End of life, does France break away?

Debate on euthanasia opened again in France. French President Hollande has received a long-anticipated Report on end-of-life, compiled at the end of two and half years of consultations by Socialist MP Alain Claeys and UMP MP Jean Leonetti, authors of a law that since 2005 regulates the end of life regime in France. The complex Report is based on the assumption, by the two MPs, that the level of medical treatment of terminal patients is “outrageous”. Controversial aspects. According to the Report, far too often in France patients in end of life situations are left alone, to their fate, in a context of national health that struggles to undertake in a serious and innovative manner the path of palliative care. In this context, the report makes a number of proposals for amendments to the current law. The ongoing debate was triggered by the right ascribed to terminally ill patients, namely, to find death avoiding suffering through “profound, constant sedation until the moment of decease”. Another aspect that has caused polemics especially in the medical and healthcare environments is the mandatory obligation for physicians to comply with the patient’s “early decision” thereby eliminating the possibility of conscientious objection. Hollande, who has always avoided the use of terms such as “euthanasia” and “assisted suicide”, so as not to hurt believers’ sensitivity, in particular those of Catholics, has announced that the reform of the end-of-life law will be discussed by the French parliament at the beginning of next year. Fraternity. And palliative treatments. Reactions to the publication of the Claeys-Leonetti Report followed suit. On behalf of the French Catholic Church the bishop of Rennes, Monsignor Pierre d’Ornellas, coordinator of bioethical issues for the Bishops’ Conference, author of a recent online discussion forum for exchanges of views and proposals on end-of-life (blog.catholic.fr) released an opinion titled “An urgent duty of fraternity”, which points the finger against the state of accompaniment to terminal patients in France. A change of course is urgently needed – the bishop writes -. To do this seriously it is necessary to “implement” a reform of the healthcare system capable of developing a palliative care that may allow terminal patients to “die well”. As relates to “deep and constant” sedation, the bishop noted that “this new right does not eliminate the causes of the bad-death. In other words, it’s not a right that promotes a just approach towards death”. “No law – concludes the bishop d’Ornellas – will remove the fact that death is difficult because it’s always an ordeal. Of course, fraternity imposes us to placate all suffering. However, we should avoid promoting the myth of serene death or ‘sound death.’ Vulnerability is our common destiny, it demands a surplus of fraternity that will make us consider that there is never a useless life. ‘You are precious to my eyes’, state the Hebrew and Jewish Bible”. The “right to Death”? The Confederation of Catholic Family associations took a strong stand whereby if the reflections contained in the end-of-life Report should be inscribed into national legislation, “the subtle distinction between ‘giving death’ and ‘alleviating suffering’ will become ever more hazy, with the risk of leading people in the direction of the right to die”. In particular, family associations question the “new right” to “deep, constant sedation”, notably the passage of the text “that identify nutrition and hydration as treatments” and as such “subjected” to being interrupted by the new measures. To this regard, also the fact “conscientious objection” is not envisaged for doctors, is a matter of concern. Associations strongly support the measures contained in the Report on the accompaniment of terminally ill patients through an increasingly better use of palliative treatments by physicians and healthcare workers. The voice of medicine students. For the first time also medicine students members of the association “Soigner Dans la dignité” speak out. “We have opted for this long and difficult path of medical studies – they wrote – to accompany persons from one extreme of their existence to the other, in the full respect of what is life. We welcome the progress made in the Report on palliative treatments. However, we are concerned over the developments that may derive from a political use of heavy medical treatment like sedation”, because – the students point out – “describing deep and continuous sedation ” or “assisted death” seems to permit a medical procedure directly linked to the will of shortening the life of a patient”.