End of life: the Ethics Committee says “yes” to assisted suicide – La Croix

“There is a path for an ethical application of active assistance in dying. This is the conclusion reached by the National Consultative Ethics Committee (CCNE) in its opinion on end of life, made public on Tuesday 13 September. The body, which had self-seized the subject in June 2021, therefore sees no opposition to a possible legalization of a chosen death, if the legislator decides to modify the current law, “and under cover that strict conditions limit the process”, specifies Régis Aubry, doctor in palliative care and one of the co-rapporteurs of the opinion. The text thus marks an unprecedented break with the previous opinions of the committee which, until now, had always opposed any active assistance in dying, including in its last opinion on the question, in 2013. Only minority opinions then validated such an option. A step towards assisted suicide What form could this “assisted death” take? CCNE has explored two avenues: euthanasia, first, during which it is the doctor who performs the lethal act; assisted suicide, then, which consists of giving a person – via a medical prescription – the means to commit suicide themselves. While Emmanuel Macron had said in the past that he was in favor of the first option (the famous “Belgian model”), it is the second way, closer to the Swiss systems or to what is practiced in Oregon (see benchmarks) favored by the CCNE, whose opinion should serve as a working basis for the Citizens’ Convention (see opposite). Concretely, “the possibility of legal access to assisted suicide should be open to adults suffering from serious and incurable diseases, causing refractory physical or psychological suffering, whose vital prognosis is committed in the medium term”, explains Régis Aubry. The “medium term” is the criterion that makes CCNE’s opinion, once again, a breakthrough text, by widening the scope of the Claeys-Leonetti law governing the end of life since 2016. “The provisions of this law are aimed at patients whose vital prognosis is short-term, that is to say a few days or a few hours, explains Alain Claeys, former deputy and co-author of this law, member of the working group of the CCNE. At this time, the patient can, for example, benefit from deep and continuous sedation until death. But the law does not apply to the end of longer lives, such as cancers or neurodegenerative diseases, the outcome of which is looming over a period of several weeks or several months. “It is because this law does not respond to situations of distress that the CCNE has changed its positions”, adds the former parliamentarian. to procrastinate,” insists Alain Claeys. The request for active assistance in dying, if it were to be legalized, should be expressed “by a person with decision-making autonomy at the time of the request, in a free, informed and repeated manner, analyzed within the framework of a collegial procedure”, specifies the opinion. Physicians should benefit from a “conscience clause”, while nevertheless having to redirect the patient to a colleague likely to follow up on the request. Above all, for the CCNE, it would not be desirable “to consider an evolution of the legislation if the public health measures recommended in the field of palliative care were not taken into account”, insists Régis Aubry. CCNE’s opinion also takes up the long list of actions to be implemented, from the training of health professionals to the development of research, including the strengthening of palliative care at home. Actions already recommended in the 5th national plan for palliative care launched in January. “Reading this opinion, I said to myself: “Finally! Assisted suicide would make it possible to take into account the voices of these patients for whom there was a legal void”, rejoices Jonathan Denis, the president of the Association for the right to die with dignity, while questioning the future of patients unable to act on their own. On the side of the French Society for Support and Palliative Care (Sfap), the tone is more worried: doctor is limited to the prescription – which changes everything compared to euthanasia where he must perform the act, the message that we send to patients changes in nature, warns Claire Fourcade, the president of the association. It goes from “We can relieve you” to “We can help you kill yourself”. By privileging, in an unprecedented way, autonomy to the detriment of solidarity, the CCNE text proposes a shift in society. “Eight minority members” The opinion has been debated within our body, “admits Régis Aubry, who recalls that the majority opinion was attached to a two-page text entitled “Reserve” and carried by eight members. “We know that there is an inequality of access to healthcare in our country. Faced with the shared observation that people die badly, in France, our concern is that recourse to assisted suicide is done through lack of care or lack of knowledge, lack of knowledge of the existing legislative mechanisms, “describes the demographer Annabel Desgrées du Loû, speaking “in the name of the eight”. For her, no change in legislation should be considered before having assessed the current arrangements and their proper application. “It is clear that recommendations of this kind have been issued for decades,” she notes. And then, she continues, “what message would be sent to the seriously ill, disabled or elderly? The idea that some lives aren’t worth living? We are concerned that this law arouses a form of guilt, even a life complex, in these people who already suffer from social exclusion. ———The other systemsIn Belgium, a doctor can administer a lethal dose to a patient, even a minor, suffering from an incurable disease causing physical and psychological suffering “unbearable, constant, which cannot be soothed.” In Switzerland, patients self-administer a lethal dose through an infusion. Associations supervise the gesture, conditioned on two criteria: being capable of discernment and having convinced another person of the merits of his request. In Canada, “medical assistance in dying” is open to patients suffering from a serious illness. and incurable, in case of unbearable suffering. In the United States, ten states have legislated for patients who have less than six months to live. In Oregon, the patient self-administers a lethal dose of medication prescribed by a doctor. euthanasia to a physician.