The Social Affairs Committee adopted an information report on Wednesday which sounds like a warning to the government. He is preparing a bill to authorize active assistance in dying in France.
It is a taste of the opposition awaiting the government in the Senate. The Senate Committee on Social Affairs adopted, Wednesday, June 28, an information report judging “dangerous” the possible introduction of euthanasia or assisted suicide in France. Advocating against any form of active assistance in dying (AAM), this text intends to demonstrate that the opening of such a right, which the executive intends to include in a bill by the end of the summer, would be “an inappropriate response” the expectations of end-of-life patients, “a real challenge” on the legal level and a factor of destabilization of “fundamental social landmarks”.
Mainly written by two senators from the group Les Républicains, Christine Bonfanti-Dossat and Corinne Imbert, this document is accompanied by a minority position defended by a third elected, the socialist Michèle Meunier. “Access to active assistance in dying is now legitimate, necessary and possible under satisfactory framework conditions”she judges, after the presentation of the work of the three senators, who have heard about forty specialists on the subject since this winter.
At a time when the government intends to involve the various parliamentary forces in the preparation of its bill, this report sounds like a warning sent by the Senate, where the right is in the majority. The arguments raised by the two main rapporteurs are in line with the reservations already expressed by a minority of members of the National Consultative Ethics Council, in September, then by a fringe of the citizens’ convention on the end of life, in April . The conclusions of the Senate also take up certain elements of language carried by organizations of caregivers hostile to the AAM, for which “to kill cannot be considered as a cure”.
Better-known rights, rather than a new right
Without denying the existence of a “social demand” in favor of euthanasia or assisted suicide, Christine Bonfanti-Dossat and Corinne Imbert see in this demand above all an aspiration of “well people”. This would be inflated by biased polls, offering “a false choice for the respondents” and presenting the AAM as “the only possibility of escaping suffering”. Gold, “the apparent degradation of the quality of life by illness reinforces the desire to live” patients, who ask above all to be accompanied in the face of suffering at the end of life, according to the senators.
More than a new right, patients would therefore need rights that are better known and applied, starting with access to palliative care, recognized by law since 1999. The current legal framework, “generally suitable” to end-of-life situations, “does not require” to open access to the AAM in France, decide Christine Bonfanti-Dossat and Corinne Imbert.
A risk of “uncontrolled enlargement”?
“Would allowing the AAM make our society a better place?”, ask the rapporteurs. Their answer seems to be a firm “no”, which they develop over more than 60 pages. They anticipate a puzzle of a “dreadful complexity” as soon as the law is written, in particular to define the eligibility criteria for AAM (possible seriousness of a pathology, incurability, level of suffering, expiry of the vital prognosis, etc.). The choices made will make people happy and disappointed, hence the probable “legal remedies” and, above all, the inevitable subsequent developments.
“In almost all countries that have authorized it, the criteria for admission to active assistance in dying have been expanded or are in the process of being expanded”, worry the authors of the text, referring for example to developments observed in Belgium or envisaged in the Netherlands in favor of minors. The elected officials fear a “uncontrolled enlargement” of the framework that will be defined by the French legislator. Hence this alert addressed to the executive, who has already promised to reserve AAM for certain adult patients with a vital prognosis committed in the medium term:
“The red lines that [le gouvernement] claims will not fail to escape the initiators of the project.”
Christine Bonfanti-Dossat and Corinne Imbert, senatorsin their end-of-life information report
A green light to the AAM would be all the more “perilous” that foreign examples demonstrate that the control of compliance with procedures is “extremely difficult”, judge the rapporteurs. In Belgium, almost a third of euthanasia would not be declared and research work has brought to light “various malfunctions”such as non-compliance with the eligibility criteria and the absence of a second medical opinion, observe the elected officials.
Euthanize more to spend less?
What could be the consequences of an authorization of the AAM in France? Without dwelling on the relief expected by some patients, Christine Bonfanti-Dossat and Corinne Imbert care about citizens “the most fragile” who could be “led to consider resorting to euthanasia”either because they do not know that answers can be found to their suffering or because they fear “to be a burden on their loved ones or on society”.
More generally, they warn against the specter “new problems of a social, political and moral order”, of which they recognize that it is today “impossible” to determine the probability, for lack of sufficient research abroad. Hence a “conservative assumption” : once authorized and “trivialized”MAID could upset certain societal foundations, undermining suicide prevention efforts or promoting a “commodification of chosen death”as in Switzerland, where assisted suicide is billed several thousand euros.
But the main concern, and perhaps “most disturbing”is that the AAM be perceived as a lever for budgetary savings, making it possible to cope with the “increasing burden represented by healthcare expenditure for an increasingly aging population”. Shortening life could limit the costly care of dying patients, a “temptation” against which the chosen ones rise up.
“The most feared effect, from this point of view, of an opening of active assistance in dying is that of disincentivizing the development of palliative care.”
Christine Bonfanti-Dossat and Corinne Imbert, senatorsin their end-of-life information report
The rapporteurs call for “develop palliative support for all”To “revaluing the role of caregivers” and to “restore the foundations of a society” more united, in particular by fighting against social isolation and the risk of suicide. “It is more to design a form of ‘support for a desirable life until the end’ that this report calls for”they conclude.