The Minister Delegate for Health Professions, Agnès Firmin Le Bodo, notably announced Sunday in the “JDD” that caregivers will be able to assert their conscience clause.
Agnès Firmin Le Bodo is now the voice of the government on the thorny subject of the end of life. The Minister Delegate in charge of Territorial Organization and Health Professions presented, on Sunday May 21 in Le Journal du Dimanche (subscribers article), the contours of the future bill, promised by the executive, paving the way for active assistance in dying (AAM). At the beginning of April, following the recommendations of the dedicated citizens’ convention, Emmanuel Macron announced that the text would take shape “by the end of summer”. Welcoming the seriousness of their work, the Head of State nevertheless recalled that a “citizen convention never replaces parliamentary deliberation”.
The law project “will include three blocks: active assistance in dying, palliative care and patients’ rights”, described the minister, who does not decide on the choice of the French model, between euthanasia and assisted suicide. The first act plans to deliberately put an end to the life of a patient, at his request, when the second gives the possibility to a doctor to prescribe a lethal product that the patient administers himself.
“What matters is that the supervised possibility of benefiting from active assistance in dying becomes effective, as demanded by 75% of our fellow citizens”says Agnès Firmin Le Bodo in the JDD. Conscientiousness clause for caregivers, vital prognosis period for patients, minimum age for those concerned… Franceinfo takes stock of the minister’s announcements.
Doctors will be able to invoke a conscience clause
While doctors are divided on the issue of active assistance in dying, Agnès Firmin Le Bodo promises that those “who do not wish not (y) participate (…) must be able to bring into play a conscience clause from the first stage of the process, when they have to decide on a vital prognosis committed in the medium term”. In early April, the Order of Physicians demanded a conscience clause on assisted suicide. Without specifying whether it is a specific clause, knowing that doctors can already assert a conscience clause.
The Council of the Order of Physicians referred to a clause “which could be highlighted at any time during the procedure”. He also wants “the evaluation, the decision of eligibility for active assistance in dying and the responsibility (be) collegial“. On the other hand, the Order is more firm on the subject of euthanasia. He believes that a practitioner cannot “deliberately cause death by the administration of a lethal product”.
The vital prognosis of the patient must be engaged in the “medium term”
At what stage of his disease will the patient be able to make an active request for assistance in dying? Agnès Firmin le Bodo asserts in the JDD that “his vital prognosis will have to be engaged in the medium term”. “The Claeys-Leonetti law only responds, with deep and continuous sedation until death, to situations where the patient is in great pain with a life-threatening prognosis a few days away.she recalls.
According to the ministry, the remaining life of a person whose vital prognosis is committed in the medium term is estimated at “a few weeks to a few months”. In the context of access to active assistance in dying, the challenge will therefore be to precisely define this “medium term”. In the JDDthe Minister cites the example of Oregon, in the United States, “where active assistance in dying has been practiced for 25 years” and where the vital prognosis engaged “must be done within six months”.
The judgment of the patient will be assessed
In addition to this delay, Agnès Firmin le Bodo lists two other criteria: the will of the patient “repeatedly collected” and one “intact discernment”. He must, according to the Minister Delegate for Health Professions, settle several other questions, such as “the time limit to repeat the request” after a first request.
VSThe measures seem to follow the recommendations of the citizens’ convention on the end of life. In detail, his work evoked six stages: pre-request to a caregiver, request to a doctor, evaluation of discernment, repeated request, collegial procedure composed of caregivers, then access to active assistance in dying. There was also a consensus among the citizens participating in the work on one point: at any time during the process of access to active assistance in dying, and until the last moment, the patient is free to change his mind and give up his asked.
Minors and people suffering from mental illnesses will be excluded from the scheme
As Emmanuel Macron had already outlined, the day after the publication of the report of the end-of-life citizens’ convention, minors will not be able to benefit from the measures contained in the new law. “If a majority of pediatric cancers led to the death of the child ten years ago, more than 80% are now cured”, justifies Agnès Firmin Le Bodo. To better care for minors suffering from chronic illnesses, she wants to create a pediatric palliative care unit at the national level.
The Minister also closes the door to patients suffering from mental illnesses. “A vital prognosis in the medium term means that there is no hope of recovery. In terms of mental suffering, science and treatment are evolving”explains Agnès Firmin Le Bodo. “Rather than fixing a list of diseases opening access to active assistance in dying, it would be better to qualify the impact of the pathologies concerned”she says.
A “ten-year plan” for palliative care
Whether he is an adult or a minor, the minister also insists on the need to “ensure that the patient has been offered palliative care”. She adds that “most [des patients] no longer wish to die when they benefit from this care”. In France, one in five departments remained without a palliative care unit (USP) at the end of 2019, according to the 2020 activity report of the National Center for Palliative and End-of-Life Care.
“We are preparing a ten-year plan, as for cancer or rare diseases, which will come into effect in 2024”promises Agnès Firmin Le Bodo in the JDD, confirming an announcement by Emmanuel Macron a month ago. A plan that “will be finalized on December 15”After “a milestone on July 13”. The government also wants to better train general practitioners in palliative care and “create a dedicated medical sector”.