Yesterday took place a new session of the parliamentary mission chaired by Olivier Falorni, aimed at evaluating the Claeys-Leonetti law. A ” important hearing “says the president of the mission. Alain Claeys, former deputy and co-author as well as co-rapporteur of the law which is the subject of the mission, was indeed the first to be heard with Régis Aubry, co-rapporteur with him of opinion n°139 of the National Consultative Ethics Committee (CCNE) (cf. CCNE opinion: moving towards “active assistance in dying”?). A round table bringing together different learned societies was the subject of the second part of the hearing.
A “national treasure”
« The Claeys-Leonetti law was written with a triptych which is “I won’t abandon you, I won’t let you suffer[1] and I will not unreasonably prolong your life” “Summarizes Professor Pierre-François Perrigault, president of the ethics committee of the French Society of Anesthesia and Resuscitation (SFAR). Dr. Claire Fourcade, president of the French Society for Support and Palliative Care (SFAP), even believes that ” the law of 2016 is a national treasure », car « she carries a philosophy of care that questions everyone in care, and not only the end of life ».
« She says care, attention, time is important “. Whereas ” our system values the act, the technique, but not the care ». Or, « the question of meaning is essential for caregivers and patients alike “, points out the doctor. ” What message do we want to send? What is important to us? »
It is difficult to face illness, death, notes Claire Fourcade. Since then, ” we need the community to tell us that what we are doing makes sense, that it is important, that our patients matter to society, to all of us “, she insists.
A text that is not applied?
Six years following the passage of the Claeys-Leonetti law, in terms of palliative care, “ much remains to be done “. This is the observation made by Alain Claeys. An observation widely shared by the interviewees. He regrets not having treated properly » palliative care. ” Addressing them quantitatively is a mistake “, he judges. And ” today, when the end of life has been medicalized, there is no personal medicine policy “, Regrets the former deputy.
Importance of advance directives, of the person of trust, the same subjects are put back on the table. The president of the SFAP prefers to speak of ” preliminary discussions », « speak with the patient throughout the illness by accompanying him “because advance directives are often” inappropriate she says.
Professor Pierre-François Perrigault indicates that “ out of 343 treatment discontinuations, deep and continuous sedation was administered in 61% of cases “. But in 17% of procedures, collegiality was not implemented. For Alain Claeys, deep and continuous sedation until death is applied in ” good conditions », « subject to verification “. With the exception of the home and the nursing homes where he is ” difficile » to implement a collegial approach.
The co-author of the text believes that ” the risk of deep and continuous sedation until death is that it is applied off-screen “. However, we do not remember having heard him rise up regarding the Vincent Lambert affair, which was not at the end of his life (cf. Emmanuel Hirsch: The Vincent Lambert affair, “an ethical and political failure from which we should learn some lessons”).
A notice out of stock
« CCNE has nothing to say other than the questions that arise says Régis Aubry, co-rapporteur of CCNE’s latest opinion. Yet Opinion No. 139 does intend to lay the foundations for “ a path for an ethical application of active assistance in dying ».
And whereas six years ago the CCNE did not envisage any change in the law, Alain Claeys explains that ” by talking regarding active assistance in dying, we are changing the paradigm ». « Politics has levers to change minds “, he assures. But ” there is no break with CCNE’s other positions “, he tries to reassure.
But Annabel Desgrées du Loû, member of the CCNE, is there to remind that the last opinion was not the subject of a consensus. Eight of its members issued a ” Reserve », “not of principle but of temporality “. Before considering any change in the law, end-of-life support care must be developed everywhere, she says.
The relevance of a new law questioned
From hearing to hearing, the SFAP reiterates its alert. Tirelessly. ” We don’t lack laws but means “ Claire Fourcade will repeat once once more (cf. Citizens’ convention: beginning (and end?) of deliberation).
In reality, requests for “active assistance in dying” are ” few “, recognizes Régis Aubry. Nevertheless, ” no matter Their frequency, he estimates. But is it legitimate to legislate for particular cases?
The meaning of these requests will give rise to a deep misunderstanding between Régis Aubry and Olivier Falorni. Indeed, the CCNE rapporteur, returning to the case of Oregon, indicates that a third of people who have obtained lethal substances do not absorb them (cf. Oregon: 25 years of “death with dignity”). The sign of a ambivalence ” that can ” to be skipped through the use of euthanasia, he underlines.
Indeed, the request to resort to euthanasia or assisted suicide ” does not always mean a will to die “. She can express something else ». « You have to be very careful “, he warns. An affirmation that leaves Olivier Falorni perplexed. By requesting access to assisted suicide, have these people not expressed their will?
« Inject a lethal product ” is not a ” trivial care » « if we consider it as such “says Régis Aubry. In the context of euthanasia, that a doctor ” either the actor reduces the person’s autonomy “he judges. Autonomy, will, even within the supporters of euthanasia the “values” come into conflict (cf. End of life: freedom, dignity, secularism?).
[1] Dr. Ségolène Perruchio, vice-president of the SFAP affirms that the relief at all costs “. In palliative care settings, 2.7% of patients are sedated, she says, and only a third with continuous deep sedation.
