End of life: palliative medicine matters as much, if not more, than legalizing euthanasia

Maxime Asseo 10:40 am, March 17, 2023

Banned in France, legal in some European neighbors - Belgium, Switzerland, Netherlands, Spain, euthanasia and assisted suicide have been unleashing passions for years in French society, between supporters and opponents of legalization. To reflect in a reasoned and peaceful way on a potential evolution of French legislation in favor of legalizing active assistance in dying, a citizens' convention on the end of life opened on December 9.

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"Euthanasia is a failure of society in general"

Largely inspired by the citizens' convention on the climate, this assembly brings together more than 170 citizens who will have to give the conclusions of their debates by the end of March. If they prove successful, a bill could see the light of day before the end of the year. As the end of the citizens' convention approaches, Europe 1 has decided to dedicate its Friday Thema to: "Euthanasia, palliative care, assisted suicide: living better at the end of life".

"Euthanasia is a failure of society in general." For Laetitia Dosne, the message is clear. According to the Executive Director of HELEBOR, which contributes to the development of palliative care, the issue of legalizing euthanasia and assisted suicide is irrelevant. The priority lies elsewhere: "Today in France, there is a gap in access to palliative medicine that must absolutely be filled", whether in terms of information on this end-of-life support for citizens, training during medical studies or palliative care units (USP), unevenly distributed on the national territory.

Today, 26 departments have no USP. "Care and palliative medicine in general have not had the same level of investment and development as other aspects of medicine in the last twenty years," regrets the director of the National Center for Palliative and End-of-Life Care (CNSPFV), Giovanna Marsico, who sits on the governance committee of the Citizens' Convention on the End of Life. As a result, "a majority of sick people who would need palliative care do not have access to it," says Laetitia Dosne. Hence the urgency of putting at the center of the debate the improvement of palliative medicine and all its components: care, information, listening, psychological support, especially by relatives and solidarity.

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Giving up euthanasia through palliative medicine?

A necessary reinforcement, when "we know that early management of the end of life can increase life expectancy," says Giovanna Marsico. Laetitia Dosne goes even further. She is convinced that a more widespread palliative medicine - which would take into account the whole person - would reduce the need for sick people or people at the end of life to resort to euthanasia or assisted suicide. "A request for euthanasia is a cry for help. When a sick person asks for it and arrives in palliative care, that we relieve his physical and psychological pain, that we take care of him by taking more time, that we meet his needs and desires, I can guarantee you that he no longer asks to die, "says the one who has experienced these situations several times when she was a volunteer accompanist.

Professor Régis Aubry, head of the autonomy unit at the University Hospital of Besançon and member of the National Consultative Ethics Committee (CCNE) shares this opinion: "Research studies clearly show that the offer of support and palliative care contributes to considerably reducing the demand for active assistance in dying". This applies as much to requests related to pain as to those related to a feeling of unworthiness of people who consider themselves "to be an unnecessary burden on society".

On the other hand, the professor is more nuanced: "It decreases, but it does not cancel all the requests," he says. Just like Giovanna Marsico, for whom it is not constant. "Despite good palliative care care, some people continue to request access to active assistance in dying. Conversely, some suffer enormously, they need palliative care, but that does not mean that they want to choose euthanasia. They just want better access to care," she said.

A considerable drop in requests for euthanasia linked to better palliative care is the main argument of those "who defend the possibility of remaining in legislation prohibiting active assistance in dying", according to the president of the CNSPFV. An argument that remains "quite audible", since the palliative offer "is a requirement, regardless of whether euthanasia and assisted suicide are legal". For Professor Régis Aubry, the palliative issue and that of active assistance in dying are parallel, but it is "impossible to treat the second without having invested the first". Yet, at present, euthanasia is more often highlighted than palliative medicine in the public debate.

>> READ ALSO - End of life: the citizens' convention in favour of "active assistance in dying"

Euthanasia retains its place in the public debate

While active assistance in dying must not fall by the wayside. As Régis Aubry explains, palliative medicine cannot always respond to the physical or psychological pain of the person. "In some exceptions, people no longer find meaning in their existence. And who would we be to decide the meaning of other people's lives?" he asks. In addition to deep and continuous sedation, active assistance in dying is then positioned as a possible alternative.

However, it must be the subject of a real listening and a journey with the person to understand what is the basis of the request "before considering that it means the will of the person", explains the professor who highlights opinion 139 of the CCNE. This text specifies that "demand should not be confused with the expression of will". Hence the importance of never considering active assistance in dying as "a response at first glance without in-depth analysis," concludes the professor.