For some “killing is not a treatment”, for others “patients must be able to decide on their life and death”: the debates on the end of life, relaunched in France, also divide the medical body.
“During the Covid-19 epidemic, a patient with a rather bleak prognosis refused sedation for 48 hours because she feared she would be euthanized,” recalls Marie-Béatrice Nogier, an intensivist and nephrologist. An illustration of the fragile relationship of trust between patient and caregiver.
Selon la médecin, c’est cette relation qui pourrait être “corrupt” par le récent avis du conseil consultatif national d’éthique (CCNE) ouvrant la porte, sous conditions, à une “aide active à mourir” por las malades incurables en fin of life.
This would force the white coats to “break” with the Hippocratic oath, according to which the doctor “(will) do everything to alleviate suffering, will not (prolong) the agonies excessively, never (will) deliberately cause death,” he adds.
“When they tell me +I want to die+, I will take the time to talk, relieve the pain, establish a psychological follow-up”, explains Alix Durroux, a geriatrician.
But this “call for help”, which “is not uncommon”, rarely persists over time. “Giving death is not a treatment. The real treatment is to understand what is behind the request” of the patient and accompany him, explains Ms. Durroux.
However, some patients make a repeated request to die, as recalled by a former health executive who requested anonymity. “It is a journey of the patient, who makes the request and who must be accompanied” in a lasting way.
– Develop palliative care –
A clandestine companion of patients at the end of life, she believes that this “freedom to leave when suffering becomes unbearable” is due to them.
In 2010, 0.6% of deaths were caused by euthanasia in France, according to the French End of Life Survey of the National Institute for Demographic Studies that analyzes medical decisions made to 4,700 patients.
But when “all means are put in place to support” patients, offering them “activities that give meaning to life”, this period goes well, according to Olivier Trédan, an oncologist in Lyon. “The problem is that this is not the case everywhere.”
Gaël Durel, vice-president of the national association of medical coordinators in EPHAD and medico-social (MCOOR), notes a lack of “anticipation, identification (of pathologies) and training” of personnel at the end of life, to which is added access unequal according to the territory to palliative care units.
“We already have four laws to strengthen access to palliative care, it is surprising to want a fifth,” he insists.
It recognizes, however, that in “very exceptional” situations, in case of failure of palliative care, of psychological discomfort of the patient, collegiate decisions may be made “other than deep and continuous sedation” (authorized by law, editor’s note ). . But “the exception cannot become a legal possibility.”
– “Not the master of life” –
However, “the long and slow end of life can sometimes be accompanied by suffering, sometimes refractory”, according to Régis Aubry, second co-rapporteur of the CCNE opinion and head of the department of pain and palliative care at the CHU of Besançon.
Then, according to him, the question of “acting as best as possible respecting the autonomy of these people and the duty of solidarity with their suffering” arises.
For a retired anesthesiologist-resuscitator who requested anonymity, “patients must be able to decide on their life and death”, if you think about it, reiterate and insist on this request: “we are not owners of the lives of patients.
According to him, the ban on the use of assisted suicide can also lead patients to commit suicide. “It was also like that during the debates on the voluntary interruption of pregnancy”, he recalls, “women inflicted terrible things” to abort clandestinely.
The Order of Physicians “is not in favor of euthanasia” and considers that in the event of a new law, doctors must take advantage of a “clause of conscience”.
Eight caregivers’ organizations or palliative care facilities expressed concern about the effects of a “major ethical shift.”
For Jean-François Delfraissy, president of the CCNE, a dialogue will be “essential with all health teams, in particular those dealing with palliative care”, in the face of a hypothetical new law.
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