The President of the Republic is somewhat embarrassed. This Monday, May 27, begins the examination by the deputies of the bill on the end of life, approved on May 18 in the Special Committee. However, the text no longer really resembles the one that the executive concocted for months. And for good reason, the 71 members of the parliamentary commission broke down many barriers that it had carefully closed, thus considerably modifying the scope of the text.
Since then, many voices have been raised against this new version. In La Tribune Sunday, the former Minister of Health, and emergency doctor, François Braun denounced “unacceptable things”. Opinion shared by more than twenty caregiver associations who took up their pen in a press release: “The deputies […] have further expanded access to induced death than have the two most permissive countries on assisted dying” (Belgium and Canada, Editor’s note). L’Express returns to the five points that divide.
1 – Expanding access to assisted dying-
In its original version, the bill limited the use of medical assistance in dying to cases of patients whose “vital prognosis (was) engaged in the short or medium term”. A safeguard whose borders have been pushed back somewhat by the deputies in the special committee. Thus, the version of the text which is about to be dissected by all the elected officials of the Palais Bourbon provides for the possibility of triggering the system in the event of an illness “in the advanced or terminal phase”.
To justify this development, the defenders of the amendment plead the absence of a definition of “short or medium term” by the High Authority of Health”. Furthermore, the general rapporteur and MoDem deputy Olivier Falorni recalls that This definition adds two other criteria: the illness must be both “serious” and “incurable”. “serious and incurable defines that your vital prognosis is not only compromised but it is even seriously, very seriously compromised. And the advanced or terminal phase strengthens this system,” he insisted.
But for the nephrologist Bruno Dallaporta, invited to the microphone of RMC this Sunday, expanding access to assisted dying would amount to “euthanizing people who are absolutely not at the end of their lives”. To illustrate, the doctor takes the example of “patients with advanced pathology who could have the right to active assistance in dying even though they could still live 30, 40 or 50 years”. Same story with the president of the SFAP Palliative Care, Claire Fourcade, who sounds the alarm in the program “Points of view” of the Figaro : “If we transpose the figures from Canada, that would make 45,000 euthanasias per year in France, or one every ten minutes.”
2 – “Assistance in dying” and “euthanasia”, the choice left to the patient
The question of administering the lethal substance to the patient also crystallizes tensions. In the first version of the text, the executive makes aid in dying – namely the provision of a lethal substance that the patient administers himself – the principle. And reserves euthanasia – the carrying out of the lethal act by a third party (caregiver or loved one) – only for cases where the person would not be “physically able to carry out it”.
But by voting in favor of an amendment allowing the patient the possibility of choosing between “assisted dying” and euthanasia, the Special Commission debunked this principle. For the president of the SFAP, an open door left for the generalization of euthanasia. “In countries that have legalized these two end-of-life modalities, it is almost exclusively euthanasia that is carried out, because medical intervention somehow facilitates this difficult decision for patients,” warned Claire Fourcade.
3 – Openness to advance directives
Many have also spoken out against the introduction of assistance in dying in advance directives. Since the first law on the end of life in 2005, known as Leonetti, it has been possible to record one’s wishes in advance in the event of inability to express oneself in a document called “advance directives”.
Until now, patients can only order to “continue, limit, stop or refuse treatments or medical procedures”, specifies the Ministry of Health. For example, it is possible to indicate the refusal of artificial nutrition and hydration following a coma or in the event of profound cognitive disorders.
But in the event of a vote and promulgation of the version adopted by the Special Commission, it will now be authorized to request the administration of a legal substance, which would thus amount to resorting to euthanasia. “Finding yourself in a situation where you can no longer express yourself, where a trusted person advocates euthanasia because three or four years ago we would have written it on a paper, suddenly sweeps away the idea that we could have changed our mind”, warns Alexis Burnod, head of palliative care at the Curie Institute, to our colleagues atEurope 1.
4 – The creation of an offense of obstruction of assisted suicide
Another fruit of the Parliamentary Commission, the creation of an offense of obstruction of assisted suicide like that which already exists for voluntary termination of pregnancy (abortion). The amendment, tabled by Insoumise Caroline Fiat, provides for a sanction of one year in prison and a fine of 15,000 euros for anyone who “prevents or attempts to prevent practicing or finding out about aid to die by any means.” The operation of a “confusion between prevention and promotion”, summarizes the nephrologist Bruno Dallaporta on RMC.
Several deputies notably tabled a series of amendments aimed at prohibiting any incitement or promotion of assisted dying. Frontist Christophe Bentz, for example, proposed sanctioning “propaganda or advertising in favor of assisted dying”. For their part, the caregivers’ associations, united in a common text, castigated “the coercion” imposed by the text on “pharmacists”, “staff of health and medical social establishments who would be required to organize the fatal procedure in their walls”.
5 – Palliative care, largely forgotten in the project
More generally, since the presentation of the bill, many doctors’ associations have deplored the weakness of the responses provided to the problems encountered by palliative care services. While around twenty departments do not have them, and the Court of Auditors called last July to “strengthen” palliative means at home and in retirement homes, the text only provides for the thawing of a 1, 1 billion euros over… ten years.
An envelope considered far too insufficient. “Only one in two French people who need palliative care have real access to it […] If we want everyone to be able to have access to palliative care, we should in theory double the capacities, said LR deputy and doctor Philippe Juvin to Catherine Vautrin, during questions to the government on March 19.
In addition, critics of the bill raise the specter of automating the use of assisted dying to the detriment of palliative care. “It could be easier to obtain a response to a request for death than to care worthy of a democracy when today it sometimes takes more than six months to obtain an appointment at a pain center,” alert caregivers.
Concerns that the Minister of Health, Catherine Vautrin, guest on BFMTV this Monday morning, tried to allay, by committing that “no one in France should be led to request assistance in dying because he would not have had palliative care.”