After months of procrastination within the executive, the “bill relating to support for the sick and those at the end of life” is taking shape. The text, which establishes “assisted dying”, was sent to the Council of State.
The bill, the outlines of which Emmanuel Macron revealed a week ago, must be presented to the Council of Ministers in April before arriving in plenary session at the National Assembly on May 27 for a first reading. The Minister of Health and Solidarity Catherine Vautrin, who will defend it on behalf of the government, will be before the deputies of the presidential Renaissance party on Tuesday to answer their questions. So to fully understand the issues, here are the main measures of this text.
Assistance in suicide
This is the great novelty of this text. For the first time in France, certain patients will be able to ask a doctor to be helped to commit suicide. Even if the bill only mentions “assisted dying”, it is indeed a question of assisting the person to kill themselves, or even of carrying out the fatal gesture for them if they are incapable of doing so. “Assistance in dying consists of the administration of a lethal substance, carried out by the person themselves or, when the person is not physically able to do so, by a doctor, nurse or voluntary person it designates”.
However, this assistance in suicide can only be granted under multiple conditions. The patient must be suffering from an incurable pathology which threatens his life “in the short or medium term”. This formulation is the subject of criticism from end-of-life specialists, because it is considered too vague. The interpretation is sent back to the caregivers, without excluding parliamentarians from specifying the criteria.
Then, the patient must be perfectly able to express his wishes. This therefore excludes patients with Alzheimer’s or other dementias, even if they made their choice before their mental capacities deteriorated. The suffering must also be “refractory and unbearable”. Here, the text is less restrictive than a version that had leaked in recent months, because it now includes “psychological” and not just “physical” suffering. Finally, the patient must be of legal age and French, or at least have lived in the country for a long time.
A step-by-step procedure
The patient who wishes to die must seek medical attention. First of all, this will necessarily offer palliative care. If the person maintains their choice, the doctor will be obliged to seek the opinion of two people: a specialist in the pathology concerned, who does not know the patient, and a non-doctor caregiver, who will preferably have accompanied the patient.
The first doctor, who may request other opinions, will have 15 days to give his opinion. And it will be up to him alone to decide. If their opinion is positive, the patient will have to wait two more days to confirm their choice, then will have three months to carry out their procedure. In the event of refusal, only the patient will be able to challenge the decision before the administrative courts.
The progress of the gesture
A doctor or nurse will inevitably have to accompany the patient to carry out his last gesture. It is this caregiver who will collect the fatal substance from the pharmacy, then prepare it when the time comes. However, if the patient can act alone, the caregiver will not have to be in the same room.
However, no caregiver can be forcibly involved. But in the event of refusal, he must provide the contact details of colleagues likely to accept.
Other provisions
Assisted dying constitutes one of the two parts of the text. The other part concerns the development of palliative care and patients’ rights. On palliative care, the text creates the broader concept of “supportive care” which is not just limited to pain management. It provides for the creation of dedicated establishments, “support houses”. However, it does not mention a vast palliative care development program, a “ten-year strategy” promised for a long time by the government and which must be announced separately in the coming weeks.
Finally, on the rights of patients, the text specifies the status of the “trusted person” who must testify to the choices of their loved one if they are no longer able to do so.