French Citizens Contribute to Forthcoming End-of-Life Bill
PARIS — After 4 months of careful consideration, France’s Citizens’ Convention on the End of Life has overwhelmingly declared that, as long as certain conditions are met, individuals should 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, President Emmanuel Macron has stated that the country’s end-of-life laws would be changed, with a bill coming out by the end of the summer.
This announcement was made on April 3, the day after the 184 citizens of the Convention submitted their final report — a 173-page document adopted almost unanimously (92%) after 4 months of deliberation, nine working sessions, and 27 days of debate. Whether Macron will incorporate its conclusions into the forthcoming proposed legislation remains an open question.
In the report, the group unequivocally calls for “radical changes.” They believe that modifications need to be made 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 is urging public authorities to go 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 favor of medical aid in dying.
The Citizens’ Convention has brought forward a majority position “with many nuances,” one of which is 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.
In addition, 28% of the participants said that they favored assisted suicide without euthanasia to avoid involving healthcare professionals, while 18% opposed opening access to active assistance in dying (1% abstaining).
Believing that such access should include a support pathway, the Convention has set up 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 multidisciplinary 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.”
Conscience Clause
The group would like there to be an option for physicians to invoke their conscience clause if they do not wish to participate in carrying out a patient’s request regarding active assistance in dying. The French Medical Association has stated that it is “not in favor” of practitioners participating in a “process that would lead to euthanasia” should the laws be changed, as “a physician may not deliberately cause death by administering a lethal product.”
End-of-Life Support
The final report of the Citizens’ Convention also presents the arguments of those opposed to active assistance in dying. Most of these individuals believe that 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. Others hold that allowing active assistance in dying “would have a detrimental effect on our model of society and on the spirit of solidarity.”
Given “the alarming state of our country’s healthcare system,” the Citizens’ Convention also considers it essential to bolster efforts to improve end-of-life support. With that goal in mind, they put forth 65 proposals.
One proposal is that a patient’s choice and desire to decide where to end their life should be better respected. There is also a call for expanding home-based care and developing ways to ensure that “everyone, everywhere will have access to palliative care.”
Palliative Care
The day after they submitted their report, the members of the Citizens’ Convention were welcomed by President Macron at the Élysée Palace. He commended them for their hard work and affirmed his desire to “move toward the establishment of a French end-of-life model.”
Acknowledging that current end-of-life support was “poorly suited” to deal with the matters at hand, the president went on to declare that a national 10-year plan would be created for the management of pain and palliative care.
Most importantly, Macron announced that an end-of-life bill would be introduced by the end of the summer. The Convention’s recommendations for framing the issue of active assistance in dying constituted “a starting point,” he said, that would help orient him in his consideration of the matter. “I do have a personal opinion, and that can evolve. I also have a responsibility as president of the Republic to ensure harmony.”
This article was translated from the Medscape French edition.
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