The government’s text will be examined by a special committee in the National Assembly from the week of April 22, before arriving in the chamber on May 27.
The die is cast. After months of drafting and delays, the bill “relating to the support of the sick and those at the end of life” was presented to the Council of Ministers on Wednesday April 10, the final step before examination of the text by parliamentarians, who will be able to make it evolve as they wish. If it begins with several articles devoted to “supportive care” in connection with the new palliative care development strategy, the document is largely devoted to the “assisted dying” system imagined by the executive.
Here are the main measures contained in this bill, posted online Wednesday afternoon on Legifrance. MEPs will work on it from the week of April 22 in committee, then from May 27 in plenary session.
A new practice: “assisted dying”
The main innovation of the bill is the introduction in France of assisted dying, which will take the form of assisted suicide, or even, exceptionally, euthanasia. “Assistance in dying consists of authorizing and supporting the provision, to a person who has requested it, of a lethal substance (…) so that they can administer it to themselves or, when they is not physically able to do so, has it administered by a doctor, a nurse or a volunteer designated by him or her.”details the text.
To access it, a person must meet all of these five conditions, which will be the subject of intense discussions during parliamentary debates:
- “Be at least 18 years old”
- “Be of French nationality or reside stably and regularly in France”
- “Being affected by a serious and incurable condition with a short or medium-term vital prognosis”
- “Present physical or psychological suffering linked to this condition which is either refractory to treatment or unbearable when the person does not receive or has chosen to stop receiving treatment”
- “To be able to manifest one’s will in a free and informed manner.”
A procedure subject to the green light of a doctor
The planned process begins with making a request for assistance in dying from a doctor. The practitioner, who must not be close to the patient, is then required to inform him about the procedure, about other “treatments and support available”but also on the possibility of waiving his request “at any time”. He must also offer to “benefit from palliative care” and ensure that he can “to access”.
The doctor must then, within fifteen days of the request, decide whether the patient meets the five criteria provided. For this, he is required to “collect feedback” of several caregivers, including at least one doctor who does not follow the person and “a medical assistant [infirmier, par exemple] or a caregiver”. If he is not himself a specialist in the patient’s serious illness, the doctor must ensure that the colleague he calls upon is. The opinion given by the other caregivers consulted is only advisory, the practitioner initially requested remaining the sole decision-maker.
In the event of a green light, the patient must respect a reflection period of two days before repeating their request. In the event of a negative response, the patient can challenge the decision before the administrative courts. After rendering its decision, the latter may revoke it at any time if new information leads it to consider that the conditions “were not fulfilled or ceased to be fulfilled”.
A lethal gesture to be carried out in the presence of a caregiver
Once the patient’s request has been approved and confirmed, the doctor prescribes the product and agrees with the patient on “the doctor or nurse responsible for accompanying him for the administration of the lethal substance”. It is this professional, and not the patient himself, who can withdraw the product, prepared by the pharmacy of a health or medico-social establishment. The date and place of the act are determined by mutual agreement between the caregiver and the applicant. If assistance in dying is scheduled more than three months after the green light, a new evaluation of the “free and enlightened character” of demand is then necessary.
After a final verification of the patient’s wishes, assisted dying can be performed on the patient, in the presence of their loved ones if they wish. The doctor or nurse sets up the device and monitors the procedure. He is not required to stay “alongside the person”, but must “be in sufficient proximity to be able to intervene in case of difficulty”. If the patient requests a postponement, a new date can be scheduled. Otherwise, “the administration of the lethal substance is carried out by the person himself”recalls the text.
It is only when the patient is faced with a physical impossibility (total paralysis, for example) that the procedure can be entrusted to the professional present or to “a willing person” designated by the patient.
A conscience clause for health professionals
Any healthcare professional may refuse to treat or be associated with a request for assistance in dying made by a patient. Likewise, any doctor or nurse may refuse to accompany the patient in the administration of the lethal product, unless they have agreed to do so after their request has been approved. “The health professional who does not wish to participate (…) must inform, without delay, the person of his refusal and communicate to him the name of health professionals likely [de le faire]“then provides for the bill.
To facilitate the identification of voluntary caregivers, they will be able to declare themselves to a commission responsible for monitoring assisted dying. Missions carried out within the framework of assisted dying cannot give rise to excess fees, and the procedure will be free for patients.
An “evaluation and control commission” for assisted dying
To facilitate monitoring of the system, the bill plans to establish a “evaluation and control commission”, attached to the Ministry of Health. Each professional who has agreed to follow a patient must transmit the documents produced throughout the process. On this basis, the commission will be responsible for monitoring compliance with “each assisted dying procedure”.
In the event of suspicion of a crime or misdemeanor, she must take legal action. Faced with a possible “breach of ethical or professional rules” on the part of a caregiver, she can report it to the disciplinary chamber of the competent order (order of doctors, order of nurses, etc.). Finally, it will have to deliver a report to the government and Parliament, each year, with recommendations to develop the system in the event of an identified need.
A new concept: “supportive care”
The project led by the government deletes the article of law currently devoted to palliative care to introduce a broader concept: “supportive care”. These aim to “offer comprehensive care for the sick person in order to preserve their dignity, quality of life and well-being”. This care must anticipate and respond to the “physical needs” of the patient, against pain for example, but also to his “psychological and social needs”. They go through the use of palliative care, while including other forms of support, and this “from the start of the illness”.
This desire for early and comprehensive care is coming to fruition, “as soon as the diagnosis of a serious condition is announced”by the proposal to set up a “personalized support plan”. The patient will thus be able to identify their needs and preferences, particularly in terms of pain management, in order to plan coordinated follow-up in terms of care, but also social support.
A new type of establishment: support homes
The text introduces a new family of medico-social establishments: “houses of accompaniment”. These will aim to“welcome and support people at the end of their lives and their loved ones”, particularly by providing residents with supportive care. These small structures, which are partly inspired by the Maison Astrolabe inaugurated last year in Tarn, will have to fill the gap which sometimes exists between home and hospital: some patients are no longer able to stay at home. them, but do not require very medical care. As part of its ten-year supportive care strategy, the government plans for each department to have at least one of these homes by 2034.