In an opinion made public on Monday July 17, the academics believe that assisted suicide should be authorized in exceptional cases but oppose euthanasia.
This is a valid support for the government in its willingness to legalize active assistance in dying soon (a bill is to be presented by the end of the summer). While the executive clashes with the hostility of a large part of health professionals and in particular of the French Society of Support and Palliative Care (SFAP), wholly opposed to this project, this reform now benefits from a medical guarantee, since the Academy of Medicine on Monday issued a favorable opinion on the legalization of assisted suicide in France. Unexpected support, given that the usually rather conservative academy had opposed any change to the current legislation in an opinion issued in 2021.
In their opinion, the academics believe that it would be “inhuman, when the vital prognosis is engaged not in the short but in the medium term, not to respond to the desperation of people who ask for the means to shorten the suffering they suffer. due to a serious and incurable disease” and that it is necessary “to respond to these situations of torture without relief of a life without hope by adapting the current system in a controlled way by opening up new rights to help die as little harm as possible by accepting, exceptionally assisted suicide”.
Inspired academics from Oregon
The Academy of Medicine requests that a clear distinction be made between assisted suicide, which it therefore accepts on conditions, and euthanasia, which it refuses. “Euthanasia, unlike assisted suicide, violates the Hippocratic oath ‘I would not cause death’, taken by any doctor; must be discarded, due to its strong moral and symbolic meaning, but also because professionals and members of end-of-life associations oppose it”, write the academics.
Through this intermediate position, shared by the Council of the Order of Doctors (CNOM), the Academy of Medicine hopes to spare the reticence of the many operators opposed to the legalization of active assistance in dying. In cases where the sick subject is no longer able to take his own life, the opinion recommends “that a collegiate court or a specialized magistrate” can authorize a third party to administer the lethal product “so as not to make the decision depend on the health only professionals, dissociating those who treat from those who would decide on euthanasia”.
If the President of the Republic Emmanuel Macron has repeatedly referred to the “Belgian model” for inspiration, the academics acknowledge that they were rather inspired by Oregon. In this northwestern US state, dying people can be prescribed a drug in lethal doses, which they can administer at home whenever they want (however most people who are prescribed a lethal drug they do not use it (perhaps due to the difficulty of dying alone or making that decision on his own.) The Academy believes that this model respects “the patient’s hesitation and uncertainty of ultimate choice,” while “the process of Euthanasia has greater binding force once it is initiated”.
Dr. Leonetti opposed assisted suicide
The Academy of Medicine also highlights some safeguards that it believes should be in place in the event of the legalization of active assistance in dying. He believes that any assisted suicide request should be validated by several doctors and that a conscience clause should be in place for practitioners who do not wish to participate in such acts.
Only “a person with discernment and a beneficiary of palliative care can make a request that must be informed, free and repeated” write the academics, thus seeming to close the door to the legalization of assisted suicide for minors, an extremely controversial issue. Finally, as regards the diseases that give rise to the right to assisted suicide, the Academy recommends excluding “psychological disorders, depression, old age with proven cognitive disturbances and diseases and disabilities with impaired judgment”.
The opinion of the Academy of Medicine was adopted by 60 votes to 24, with 10 abstentions. Among the opponents of the opinion there is in particular Dr. Jean Leonetti, author of the law currently in force on the end of life, who believes that “assisted suicide is certainly preferable to euthanasia, but it has more disadvantages than advantages”.
The Minister of Health Professions Agnès Firmin Le Bodo, who has been entrusted with the future bill on the end of life, welcomed the decision of the Academy of Medicine, “expression of an ethical path” which “proposes a path of accompaniment so that all
vulnerabilities are considered”. While the desire to “co-construct” the bill with oppositions and caregivers has struggled to materialize in recent weeks, this opinion from the Academy of Medicine is appropriate for the executive.
(Quentin Haroch on Jim-Journal International de Médecin del 17/07/2023)
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