“Assistance in dying”: the bill in the Assembly chamber on Monday

After a long gestation, the end-of-life bill arrives for first reading in the Assembly chamber on Monday, for two weeks. Objective: to authorize for the first time in France “assisted dying” for certain patients, not without raising concerns and divisions among the majority. Emmanuel Macron presented his decisions on this ultra-sensitive subject on March 10, almost a year after the end of a Citizens’ Convention devoted to this issue. Time to refine a “French end-of-life model”, offering “assisted dying” which allows certain patients, under “strict conditions”, to receive a “lethal substance”.

Among these conditions, in the government version: being suffering from a “serious and incurable condition which threatens one’s vital prognosis in the short or medium term”, being of legal age, capable of expressing one’s will in a free and informed manner, and presenting suffering that is refractory to the treatments or unbearable. The Minister of Health Catherine Vautrin has constantly praised a “balanced text”.

But the debates of the special committee in the Assembly resulted in the modification of several key points, endangering this fragile balance according to many voices. “The original balance, that of respect for the wishes of patients and the place given to health professionals, has been broken,” protested MP Agnès Firmin-Le Bodo (Horizons, presidential majority) in L’Opinion. , who participated as Minister of Health in the birth of the text.

Object of her ire, a modified eligibility criterion: the mention of “vital prognosis engaged in the short or medium term” was replaced by the notion of affection “in an advanced or terminal phase”, which “broadens” according to her the number of potential beneficiaries.

A change welcomed by the Association for the Right to Die with Dignity (ADMD) and by the general rapporteur of the text, Olivier Falorni (attached to the MoDem group, also in the majority), a lifelong defender of this cause, but fought by Catherine Vautrin, who has already tabled amendments to return to the initial text. “The short and medium term vital prognosis refers to notions which are precise and which the healthcare world understands,” Minister Delegate for Health Frédéric Valletoux argued on Saturday on franceinfo.

“Last resort”

Another development raises concern, concerning advance directives: the deputies approved in committee, at the initiative of Frédérique Meunier (LR), an amendment providing that in these directives the patient can specify the “type of support for a “assisted death” desired in the event that he loses “irreversible consciousness”. Elsewhere in the text, the criterion according to which the patient must be “able to express his will in a free and informed manner” is maintained, but the modification introduced “casts doubt”, maintains Agnès Firmin-Le Bodo.

Third subject of alarm, the administration of the lethal substance. The text provided that patients should administer it themselves, unless they were unable to do so. But an amendment by Cécile Rilhac (related to Renaissance) gave patients the possibility of freely choosing to delegate this action to a third party.

These modifications reinforced the hostility of opponents of the text. The Catholic Church and the Protestant Federation of France deplored them, and a group of healthcare organizations considered that “Pandora’s box (was) open”. “In less than a week of parliamentary discussions, most of the safeguards have been blown,” criticized Philippe Juvin, LR deputy. The text is “absolutely not unbalanced”, replied Olivier Falorni, for whom the deletion of the mention of the vital prognosis engaged in the short or medium term is justified by the difficulty of defining what the “medium term” is.

Another part of the text concerns palliative care, which MPs from all benches want to see strengthened. Thomas Ménage (RN) said he was ready in committee to vote on the text “on one and only condition (…) that it will not be, this assistance in dying, a stopgap because there is no does not have effective palliative care.

Even if the left and the presidential camp should provide most of the support for the bill, faced with the hostility dominating the right and the extreme right, the parliamentary debates will not be reduced to traditional divisions, voices against -current expressed in the different groups. The bill is expected to continue its legislative journey until at least the summer of 2025.

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