The National Assembly examines Thursday April 8 the bill of the deputy Olivier Falorni for a “Free and chosen end of life”. With some 3,000 amendments that have been tabled, including 2,300 from five members of the Republican group, the bill will probably not have time to be voted on.
What do we know about the problems posed by the end of life in France? What does the law currently allow? The teacher Regis Aubry, head of the disability autonomy center of the Besançon CHRU and member of the National Consultative Ethics Committee, answered questions from readers of the World.
AllôLaFrance: What does “being at the end of life” really mean today in France? And why do we fail to respect the wishes of those who suffer and want to leave with dignity?
Régis Aubry: We are “at the end of life” when we have a disease that specific treatments can no longer cure. Due to advances in medicine, the “end of life” is getting longer because we can live longer and longer with one or more incurable diseases.
However, when lawmakers speak of the end of life, it should be understood as close to death, from a few days to a few weeks maximum, even if, of course, it is impossible to have such certainties.
M: What is the difference between euthanasia and assisted suicide?
The distinction is as follows: assisted suicide is the person who injects himself or absorbs the lethal product while exercising his autonomy, at the end of a reflection. In the case of euthanasia, the administration of the lethal product depends on a third party.
Banshee: Do you think the problem of euthanasia is as massive as that of the lack of palliative care?
I think that the question of the possible decriminalization of euthanasia is “the tree that hides the forest”: it is necessary that France adopts a more ambitious palliative care policy, and that it has a policy. , more broadly, support for the most vulnerable people (chronic illnesses, old age, etc.) so that these people do not have the feeling of being a “problem” (this is unfortunately often the case today).
“We must avoid producing situations of insane survival that can generate a real desire for death in some people”
Medicine must also change… We must avoid producing situations of senseless survival that can generate a real desire for death in some people. In other words, it is necessary that future health professionals are trained to learn not to do for the sole reason that we know how to do, if doing contributes to suffering … The medicine of tomorrow must be medicine marked by modesty and humility, respecting the question of the limits of knowledge, the limits of life, respecting people within their limits and their rights.
Simo: Within the framework of this new law, how the patient will be able to ask for his right to euthanasia? How will it be supervised?
The stake of this bill is to allow euthanasia (a third person injects or administers a lethal product) or assisted suicide (it is the person who takes a lethal product), under fairly strict conditions ( people with an incurable and advanced disease …) with the need for several prior medical opinions (2 or 3) and the setting up of a control committee.
Loulou: Don’t you think that “deep and continuous” sedation is French hypocrisy?
No, I do not think so. Deep and continuous sedation until death responds to the following request: “I don’t want to be conscious for the few hours and days that I have left to live. “ It seems to me that the legislator tried to answer the following question: is it justified that a person, at the very end of his life, remains conscious if he does not wish to do so?
Marie: What are the arguments of the detractors of this law on euthanasia, insofar as it is about the patient’s desire to have a more “acceptable” death than his illness and the current law on the end of? life offer him?
The arguments of people who are reluctant or opposed to this evolution of the law are of several types: what does a request for death formulated by a person at the end of life mean? Does it correspond to a request not to live any more or to a request not to live any more as at the time of the request, or to a request not to suffer any more, or to a request to no longer be conscious? For the clinician, a major stake, whatever the evolution of the law, will be to discern the direction of the request.
Maly: Do we know if dehydration and lack of nutrition at the end of life are caused by pain in patients?
Cachexia, which is the consequence of a loss of appetite, a decrease in diet and hydration in patients at the end of life, is linked to the fact that the specific course of the disease prevails on the natural defenses of eating and drinking.
Manu: I have a single brother without children. He has ALS (Charcot’s disease). He wants to stop everything before he finds himself in a state of total assistance. What is possible today?
Current French law prohibits forcing a person to take treatments that can help keep them alive. Once a person confirms that they no longer wish to prolong their life, everything must be done so that they can live an end of life, not prolonged, and with as little discomfort as possible. Even so it has to go through being put into a coma so that the person does not have the feeling of their own asphyxiation (in the case of ALS).
Telly: When can we hope to no longer have to leave France to die with dignity?
The development of the law depends on Parliament. But I am not shocked that we are taking the time to tackle such complex, essential questions. The National Consultative Ethics Committee would be in favor, before a possible modification of the law, to real States General of the end of life, so that everyone can express themselves so that the evolution of the law is nothing else. that the expression of a democratic will, very nuanced and very argued.
Eric61: Why not be inspired by the laws of neighboring countries which have been in force for a long time and do not cause debate among the population, with rare exceptions?
In fact, since 2002, the Netherlands, then Belgium, Luxembourg and recently Spain have changed their legislation. I think that we had a big deficit of non-passionate and non-militant dialogue and debate on these questions, which is added to a cultural, probably historical difficulty too, in addressing the issue of death, which is a taboo subject, and even more so that of euthanasia and assisted suicide.
Mouche: Will it be possible to refuse this assistance in dying if you do not want it for your loved ones?
If the law currently under discussion is passed, it will be necessary to ensure that euthanasia or assisted suicide (strangely the proposed law does not use these words) is only done if such acts are indeed the expression of the will of the person. A third party obviously cannot or could not take the place of such an intimate and serious decision.
MT: Do we know if impact studies on the bereavement process have been carried out in countries that practice euthanasia? What is your view on the issue?
We really lack research on this crucial point; this is why we have created a national end-of-life research platform, to be able to bring arguments such as these into a debate that is often very partisan. We need real support from research, which is a bit stricken and the poor relation, when the question is central.
Switzerland / France: We sometimes read that currently patients go to Switzerland to die. What is Switzerland’s specificity in this regard? Is this an example that the new law wants to follow?
In Switzerland, there is a legal vacuum, which means that assisted suicide (if it is not incitement to suicide) is tolerated. These are associations that facilitate this possibility. The proposed law that is being discussed unfortunately does not enter into these differences between euthanasia and assisted suicide, although this distinction seems essential to me.
Inactive surgeon: What is the place of local ethics committees? As the situations are quite specific, shouldn’t they be systematically called upon?
I agree with you. I think that local ethics committees could become a sort of mobile team to support ethical questioning, to help professionals confronted with these end-of-life issues, for example.