Jean-Marie Gomas, is a former geriatrician and pain and palliative care doctor.
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Pascale Favre, doctor, has a DEA in health law and is a doctoral student in philosophy.
The press recently revealed the details of the bill (PJL) relating to the end of life, even before it was sent to the Council of State. No doubt, in its monitoring mission, the institution guaranteeing legal seriousness will make certain essential amendments and the text will come back modified. However, several elements of this first draft require real questioning, because their disconnection from the medical clinic and the contradictions they contain prove to be unsuitable or even inapplicable.
Vocabulary twists. The invention of “supportive care”, distinct from “palliative care”, is superfluous. This last expression is the subject of a true international consensus and above all the definition proposed in this bill for supportive care only repeats that given for palliative care by the 1999 law. More serious is the deliberately maintained confusion between euthanasia and assisted suicide, further aggravated by the complete deletion of the words themselves, to make everyone believe that the deadly gesture would be “help”, in a misleading imprecision. Not to mention unrealistic deadlines, which take into account neither the singularity of each situation, nor the ambivalence of patients (48 hours for the reiteration of a request for induced death, 15 days for the response). Forget also the abysmal lack of caregivers and doctors - currently several weeks are necessary to obtain an appointment with a pain doctor.
Also read “Euthanasia: falsified words”
This project is thus a triple incitement to suicide: firstly by announcing the possibility of resorting to planned death upon diagnosis of a serious illness, with the creation of a personalized assistance plan (PPA) that can be used to announce early the option of euthanasia, following the example of what is practiced in Quebec (a country in which the rate of deaths by euthanasia is close to 10% at the end of 2023, only eight years after the introduction of the law decriminalizing).
Then by the obligatory presence of a caregiver for the eventuality of the injection of an “additional safety dose”, requiring an appointment to be made. This organization, fundamentally contrary to the principle of freedom invoked to promote assisted suicide, imposes a real confinement, freezing the person in a process which exceeds them by limiting any potential turnaround. The various states of the USA, like Oregon which decriminalized assisted suicide more than 20 years ago, restrict the role of the doctor to verification of criteria and lethal prescription; the patient for his part remains free until the end to obtain the lethal product or not, then to absorb it or not. In fact, more than 30% of patients never take it and die a natural death as a result of their illness. It is not insignificant to note that in this state, the rate of deaths by assisted suicide remains relatively stable at around 0.6%.
How will the person who helps their mother swallow the deadly product be viewed by their brothers and sisters?
Jean-Marie Gomas and Pascale Favre
Finally, the inclusion of an “expiration date” for the process inevitably puts pressure on taking action. If after three months the person has not committed suicide, new mandatory checks are provided for by law.
The exception of euthanasia envisaged in certain situations is as inappropriate as it is useless. Despite the strange assertion of the National Consultative Ethics Committee (CCNE) in its opinion 139, the exception of euthanasia should not be implemented in addition to assisted suicide. It is inappropriate because no exception is defensible in law. Opinion 63 of the CCNE had in its time caused a lot of ink to be spilled on this question, with commentators agreeing on this inapplicable legal incongruity. Above all, it is useless since assisted suicide would be possible for any disabled patient or patient incapable of swallowing, who would like an early death, thanks to simple techniques or adapted home automation - an installation already in place for these patients who have often been equipped for a long time. Let us recall here that for most of them, who benefit from artificial supports, the question is not that of euthanasia, but that of stopping treatment; the latter always being possible, at their request (law of 2005) and accompanied by the implementation of deep and continuous sedation maintained until death (law of 2016) to optimize their comfort while respecting their rhythm.
Furthermore, the participation of a loved one in the deadly act denies three essential aspects of family functioning. On the one hand, the inevitable dissensions: how will the one who helps their mother swallow the deadly product be viewed by their brothers and sisters? What will become of blood ties once the grandson has participated in the death of the grandfather? On the other hand, potential conflicts of interest and the risk of abuse of weakness; for comparison, Switzerland tolerates assisted suicide on the express condition that there is no selfish motive. Finally, the major psychological impact of such an action, on the person themselves but even more widely through its transgenerational consequences.
The rapid obsolescence of the criteria initially set by the legislator is observed in all the countries which have decriminalized euthanasia: the end of life criterion has disappeared in Canada, euthanasia has been opened to minors in Belgium.
Jean-Marie Gomas and Pascale Favre
As for supervision by criteria that are intended to be strict, this is illusory, as all the foreign countries which have embarked on this path show us. Several criteria, by nature subjective, prove unverifiable, such as the notion of “unbearable suffering”. Furthermore, the notion of psychological suffering in itself is an invariant of all psychiatry. Would it therefore be appropriate to grant planned death at the request of tens of thousands of patients suffering from mental pathology? How to reconcile suicide prevention and planned death?
On a more general level, the rapid obsolescence of the criteria initially set by the legislator is noted in all the countries which have decriminalized euthanasia: the end-of-life criterion has disappeared in Canada, euthanasia has been opened to minors in Belgium. By means of a legislative enlargement or an interpretative extension, the caution initially envisaged fades in a dizzying manner: in Canada, one can be euthanized on the same day of his request “in case of emergency”; in Holland, you can be euthanized as a couple, even if the partner is not sick…
Also read: Michel Houellebecq: “A civilization that legalizes euthanasia loses all right to respect”
The promise of the generalization of the palliative offer is untenable. In a context where financial resources are limited, the delay now seems irrecoverable. Hence the derisory announcements, barely intended to compensate for inflation, while needs are constantly increasing with the aging of the population. Let us remember that every day 500 people die in our country without having benefited from appropriate palliative care. In addition, the palliative world, like the entire health system, is faced with a wave of resignations and bed closures, consequences of the lack of duly trained professionals. The lack of caregivers also considerably limits the home care desired by so many French people.
Still other points deserve reflection and discussion. Let us hope that the political world becomes aware of the need to prioritize a real offer of care before any other decision relating to induced death, taking into account the importance that our society places on the collective dimension of solidarity; and the essential reworking of the text proposed by the executive, to frame it by duly clarified medically and legally criteria.