France’s end-of-life laws are to be changed, with the green light being given to assisted suicide or euthanasia, President Emmanuel Macron has announced, with, however, certain provisions and conditions.
The decision was made after “careful consideration”, with the country’s Citizens’ Convention on the End of Life declaring that, as long as certain conditions are met, people will be permitted to obtain active assistance in dying through assisted suicide or euthanasia.
Though he did not commit to saying “which of the two forms” would be taken up, Macron said the laws would be changed and a Bill passed by the end of the summer, reports Medscape.
The announcement was made on 3 April, the day after the 184 citizens of the Convention submitted their final report – a 173-page document adopted almost unanimously (92%) after four months of deliberation, nine working sessions, and 27 days of debate.
The group unequivocally called for “radical changes”, urging modifications to the Claeys-Leonetti law, which, in 2016, gave end-of-life patients the right to request the discontinuation of treatments and receive continuous deep sedation until death.
Numerous guardrails
Seven years after that law went into effect, the Citizens’ Convention wants public authorities to go even further. To bring a sense of coherence to a course of action that some say is circuitous for current patients, a majority (75.6%) voted in favour of medical aid in dying.
The organisation brought forward a majority position “with many nuances”, one being the need to implement assisted suicide and euthanasia (40% of votes), as neither assisted suicide (10% of votes) nor euthanasia (3% of votes) alone would cover every case.
Additionally, 28% of the participants favoured assisted suicide without euthanasia to avoid involving healthcare professionals, while 18% opposed opening access to active assistance in dying (1% abstaining).
Believing such access should include a support pathway, the Convention has established guardrails to prevent things from veering off course. Whether the lethal drug would be administered by the patient (assisted suicide) or by a caregiver (euthanasia), the individual must express the request clearly, free from coercion, and be allowed to change his or her mind at any time.
The patient must have an incurable disease with physical pain and psychological suffering that cannot be treated. Medical and mental health support must be provided. In addition, the patient’s capacity to make this kind of decision must be assessed before moving forward.
The Convention recommends that a “collegial multi-disciplinary procedure’ be carried out to review case files and that a monitoring and control committee ensure compliance with these rules.
Should everyone, regardless of age, have the right to access active assistance in dying? How old should one have to be? On this topic, the report noted, “the debates were not conclusive”.
End-of-Life support
The final report also presents the arguments of those opposed to active assistance in dying. Most of these people believe the current Claeys-Leonetti law is not fully known and therefore is little used.
Some argue that modifying the law could put vulnerable people at risk, while others feel that allowing active assistance in dying “would have a detrimental effect on our model of society and on the spirit of solidarity”.
Macron said the Convention’s recommendations for framing the issue of active assistance in dying constituted “a starting point”.
Medscape article – French Citizens Contribute to Forthcoming End-of-Life Bill (Open access)
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