Emmanuel Macron announced, on Tuesday 13 September, the launch of a citizen conference on the end of life, which will be “established in October”. The latter will report its findings in March 2023, the Elysée said in a press release.
At the same time, the government will initiate a “Concerted and transversal works” with deputies and senators, the presidency stressed. “All this work will allow us to consider, if necessary, the clarifications and changes to our legal framework by the end of 2023”added the Elysée.
What does the current end of life law allow? What does it prohibit?
Euthanasia, assisted suicide … What the law prohibits
French law prohibits so-called active euthanasia, i.e. the deliberate administration of lethal substances with the intention of causing death, at the request of the patient who wants to die or without his consent, i.e. on the decision of a relative or the medical profession. According to the law, it is a murder, a crime punishable with sentences ranging from thirty years of imprisonment to life imprisonment. The penal code also provides for the prohibition of practicing the profession for doctors who are guilty of it.
French legislation also prohibits assisted suicide, which consists in giving the patient who requests it the means to end his life.
Euthanasia and assisted suicide, on the other hand, are authorized in a handful of European countries. The Netherlands and Belgium were the first two European countries to authorize euthanasia twenty years ago. Luxembourg decriminalized euthanasia and assisted suicide in 2009, as did Spain, which adopted a law with the same effect in March 2021.
Switzerland authorizes assisted suicide, the practice of which is governed by codes of medical ethics and is supported by organizations. Austria legalized assisted suicide for people with a serious or incurable disease in a vote by Parliament in December 2021. This law entered into force on 1uh January 2022. Finally, in Italy, where the penal code is punished “incitement or assistance in suicide”the Constitutional Court de facto decriminalized suicide assistance in September 2019 in some cases: for fully conscious patients “Kept alive by treatments (…) and suffering from an irreversible pathology, a source of physical and psychological suffering that they consider intolerable “.
Deep sedation, advance directives … What the law authorizes
For the moment, in France, it is the Claeys-Léonetti law, adopted in 2016, after a first version in 2005, which regulates the end of life of the incurable. Allows a “Deep and continuous sedation until death” for terminally ill patients in very serious suffering, whose vital prognosis is committed ” short term “. This short term, which ranges from a few hours to a few days, has been defined by the High Health Authority.
The patient falls asleep, the treatments (hydration and nutrition are considered as such in particular) and painkillers are administered. Sedation can take place at the patient’s home, if desired, or in the hospital.
The law provides for the termination of processing in the event of “unreasonable obstinacy” (or relentless treatment): If the patient so desires, treatments can be “suspended” when they “appear useless, disproportionate or when they have no other effect than the only artificial maintenance of life”. If the patient cannot express her wishes, the decision must be made by the doctors in a “collegiate”. In all cases, “The doctor must safeguard the dignity of the dying and ensure the quality of the end of life by providing adequate palliative care”specifies the text of the law.
The 2016 text reinforces the value of “advanced directives” that patients are able to formulate, in anticipation of a situation in which they would no longer be able to express their wishes. These directives can be transcribed on plain paper or through the form proposed by the Ministry of Health. The document must be dated and signed, and the patient must identify himself by surname, first name, date and place of birth.
The patient can also designate an adult who will represent him if he is no longer able to express himself. The word of this person, whose appointment can be revoked at any time, takes precedence over the will of the other relatives and family members of the patient.
Access to treatment, medium-term prognosis… What the law does not regulate
“We have never provided the means necessary to implement this law, we do not have the means to do our job”, affected by Dr. Claire Fourcade, doctor in palliative care in Narbonne and president of the French Society of Palliative Care and Support. In France, “Two thirds of patients do not have access to palliative care, or 200,000 people every year”, explains. Otherwise, “twenty-six departments do not have a palliative care service”. Patients therefore have two options: “Either get treated by a less suitable service, or go away from home. “
Implementation of the law “it requires human resources that we do not have and very close support for the patient and his relatives, which we do not have the time to provide”Claire Fourcade insists.
“Deep and continuous sedation until death is intended for patients who are dyingexplain to World Jonathan Denis, president of the association for the right to die with dignity. We will stop treatment, the medicine will withdraw and wait for the person to leave. This can happen quickly or take several weeks. Thus, the law ignores all people who are not in agony but who have a committed vital prognosis in the medium term. There is no other solution than to go into exile in Belgium or Switzerland. “