Lhe debate on active assistance in dying is shaking up our conception of medicine. The National Academy of Medicine was able to express reservations with regard to this aid which would go against the vocation of the doctor and the Hippocratic oath. While discipline has until now been in the service of life in general, and the survival of the patient in particular, the question arises for the first time of a medical act aimed at ending the life of a sick person. .
In any case, this is how the public health code today defines active assistance in dying, namely “the prescription to a person by a doctor, at the express request of the person, of a lethal product and assistance in the administration of this product by a doctor” (article 1, L. 1110-5-4). From now on, in the hypothesis of application, it must be kept in mind that this act must arise from the patient’s desire to choose the conditions of his death.
How then can we think about the conditions of a “liveable death” rather than allowing a life considered “unlivable” to continue? The seriousness of this question leads us to think that we must establish a new relationship between the patient and the caregiver, because, as the sociologist Frédéric Blondel points out in the New Journal of Psychosociology, “the end of life concerns a problem of social bond which involves a process of social construction of consent”.
The patient-doctor relationship is today marked by the requirement for so-called “free and informed” consent, defined by Professor Grégoire Moutel – cited in the same journal – as “the approval of an approach, with full knowledge of the facts” within a “explicit association of the patient and the doctor against the disease”. But who consents to what? Too often, consent is reduced to the signing of a document demonstrating a patient’s approval of a therapeutic treatment proposed by the doctor, which makes the patient a passive person receiving or undergoing treatment, rather than an actor in their illness and their care trajectory.
A “paternalistic” legacy
However, the original project of what we call “therapeutic education” lies in the ability of health professionals to make the patient an autonomous actor in their illness, capable of giving and following their own rules. The risk is then that therapeutic education is reduced to the effort of the medical profession to lead the patient towards the treatment recommended by the evolution of the disease, without paying real attention to their own wishes.
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