Olympe’s voice breaks. When she tries to evoke his death, her blue eyes mist up. The young Frenchwoman, suffering from a dissociative syndrome of identity, cuts the recording, searches for her words, then raises. “I have not found anything to counterbalance my troubles and my past […]. There are no moments that I appreciate. And it’s not the effect of one of my mental phases”. The takes are good. She chases away her tears, and publishes.
On January 11, this 23-year-old Youtuber announced that she wanted to resort to assisted suicide. In Belgium, because in France, the practice remains prohibited for the moment. To its 270,000 subscribers on Instagram, she then confides that she no longer supports her illness. No physical suffering or vital prognosis: the evil is in his head, where eleven distinct personalities compete to impose themselves, without respite. In the midst of a national debate on the “end of life”, his decision is strongly commented on.
Under the impetus of Emmanuel Macron, the government has been thinking since the fall about a “new law” in terms of assisted dying – a majority of French people are for it. Should we include patients whose body is well, and whose death is neither imminent nor inevitable, like Olympe? Can we facilitate the death of people with mental illness, as in Belgium, Switzerland, the Netherlands or Luxembourg? The conditions for the “French model” remain to be found, the executive said in early April.
A scarecrow for anti-right to die
So far, the debating bodies wanted by the president have mainly mentioned physical suffering. The evolution of the Leonetti law (2005), which only allows deep sedation, under strict conditions, seems the most “obvious”, according to the Citizens’ Convention on the end of life, whose 184 members were drawn by lot to produce an ethical reflection. Psychological suffering has been addressed, but without a consensus emerging. “Debate […] deserves to be prosecuted”, specifies their report, submitted at the beginning of April.
The subject is polarizing: “Psychic suffering has been the subject of fiery parentheses. Often, these cases are erected as scarecrows by those against the right to die”, regrets Raymonde Poncet, Senator Europe Ecology The Greens and member of the cross-partisan parliamentary group on the end of life, another body responsible for informing the government. “According to them, authorizing this form of assisted dying would amount to saying amen to all suicidal impulses. This extrapolation stifles the debate, while it would allow us to refine our vision”, continues the elected official.
Abroad, four of the ten countries that already have a form of right to die take into account situations of “psychiatric suffering”. None of them, however, is an Eldorado of death. In the form of euthanasia, performed by the doctor, or assisted suicide, assisted death for mental illnesses does not exceed 5% of annual recourse, according to official statistics from different states. Each case represents a dilemma. “These wishes are often the most sensitive and therefore the most controlled. They are very complex to manage”, recognizes Jean-Jacques Bise, co-president of EXIT, one of the Swiss associations which takes care of supporting the people concerned.
A dilemma, even in the most open countries
In Switzerland, assisted suicide has been decriminalized since 1942, but euthanasia remains prohibited. The country refuses any medical approach to death, but consecrates a form of individual freedom. Which is not without limits: in 2006, after the emergence of cases of assisted dying for psychiatric reasons, the Federal Court decided that an expert report attesting to the plaintiff’s discernment should be brought to the file. Otherwise, associations that accompany suicide are sanctioned.
Belgium has legalized euthanasia for mental suffering. From 2002, at the same time as it authorized this approach for physical suffering. Here again, the approach consecrates a form of freedom, very marked out. Two psychiatrists must give their approval. And in any case, the situation must be “dead end”, “serious”, “incurable”, and unappeasable, limits the law. Shanti de Corte, a 23-year-old survivor of the Brussels attacks, was refused several requests for euthanasia, before obtaining one, and dying on May 7, 2022.
With the Netherlands and Luxembourg, two countries where euthanasia and assisted suicide coexist and also include psychiatric cases, a fifth nation could soon take the plunge: Canada. Since 2016, it is no longer necessary to have a committed vital prognosis to request assistance in dying. A legislative change that paved the way for mental illness. However, the Canadian government has suspended this right until 2024time to put safeguards in place.
While waiting for this deadline, the reports are linked to develop a framework. “The psychiatric issue was inevitable, but remains very controversial. The rules will be tighter than for physical problems. We are talking about several decades of follow-up before authorization. We must avoid premature deaths, while diseases such as schizophrenia can stabilize over time, for example,” explains Georges L’Espérance, president of the Quebec Association for Medical Assistance in Dying.
“How to obtain free and informed consent?”
A sign of the complexity of the issue, some States like theOregon, a reference in matters of assisted suicide in the United States, adopt an opposite approach. There, mental pathology is excluding. If diagnosed, the patient does not have the right to request assistance in dying, even if the suffering is also physical. The authorities consider that most of these affections are inseparable from the death wish of the patients: medically, the individual cannot be free of his choice.
A point of view shared by many French psychiatrists: “Our patients have a pessimistic vision of life. This is their main symptom. How do you want to obtain free, informed and repeated consent? They have no capacity for discernment , autonomy or consent”, warns Rachel Bocher, psychiatrist at the Nantes University Hospital. She recalls that her medical field is one of the few to be able to practice an obligation of care. The right to die would therefore come in total contradiction with this faculty.
What predict the choice to come in our country? “The French approach is focused on the impasse of care, and not on the freedom to help or to be helped to die. However, authorizing cases of psychic disorders also means admitting a much greater renunciation than that palliative care. We consider that we are not capable of alleviating this suffering, which is debatable with regard to existing therapies, even if we cannot deny the experience”, underlines Xavier Briffault, sociologist of mental health at CNRS.
According to the first clues sown by the government, the future law would not go in the direction of a general right to die. In particular, the Minister of Health has shown himself to be opposed to an excessive development of the current framework. And Emmanuel Macron did not hide his hesitations. But so far, neither he nor any member of the government has set any formal limits. Response will be made with the future bill, expected at the end of the summer. Thinking about death takes time. Olympe, the youtuber who announced her steps in Belgium knows this well. Before dying, she gave herself a year, and the right to change her mind.