel Macron is considering a change in legislation, but refers the responsibility to a citizens’ convention which is to meet from December.
The Constitutional Council had been seized by the family of a patient, plunged into a coma since May after an accident and whose doctors consider the situation desperate. The medical team at the Valenciennes hospital (Nord) wanted to stop treatment – artificial nutrition and respiration – but this decision went against the intentions expressed by the patient in his “advance directives”. These, which consist of a document previously written and signed by the patient, are supposed to testify to his will in the event that he is no longer able to express a choice.
Provisions “neither imprecise nor ambiguous”
But the law provides that the medical team, after a collegial procedure, can overrule if they appear “not medically compliant” of the patient. It was on the validity of this law that the Council had to decide. The latter considered that the legislator had played its role in providing such a way out for doctors, in particular because the patient cannot be fully able to assess his situation in advance.
The law aims to “ensure the preservation of the dignity of people at the end of life”, believes the Constitutional Council, without going so far as to directly mention the notion of therapeutic relentlessness. He also considers that the law is sufficiently clear by referring to the case of directives “manifestly inappropriate” to the medical situation of the patient, whereas the defenders of the family considered these terms too vague. “These provisions are neither imprecise nor ambiguous”believes the Council.
Recalling, moreover, that such a decision was only taken following a collegial procedure and that it could be the subject of a “timely remedy” family or relatives, the Council concluded that the legislation in force did not disregard “neither the principle of safeguarding the dignity of the human person nor personal freedom”.