The citizens’ convention on the end of life expressed itself in favor of an “opening” of “active assistance in dying” in France, judging the current management of the end of life insufficient. What arrangements are provided for by law?
“Active assistance in dying” must be provided for in France. This was concluded by an overwhelming majority (84%), the citizens’ convention on the end of life on Sunday, February 19, 2023. The convention, made up of 180 citizens drawn by lot, adopted the same position as that defended by the Ethics Committee on September 13, 2022, namely: it is possible to provide medical assistance to help a suffering patient end his life. If this active assistance in dying must be implemented, according to the opinion of the citizens’ convention and the Ethics Committee, it must be thought out within a framework and with conditions. And this is where many questions arise.
This first opinion issued, the citizens’ convention which has been debating for three months, still has three weekends to determine the conditions under which assisted dying must be provided. On March 19, the work of the citizens will end with the rendering of their conclusions and their definitive answer to the question posed by the Prime Minister, Elisabeth Borne: “Is the end-of-life support framework adapted to the different situations? encountered or should any changes be introduced?” The president of the governance committee of the citizens’ convention on the end of life, Claire Thoury, however recalled on Monday February 20 on franceinfo that the executive will be free to comply or not with the recommendations of the convention. According to her, the Prime Minister promised to “respond to the proposals by arguing, explaining why they have chosen this or that proposal and why not this or that other proposal”, before concluding: “Afterwards, the ball will be in the camp of the government”.
Euthanasia and assisted suicide banned in France
Impossible to kill or help a patient die, French law is clear on this subject: neither euthanasia nor suicide assisted by the injection of a lethal product are authorized. A doctor or healthcare professional who performs such acts, even at the request of the patient, commits a criminal offence. Only one form of euthanasia is possible in the French health system and it can only be used under certain conditions: passive euthanasia, that is to say that caused by the cessation of care provided for by the prohibition of therapeutic relentlessness or by the patient’s refusal to receive treatment.
The right to long and deep sedation
End-of-life law evolved with the Claeys-Leonetti law of February 2, 2016, which gave the patient the right to request “long and deep sedation until death”. But only patients in very great suffering whose vital prognosis is committed in the short term – a period ranging from a few hours to a few days according to the High Authority for Health – or those whose death is recognized as inevitable and imminent can take advantage of this right. Right which is not an aid in dying but rather pain relief until death. The patient is asleep and continues to receive painkillers or palliative care until the disease prevails, all treatments being stopped.
In addition to being reserved for a handful of patients, long and deep sedation can only be implemented after discussions with health professionals in a collegial procedure, even if the advance directives or the person of trust support this choice.
Is it possible to stop treatment in France?
Doctors and the medical profession must offer their patients all the solutions to save them and keep them alive, only the patient himself can oppose a treatment. This also applies if the non-use of drugs and other medical procedures results in death. It should be noted that artificial nutrition and hydration of unconscious people are considered as treatments. Refusal of treatment may therefore be a way for patients to shorten their lives.
The Claeys-Leonetti law of 2016 made refusing treatment binding on doctors, even if stopping treatment can be fatal. In this case, the patient must simply reiterate his refusal to be treated knowingly. If all treatment is then prohibited, doctors have an obligation to “safeguard the dignity of the patient, ensure his quality of life and relieve his suffering” by resorting to palliative care if necessary. Refusal of treatment can in some cases lead to long and deep sedation.
Is unreasonable stubbornness allowed?
Formerly called therapeutic relentlessness, unreasonable obstinacy and artificial prolongation of life have been prohibited since 2005 and the Leonetti law, the first law to legislate the end of life. This measure is similar to the counterpart of refusal of treatment, except that the decision to stop treatment comes from the medical profession. This decision must, however, be collegial and necessarily requires the agreement of the patient or his trusted person when the latter is no longer able to express himself. Again, despite the discontinuation of care, physicians must take care of the patient’s pain.