150 French people will debate on the end of life from this Friday and until March, with a view to a possible change in legislation.
These debates will not only refer to incurable physical suffering, but also to psychic ailments.
Since 2002, Belgium has authorized euthanasia in the event of "constant and unbearable" mental suffering linked to a "serious and incurable" condition.
Complex criteria to define.
Her name was Shanti de Corte and she was 23 years old.
On May 7, 2022, she was euthanized in Belgium.
The young woman did not suffer from Charcot's disease or terminal cancer, and her days were not numbered.
Suffering from depression for years, her suffering was mental.
Belgium authorizes euthanasia in the event of mental suffering.
During the years 2020 and 2021, 57 acts of this type were carried out in the country, i.e. 1% of euthanasias.
On the French side, the Leonetti law of 2005 authorizes adults to write advance directives.
The latter make it possible to define the conditions for limiting or stopping the processing in the event that they are one day unable to express their wishes.
As the citizen's convention on the end of life opens this Friday in France,
20 Minutes
therefore wonders about euthanasia linked to a psychiatric disorder, which could appear in the debate planned for the coming months.
A constant, unbearable and inappeasable psychic suffering
In our Belgian neighbor, a law of May 28, 2002 indicates that the patient wishing to be euthanized must find himself in a hopeless medical situation and report constant and unbearable physical or psychological suffering which cannot be appeased.
"The unbearable side is subjective", according to Ariane Bazan, professor of clinical psychology and psychopathology at the University of Lorraine, who says she is "radically opposed to euthanasia for psychic reasons", because "it is the patient who decides of what is unbearable”
.
The Belgian Order of Physicians has issued directives - a sort of guide to good practice - relating to requests for this type of euthanasia.
“The doctor seized of this request must consult two psychiatrists, which is in accordance with the law relating to euthanasia, which provides in the event of death not foreseeable in the short term the consultation of two doctors”, explains Jacqueline Herremans, lawyer at the bar. of Brussels, President of the ADMD (Association for the Right to Die with Dignity) Belgium and member of the Advisory Committee of Bioethics of Belgium.
One of the first questions to ask: Doesn't the illness affect the request, which must be voluntary, repeated and without external pressure?
“A paranoid patient, for example, will filter all the answers that will be made to him by analyzing them as damaging to his person.
Right from the start, one element falsifies the quality of his request.
Under these conditions, the latter is rejected.
A serious and incurable psychiatric pathology
After verifying the unbearable character of the suffering, the doctor must focus on the psychiatric pathology.
People who have had recourse to this type of euthanasia over the past two years in Belgium suffered from various illnesses: depression, bipolar disorder, complex personality disorder, schizophrenia, anxiety or autism spectrum disorder... To give right to euthanasia, these pathologies must be serious and incurable.
“These are, for example, endogenous depressions, that is to say which do not result from an event or a situation such as a separation or a burn-out, explains Jacqueline Herremans.
These are refractory depressions to any treatment.
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But if there are markers for somatic diseases like cancer, “it is much more difficult in psychiatric matters”.
According to
Belgian law, to be considered "incurable", the patient must have tested all possible treatments.
However, there is no specific list
.
On the side of the Order of Physicians, it is added that it is necessary “to ensure that the person has benefited from all the treatments which have proved effective for a large number of patients” explains the lawyer.
Healthcare professionals should take into account medications and therapies that the patient has already experienced.
“If we see that a treatment that may be effective for a person has not been effective for him, we are not going to impose it on him again, specifies the lawyer.
It's really a case-by-case analysis.
»
give yourself time
For Ariane Bazan, in terms of psychiatric disorder, it is impossible to know a priori if the situation is hopeless.
She regrets that patients have "knocked on many doors without being heard" coming "to reaffirm the belief that they have no place anywhere", but finds it "serious" that at that moment, "death para [isse] an option that seems reasonable to them.
According to the professor of clinical psychology, the most important factor in recovery is therapy, and therefore the personality of the psychiatrist or psychologist.
Consequence, according to her, of a (good) change of therapist: “in practice, we can see that people who we thought they would not get out of it, get out of it.
Jacqueline Herremans believes, on the contrary,
that she has “rarely seen a patient cured of his psychiatric illness.
However, there are treatments that he can live with.
»
To allow the different solutions to work, you have to give yourself time.
If the law imposes at least one month between the request and the act, in fact, it can take a year, even a year and a half, according to the president of the ADMD.
After this duration, some people finally manage to get by.
She gives the example of a 25-year-old Belgian who requested euthanasia before the Covid-19 crisis.
The young man was referred to a new psychiatrist, who prescribed him further medication.
“He is much better.
It is transformed,” rejoices Jacqueline Herremans.
But the lawyer recalls that some people in great suffering do not respond to any treatment.
“If we had been able to find a solution for Shanti, obviously that would have made everyone happy.
Euthanasia is not an end in itself but a means of offering a peaceful death when everything has been tried.
»
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