The debates on the end of life, revived in France, also divide the medical profession (AFP / Pascal POCHARD-CASABIANCA)
For some “death is not a treatment”, for others “patients must be able to decide about their life and their death”: the debates on the end of life, relaunched in France, also divide the body medical.
“During the Covid-19 epidemic, a patient with a fairly gloomy prognosis refused sedation for 48 hours because she was afraid that she would be euthanized,” recalls Marie-Béatrice Nogier, intensive care physician and nephrologist. An illustration of the fragile relationship of trust between patient and caregiver.
According to the doctor, it is this relationship that could be “corrupted” by the recent opinion of the National Advisory Council on Ethics (CCNE) opening the door, under conditions, to “active assistance in dying” for incurable patients at the end of their lives. of life.
This would force white coats to “break” with the Hippocratic oath, according to which the doctor “(will) do everything to relieve suffering, will not (prolong) the agonies excessively, will never (cause) death deliberately”, adds she.
“When I am told + I want to die +, I will take the time to talk, relieve the pain, set up a psychological follow-up”, explains Alix Durroux, geriatrician.
But this “call for help”, which is “not uncommon”, rarely persists over time. “Giving death is not a treatment. The real treatment is to understand what is behind the request” of the patient and to accompany him, explains Ms. Durroux.
However, some patients make a repeated request to die, as recalled by a former health executive who requested anonymity. “It is a journey of the patient, who makes the request and which must be supported” durably.
– Developing palliative care –
Clandestine companion of end-of-life patients, she believes that this “freedom to leave when the suffering becomes unbearable” is due to them.
In 2010, 0.6% of deaths occurred by way of euthanasia in France, according to the survey on the end of life in France by the National Institute for Demographic Studies.
The debates on the end of life, revived in France, also divide the medical profession (AFP / Fred DUFOUR)
But when “all means are implemented to support” the patients, by offering them “activities that give meaning to life”, this period is going well, according to Olivier Trédan, oncologist in Lyon. “The problem is that this is not the case everywhere”.
Gaël Durel, vice-president of the national association of coordinating doctors in EPHAD (retirement homes) and medico-social (MCOOR), notes a lack of “anticipation, identification (of pathologies) and training” of personnel at the end of life, to which is added unequal access depending on the territory to palliative care units.
“We already have four laws to strengthen access to palliative care, it’s surprising to want a fifth”.
He recognizes, however, that in “very exceptional” situations, in the event of failure of palliative care, of psychological distress of the patient, collegial decisions “other than deep and continuous sedation” (authorized by law, editor’s note) may be taken. But “the exception cannot become a legal possibility”.
– “Fundamental” dialogue –
However, “long, slow end of life can sometimes be accompanied by suffering, sometimes refractory”, according to Régis Aubry, second co-rapporteur of the CCNE opinion and head of the pain and palliative care department of the university hospital center of Besançon (center-east).
Then arises, according to him, the question of “acting as best as possible while respecting the autonomy of these people and the duty of solidarity towards their suffering”.
For a retired anesthesiologist-resuscitator who requested anonymity, “patients must be able to decide about their life and their death”, if this request is thought out, repeated and insistent: “we are not the master of the patients’ lives.
According to him, the ban on the use of assisted suicide can also lead patients to commit suicide. “This was also the case during the debates around the voluntary termination of pregnancy”, he recalls, “women inflicted terrible things on themselves” to abort clandestinely.
The Order of Physicians is “not in favor of euthanasia” and considers that in the event of a new law, doctors must benefit from a “conscience clause”.
Eight organizations of caregivers or palliative care establishments were for their part worried about the effects of a “major ethical change”.
For Jean-François Delfraissy, president of the CCNE, a dialogue will be “fundamental with all the healthcare teams, in particular those who deal with palliative care”, before a hypothetical new law.
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