Euthanasia, euthanasia, conscience clause…words to understand the end-of-life debate

“There is inequality in the face of death.” Emmanuel Macron reacted on Monday morning to the report of the Civil Convention on the end of life. This text, voted for by 184 citizens chosen by lot, advocated the opening of assisted suicide or euthanasia with a certain number of guarantees. But what are we really talking about?

End of life

This is the central subject of the Civil Convention and a possible future bill. The end of life corresponds to the situation of people “having a serious progressive disease in an advanced phase, potentially fatal; or people whose life prognosis is concerned in the short or medium term, for example, after an accident, ”the report clarifies.

The Convention rightly voted 97% in favor of a better basis for end-of-life support for the French. For 82% of them, the framework is not adapted to the various situations that arise. It is from this observation that the thinking about “active dying assistance” mentioned by Emmanuel Macron was born, which includes euthanasia and assisted suicide.

Euthanasia

We’re getting to the heart of the matter. According to the National Advisory Committee on Ethics, euthanasia is “the act of a third party that deliberately ends the life of the person who requests it, with the intent to end a situation deemed intolerable. »

“It is not murder, because not only the person agrees, but she herself asks for it,” explains Yves De Locht, a general practitioner from Brussels who accompanies her patients at the end of life.

In fact, the lethal substance can be administered orally or intravenously to a person who asks for it, by another person in the medical profession. “In less than a minute, the patient falls asleep without any pain, and death occurs in two to three minutes,” adds the Belgian doctor. This method is currently banned in France. Thus, in other countries, such as Belgium, euthanasia is legal but has its own legal basis (eligibility conditions, control methods, etc.).

Euthanasia

Assisted suicide is somewhat different from euthanasia. This method consists of providing the requester with “the environment and means necessary to end their own life”, as defined by the National Center for Palliative and Death Care. Thus, the patient himself injects the lethal substance intravenously or orally.

“When a patient chooses the oral route, there may be complications, regurgitation or otherwise,” warns Yves De Locht. This passes through the digestive tract and lasts 4 or 5 minutes. It’s less common, we practice a lot more intravenous in Belgium. We also talk about euthanasia or medically assisted suicide. The practice is banned in France but allowed in Switzerland, where euthanasia is illegal.

deep sedation

Deep and continuous sedation, maintained until death, is a right introduced by the law of February 2, 2016. It consists in placing a person suffering from a severe and incurable disease, whose life prognosis is made in the short term, into deep sleep in order to alleviate or prevent untreatable suffering in accordance with the End of Life Civil Convention. “This is euthanasia, the name of which does not mean. We no longer feed, we no longer hydrate, we stop caring. This can last for several days,” sums up the Belgian doctor.

It can be carried out on the basis of a collegiate medical proposal or at the request of the patient. “The problem is that we don’t know anything about deep sedation. We don’t have statistics. who? When ? Or ? How many ? These are the questions that will need to be answered in this new bill,” warns Dr. Jean Daquin, national delegate in charge of the nursing committee at ADMD (Association for the Right to Die with Dignity).

conscience clause

This is the protection of doctors. The conscience clause allows them to refuse to perform a medical act or engage in an act that, while permitted by law, is contrary to their personal or professional beliefs. After the report of the Civic Assembly, the National Order of Physicians recalled the importance of this clause, which “guarantees the independence of the physician.”

“It’s inalienable. You can’t force or influence a doctor to do something they don’t want, Dr. Jean Daquin reiterates. This is the basis of our profession, and it has always been respected. »

Clay–Leonetti law

This is the law that governs the end of life of terminally ill patients in France. Passed in 2016 after the first version in 2005, it bans euthanasia and assisted suicide, but allows “deep and continuous sedation to death” in certain cases. This law also provides for the termination of treatment in the event of “unreasonable obstinacy” (or therapeutic inexorability).

“Today we cannot continue like this with this law. Palliative care is no longer needed. The usual role of a doctor is to accompany the dying person until the last minutes of his life, maintaining contact with him, and not primarily sanctifying his life, ”regrets Dr. Jean Daquin. Emmanuel Macron did not specify whether the end-of-life bill would replace part of the Clay-Leonetti Act.

Orders

These are written instructions that allow you to indicate in advance your wishes for medical decisions that will be made if you reach the end of your life and can no longer express yourself (accident, serious illness, etc.). “It’s a bit like organ donation,” explains Yves De Locht. You choose what you want for the end of your life, and that makes it easier for doctors to decide to act faster. »

These directives make it possible to establish that a person opposes, for example, therapeutic inexorability. They are “imposed on the doctor” according to the Clay-Leonetti law. However, physicians may reverse a decision if these directives “appear manifestly inappropriate or inappropriate for the medical situation” of their author.