All the perplexities of the Church ” “

In France people often die badly: in hospital, in a state of abandonment and pain. That’s why French citizens are calling for a law on euthanasia. However, the challenge of death cannot be met with a law, but with fraternity and with the development of a plan for palliative care and the training of medical staff in the accompaniment of terminal patients. That, in a nutshell, is the position of the Catholic Church in France in the public debate on the end of life. On Tuesday March 17 the French National Assembly gave the green light to the legislative proposal advocating “continuous, constant sedation” to terminal patients. The adoption of the text – presented by MPs on opposite sides of the political spectrum Alain Claeys (Socialist Party) and Jean Leonetti (neo-Gaullists, Ump) – was supported by a large majority vote: 436 ayes and 43 noes. Maria Chiara Biagioni for SIR Europe, asked Monsignor Pierre d’Ornellas, bishop of Rennes, president of the group on Bioethics set up by the Church of France on end-of-life, to comment on the law and on the debate ongoing in the Chamber of Deputies. The legislative text introduces in the on end-of-life regulation “prolonged, deep sedation”. What are your perplexities? “In our book ‘End of life. A question of fraternity, we highlighted three difficulties. First of all, the systemized connection between the halt in medical treatment and deep, prolonged sedation, which remains an exceptional measure. Such form of sedation could leave room for ordinary treatment needed for personal care. Moreover, the stop to medical treatment doesn’t always require sedation. Every situation is unique! Thus – and this is the second question – why should be described artificial hydration and nutrition as ‘treatment’? In some cases these are ordinary cures that need to be carried out. Finally, the concept of ‘right’: cure is practice within a relationship of trust. But this relationship risks breaking apart if the patient has the ‘right’ to deep and prolonged sedation and if/she requests it. At that point the physician becomes an executor with no responsibility”. Each year, over 4 thousand interventions are carried out in France to help people die in a situation of illegality. Do you agree that it is necessary to set in order what is happening? “I do. But the ways in which this is done pertains to the training of the medical staff in charge of palliative treatment and it also involves the funding during the period required for accompaniment of terminal patients. In any case using medical-patient relationship to enable death should never be permitted. It would be a serious contradiction. To the requests of death, it is necessary to respond with greater efforts of accompaniment to be offered with the necessary competence to decrypt the very request and understand its meaning”. Recent surveys show that the request of euthanasia depends on the fear of dying in a situation of suffering. How do people die in France? “Too many people die badly in hospitals, in a situation of pain and abandonment. On June 9 1999 the French government adopt a law whereby every citizen has a right to palliative treatment. But the development of palliative care and the specific training of medical and healthcare staff are still lagging behind”. What were the developments of the debate in the National Assembly? Has there been the necessary serenity to discuss such a delicate issue? “On the whole the debates were respectful, exception made for some ideological proposal of euthanasia. Serenity is of the essence. An MP may encounter a concrete difficulty: namely to project on French citizens his personal family experience marked by suffering. This could unconsciously lead to request help to die or euthanasia for everyone, to give a response to his personal experience. An MP, without denying his personal experience is instead called to reflect what is best for the common good, to listen to the advice of the National Board of Nurses with experience in euthanasia. Fraternity is necessary to soothe the pain, not to die”. Now the legislative text will be examined by the Senate. What is your message for Senators? “First, they should examine the three aspects previously mentioned: how to best preserve the unique relationship with ever patient until the end? Moreover, the concept of ‘uselessness’ cannot be applied to the life of an individual but to a treatment. For his reason, the expression ‘to uselessly prolong life’ is to be withdrawn from Article 3. Its elimination would not change the law. Moreover, it is essential that the doctor that prescribes deep and prolonged sedation clear states that the purpose is to soothe the pain and the suffering. This purpose or intention should be included in the medical report”.