2024-04-10 10:00:14
The law on the end of life might, in our opinion, open Pandora’s box: the experiences which have taken place in the Benelux show that these countries have revised their initial laws to remove the requirements in terms of prognosis, eliminate psychiatric exclusions and define unbearable suffering broadly, to include conditions such as geriatric syndromes and existential distress. The influence of the “fraternity” should not make us forget the humanity of the medical relationship.
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Let’s return to President Emmanuel Macron’s interview of March 10 on the end-of-life bill. The Head of State surprised by substituting the term “assisted dying” for the classic terminology – “euthanasia” and “assisted suicide”. The question of whether there are conceptual or empirical differences between assisted suicide and suicide remains controversial, but it is clear that Emmanuel Macron is making a scientific error in asserting that “assisted suicide corresponds to the free and unconditional choice of a person to dispose of their life”.
Context of distress
Suicide, in fact, is not a rational and freely chosen decision: the suicidal act is a desperate response to unbearable psychological pain. The person cannot consider any other relief solution due to cognitive alterations such as decision-making deficit, tunnel vision or focus obscuring alternative solutions. In this context of distress, it is essential not to confuse assistance in dying with a free pass for suicide.
While President Emmanuel Macron announced that patients with a psychiatric illness that impairs discernment – such as schizophrenia – will not be eligible for assisted dying, patients with serious physical illnesses such as cancer (majority reason of recourse to assisted dying), but also those suffering from psychiatric disorders – such as anxiety or depression – will not be excluded.
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However, studies show that 58% of cancer patients suffer from depression, a condition which can impair their ability to make informed decisions and which induces feelings of despair, helplessness, uselessness, but also the desire for accelerated death. In almost a third of cases, depression can even compromise their ability to consent.
This suggests the need for a thorough psychiatric assessment for all patients requesting assisted dying to ensure that they are not influenced by treatable mental disorders: in this case, the quality of care would need to be improved. end of life for these patients.
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