- Euthanasia, prohibited in France, would have been legalized in all discretion by a government decree dated March 28. At least if we believe an accusation relayed on social networks.
- The latter states that the possibility given to doctors of having recourse to the drug Rivotril for patients suffering from Covid-19 "whose clinical condition justifies it" would amount to authorizing their euthanasia.
- Far from authorizing the euthanasia of these patients, the decree actually plans to alleviate the suffering of those who will not be resuscitated after a collegial decision. 20 Minutes takes stock with several specialists.
While confinement continues in France to fight the coronavirus epidemic, has the government adopted with the utmost discretion a decree allowing euthanasia of people with Covid-19?
This was stated by the deputy (UDI) Meyer Habib in a tweet published on April 2: “We give the legal permit to euthanize in France! Decree of 03/28, the Rivotril, passport for soft death, is in free prescription for 15 days […] It is morally unbearable! even to relieve suffering. Life is hope! I write to Olivier Véran ».
We give the legal permit to euthanize in France!
Decree of 03/28 the #Rivotril, passport for soft death, is in free prescription for 15 days # COVID19
It is morally unsustainable! even to relieve suffering. Life is hope!
I write to @olivierveran
Since then, whether Facebook posts, videos or articles on the Mediapart blog, the claim has been taken up by many Internet users denouncing this "scandal".
However, if a decree on Rivotril was adopted on March 28, it does not legalize euthanasia, which remains prohibited in France - the last law on this subject, adopted in 2016, providing only for a "right to deep sedation and continuous ”for people whose life-threatening condition is engaged in the short term.
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The decree of March 28 allows "dispensation of Rivotril by community pharmacies" only for "patients affected or likely to be affected by the SARS-CoV-2 virus whose clinical condition justifies it on presentation of a medical prescription marked “Prescription Except AMM within the framework of Covid-19”. "
The text also specifies that the doctor issuing this prescription must “comply [r] with exceptional and transient protocols relating, on the one hand, to the management of dyspnea [respiratory discomfort] and, on the other hand, palliative care for respiratory distress, established by the French Society for Palliative Care and Support [SFAP] and posted on its website. "
“Clonazepam (Rivotril) in injectable form is a product necessary to deal with certain critical situations that may arise, such as respiratory distress. It is more suitable than other similar drugs such as Valium, "said Professor Claude Jeandel, president of the National Professional Geriatrics Council, at 20 Minutes .
"Rivotril is not used at all to precipitate death"
"Its provision by this decree aims to alleviate the suffering and anxiety of the patients concerned. It uses its anxiolytic properties to relieve anxiety, it is not at all to precipitate death. As soon as we face an end-of-life situation, it improves its comfort, ”continues the specialist.
On its website, the Federation of dispensing pharmacists (FSPF) also confirms that this prescription, accessible to any doctor, is only aimed at "the palliative care of patients facing an asphyxious state and who cannot be admitted to intensive care or for whom decision to limit active treatments has been taken ”.
“Respiratory distress is like drowning, it is horrible to live and gives rise to moments of excruciating pain. Rivotril is a powerful anxiolytic of the Lexomil family, which allows the patient in respiratory distress to have an accompaniment to remove this morbid anxiety. It is not a drug which causes death but it makes it possible to avoid this suffering ”, abounds the president of the FSPF, Philippe Besset.
Contacted by 20 Minutes , the Directorate General of Health (DGS) confirms that the purpose of the decree is "to improve support for palliative care, including outside hospitals, in nursing homes for example, where doctors had not access to Rivotril "and that its prescription is intended" to improve [the] end of life "for" patients for whom a decision to limit active treatments has been taken ".
Concerns raised about the risk of " an individual decision "
If the text of March 28 therefore clearly defines the restrictive framework in which Rivotril can be used in the midst of the Covid-19 epidemic, Jean-Paul Zerbib, president of the National Union of Salaried Doctors for the CFE-CGC, underlines that “ this type of decree is not usual, all the more so when we anticipate a considerable number of patients whose condition will deteriorate. "
“If the patient's condition is already extremely serious, [the use of Rivotril] is not euthanasia. But the risk posed by this decree, and the question posed by some, is whether the decree is not likely to organize support towards the end of life for people who cannot be treated for lack of space , usually elderly or co-morbid? I do not see it like that and I do not think that the doctors who will be confronted with these cases will see it like that ”, continues the specialist.
Before pointing the finger at the excesses he dreads during the extraordinary health situation being crossed at the moment: "But in palliative care units, the decision to accompany towards the end of life with sedatives, patients without hope of improvement is collegial and always with family consultation, it cannot be taken alone. The decree does not mention the family, and my fear is that it will leave general practitioners, staff in charge of home care for dependent elderly people or even Ehpad doctors alone in decision-making. Families must be involved and doctors - overwhelmed at the moment - must consult healthcare communities to avoid the decision being made on an individual basis. "
" The decision is taken early and collegially"
However, the collegiality of the decision is indeed one of the prerequisites mentioned in the proposals of the French Society for Support and Palliative Care to which the decree refers, as pointed out to 20 Minutes Frédéric Guirimand, associate professor of palliative medicine and co-author of this document: "These files clearly state that these proposals only concern patients for whom a collegial decision to limit treatment has been taken, excluding placing them in intensive care. "
“Given the situation, and the fact that patients can get worse within a few hours, with the risk of sometimes very rapid asphyxiation, the decision cannot be made when it occurs. It is therefore taken early and collegially, by the treating doctor with the coordinating doctor in Ehpad, with if possible the help of a palliative or geriatric care team and the family is obviously consulted and informed at that time. This ensures that the nurse has the medication available at the time the asphyxia occurs, in order to administer it and avoid suffering for the patient, ”continues Frédéric Guirimand.
And the specialist in turn reminds that "the patients in asphyxial respiratory distress concerned, will die from Covid-19: the injection of Rivotril is not at all lethal, it just avoids the unbearable perception of asphyxia. "For its part, the Directorate General of Health finally stresses that" access [to Rivotril] will be coupled with a reinforcement of personnel to ensure its proper use ".
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