The end-of-life bill continues its legislative journey. What exactly does this text contain?
The end-of-life bill was presented this Wednesday, April 10 to the Council of Ministers. It is part of the major reform of Emmanuel Macron’s second five-year term, which wants to build “a French model”. Refusing to speak of euthanasia, which refers to the fact of “ending someone’s life, with or even without their consent” or of assisted suicide “which corresponds to the free and unconditional choice of a person to dispose of their life”, Emmanuel Macron prefers the term “assisted dying”. But despite the distinction, in reality, it is indeed assisted suicide that is considered with exceptional recourse to euthanasia in certain cases.
Explanations: a patient may request this and it will be taken into consideration after a period of two days. The decision will then be made by a doctor after a 15-day reflection procedure where he will be able to consult other caregivers before rendering his verdict alone. If the doctor is favorable, the patient will be able to benefit from assistance in dying within three months. Even once the prescription has been made, the patient will be free “to withdraw at any time,” said Emmanuel Macron. In the event of an unfavorable opinion, the patient may consult another medical team or “proceed with appeals”.
To date, the Claeys-Leonetti law of 2016 authorizes the use of deep and continuous sedation until death when the patient’s vital prognosis is compromised in the short term. It consists of putting the patient to sleep and stopping their hydration and nutrition. This law will continue and will be supplemented by assistance in dying.
The new bill is divisive. It is considered too weak by supporters of the legalization of assisted suicide and, conversely, dangerous by opponents such as religious people or certain caregivers.. Nevertheless, sAccording to an Ifop-Le JDD survey unveiled on April 1, 70% of French people are in favor of the principle of promoting active assistance in dying.
After this presentation to the ministers, the text will be far from having finished its journey: it will arrive on May 27 before the deputies and the final adoption could take up to two years in the event of differences between the Senate and the Assembly national, according to BFMTV.
Specific conditions for accessing assisted dying
Assistance in dying can only be offered to adults as recommended by the Citizens’ Convention on the end of life in its conclusions delivered on April 2, 2023 as well as the National Consultative Ethics Committee in September 2022. They must also be born in France or have lived for a long time. Several other conditions concerning the patient’s state of health will determine access to assisted dying. Patients will thus have to be capable of “full and complete discernment”, which will deprive people suffering from psychiatric or neurodegenerative illnesses such as Alzheimer’s from assisted dying, which will allow them to clearly express their wishes. They must be affected by an incurable illness, have a vital prognosis in the short or medium term and present psychological and/or physical suffering that is impossible to relieve. No list of diseases concerned will be established.
How will the lethal product be administered?
After a favorable opinion from a medical team, a lethal substance will be prescribed to the patient who will be able to administer it himself, a situation close to assisted suicide. If, and only if, the patient “is not physically able to carry out” the assisted suicide, he may be helped by a third party, whether it is the “doctor or the nurse who accompanies him” or a “volunteer person designated by them when no technical constraint prevents this”, according to the bill. A scenario comparable to euthanasia carried out with the consent of the patient. The administration of the lethal product may take place at home, in a health establishment or in an Ephad.
Strengthened palliative care? A ten-year plan promised
The end-of-life bill includes a part on assisted dying, which must be the last resort, and a part on supportive and palliative care which must not be forgotten according to Emmanuel Macron. “We are going to put palliative care back at the heart of support even before the law is promulgated,” he promised. A ten-year strategy for the development of palliative care must be presented by the end of March. While 1.6 billion euros is currently devoted to supportive care, “we are going to invest 1 billion more,” declared the head of state.
“What is important is that, from the diagnosis and the start of treatment, the pain is taken care of and human support intervenes. For this, we must continue to deploy mobile teams which help hospital services to better take care of the pain,” said Emmanuel Macron. Palliative care must also be developed in pediatric services for children who will not be eligible for assistance in dying, whatever their state of health: “It is essential to improve the management of infant pain and children.”
Strengthening palliative care must also involve the establishment of a “continuum with community medicine” and investment in “home support supported by care networks”. For this, “support homes which are the missing link between the hospital and the home” are being planned. Above all, the Head of State promises to provide palliative care units to the 21 departments which still lack them.