Published on
Updated
Reading 4 min.
In an interview with Libération and La Croix, President Emmanuel Macron positioned himself in favor of “assisted dying” limited to strict conditions, the bill of which will soon enter Parliament. An expected position which does not This Monday will not fail to create reactions among those who campaign for free choice and those who plead for better palliative care.
Almost a year after the end of the Citizens’ Convention on the end of life, closed in April 2023, Emmanuel Macron finally spoke out on a bill concerning “assisted dying”, presented to the Council of Ministers from the month of April. Assistance in dying, which he prefers to the terms “assisted suicide” or “euthanasia”, which have too many connotations.
Four main conditions for “requesting” assistance in dying
In the interview given to Release and to The crossthe Head of State thus opens the way to a modification of the Claeys-Leonetti law to give “the possibility of requesting assistance in dying. But this possibility would be governed by four conditions, in his words:
- This support will only be reserved for adults;
- People must be capable of full and complete discernment at the time of the request, which excludes patients suffering from psychiatric illnesses or neurodegenerative diseases such as Alzheimer’s;
- It will only concern patients suffering from an incurable disease with a vital prognosis in the short or medium term;
- It will only come into play if physical or psychological suffering cannot be relieved.
If these 4 criteria are met, the person can then request help to die. The decision, however, must be made by a medical team to collectively define what action to take on this request. The act will be that of the patient himself or if he cannot do it, can be delegated to a relative or a doctor.
A context which will remain at the heart of attention it seems. On this Tuesday, March 11, the Order of Physicians congratulates progress in this area, but declares to remain in its positions and will “extremely vigilant regarding compliance with the code of ethics, as well as the choice of people involved in carrying out the act, if the law so provides.”
Still the absence of a free choice for the Association for the Right to Die with Dignity
If the announcement has the advantage of concretely relaunching the debate after months of pause and postponements, it is today criticized or perceived incomplete for those who work for the right to die as desired. For Yoann Brossard, national secretary general of the Association for the Right to Die with Dignity, contacted by Doctissimo, this announcement is a first step, but leaves many people behind in this commitment.
“Certainly our first reaction is to say to ourselves, finally, the president stops procrastinating. And finally, we have a timetable so that Parliament can take up the subject and work on this law requested by many. But we can also note that “free choice” is still not respected in what the president announces. This is a possibility of appeal, the decision of which comes down to collegiality. It is not the patient who decides, he will always be dependent at the discretion of the doctors.”
The other point which upsets defenders of the right to the end of life lies in this notion of “middle term”. “VSThis is a total aberration, because no doctor is capable of ruling on the end of an illness. And this middle term, for example, cannot resolve cases like that of Jonathan Humbert.”
In its press release the Association also mentions cases such as Charcot’s disease, which can cause great suffering for patients in the medium to long term, patients who would be forgotten.
“If we want to put in place safeguards too much, we risk having a law that won’t concern anyone.”
A bad message sent to patients, according to health care advocates
On the other side of the barrier, among those who work closest to end-of-life patients, the pill is difficult to swallow. For Dr Alexis Burnod, head of palliative care at the Institut Curie, the priority is not the right one. “In my department, we expected different timing. Of course we are aware of the ongoing debate, but we hoped that President Macron would first position himself on a massive development plan for the provision of care and palliative care, particularly in the departments where it is low.
Note that the interview also announces a plan of an additional billion euros to improve palliative care, detailed by the end of the month. But indeed, in a second step.
In addition, Dr. Burnot deplores a message that is gradually changing with this decision. “I hear that there is a societal demand, that this decision could perhaps be of service to some, but I fear that this will push others to demand this type of planned end of life because the law sends a message: “you can be euthanized” when we could instead try to improve and alleviate the causes that impact patients.”
A fear shared by Emmanuel Hirsch, professor emeritus of medical ethics, Paris-Saclay University, also contacted:
“Confusing support within the framework of a palliative humanist approach with active medical assistance in dying is to cause confusion where transparency and loyalty are required. That we envisage, as it were, by default, the exceptional establishment of lethal intervention by a doctor should only be possible when all recourses to alleviate suffering have been requested. The last act of treatment is treatment. death is not one of them” he concludes.