the citizens’ convention considers it “necessary” to authorize assisted suicide and euthanasia and calls for “profound changes”

They have come to the end of “their” Paris marathon. After 27 days of meetings and four months of reflection, 184 citizens drawn by lot and from all walks of life completed, on Sunday April 2, in the capital, the work of the citizens’ convention on the end of life. In a report as rich as it is nuanced, adopted almost unanimously (92% for, 3% against and 5% abstention), these “conventionals” call on the government to “profound changes” to provide better support for end-of-life patients. They also open the door to a form of active assistance in dying (AAM) in France, without masking their divisions on this sensitive subject.

>> End of life: follow the reactions to the recommendations of the citizens’ convention in our live

This citizens’ convention has, since December, worked on a single question, addressed by Elisabeth Borne: “Is the end-of-life support framework adapted to the different situations encountered or should any changes be introduced?”. In unison, the participants replied to the Prime Minister that this current framework “is not adapted”due to a “unequal access” to care on the territory and, in certain cases, of a “lack of satisfactory answers” permitted by current law. From this observation, the citizens drew a list of 146 proposals.

A consensus in favor of palliative care

The members of the citizens’ convention first insist on the points which have generated near unanimity within their assembly. They express a “common belief” that need “strengthen and improve” the care offered to the population, including at home and in nursing homes. They claim “a guarantee of access to palliative care”, intended to prevent and alleviate physical and psychological suffering, in application of the Claeys-Leonetti law of 2016. This would be enough to achieve equality “everywhere and for everyone”they point out, on condition that “significantly strengthen the dedicated budget” palliative and end-of-life care. However, this legislative shift was never followed by the necessary investment.

“Our health system is in an alarming situation, due to a lack of human and financial resources.”

The citizens’ convention on the end of life

in its final report

More generally, citizens are calling for the human and the“exchange” at the center of the doctor-patient relationship, with the idea of “valuing time” devoted to discussion and better “respect the patient’s choice and wishes”. Such an evolution would notably require a cultural change among caregivers, hence the invitation to “strengthen the training of health professionals”. From their studies, they would follow a “university common core” dedicated to end-of-life care and would carry out “a course in palliative care”.

These positions “strong” are part of a “basement” of 65 proposals which achieved consensus within the citizens’ convention. They sound like a call to action, addressed to the public authorities, especially since they are in line with the recommendations already formulated by the National Consultative Ethics Committee (CCNE) in September, and by the parliamentary evaluation of the Claeys-Leonetti law, Wednesday 29 March.

A majority position in favor of active assistance in dying

Then comes the delicate question of the AAM. Without trying to speak with one voice, the French people drawn by lot claim their consensus and dissensus to allow the public to “find out all the complexity” of the debate on assisted suicide and euthanasia, which is not only due to a confrontation between “pro” and “anti”.

At voting time, three “conventional” out of four (76%) voted in favor of the opening of the AAM. They judge this measure “necessary” For “answer better” to certain end-of-life situations and for “respect everyone’s freedom of choice”. Conversely, a quarter of them (23%) believe that “full application of the current legal framework would be sufficient”. For them, a green light for active assistance in dying would risk giving rise to “drifts” societal, of which vulnerable, dependent people or people with impaired discernment could be the first victims.

Rather euthanasia or assisted suicide ? The citizens lean “rather in favor” a free choice between the first option, which consists of the medicalized administration of a lethal product, and the second, which implies that the patient performs the final procedure himself (40%). Part of the group (28%) would prefer assisted suicide to be the main option and euthanasia to remain a “exception”, for example when the applicant would not be able to commit suicide. This alternative would “to avoid too much involvement of caregivers”, explain the citizens, joining there a concern expressed by those of them opposed to the AAM. They are concerned about “risks of destabilization of the health system” in case of legalization, “in view of the strong reluctance of some health professionals”.

“Feeding the public debate rather than closing it”

Ready for a great start at the AAM, the citizens’ convention nevertheless imagines a course worthy of a hurdle race rather than a sprint without obstacles. The opening must be subject to “Access conditions”of the “safeguards“ and “control mechanisms”, according to the opinion of the majority of Convention members. Relatively consensual votes made it possible to arrive at a standard model of access path, in which the patient should regularly repeat his request, submit to an evaluation of his discernment and comply with the decision of a “collegial and multidisciplinary procedure”. Caregivers could use a conscience clause to refuse to participate in the process.

Finally, the main point of disagreement relates to the criteria that would allow access to assisted suicide and euthanasia. The members of the citizens’ convention cautiously put forward the need to justify an incurable situation, suffering that resists all treatment and, more particularly, physical suffering. In a way “less assertive”they also suggest making access to AAM conditional on the existence of a vital prognosis, without deciding the question of the short, medium or long term.

Convention members recognize that they remain “shared” on many points, including questions of possible open access to minors and people with mental illness, “even existential”. Worried of “feeding the public debate rather than closing it”the citizens explain at length in the report the “color chart“ of their opinions, articulated around 19 families of points of view. One emerges “fields of possibilities of what the French model of active assistance in dying could be”allowing each citizen and decision-maker to position themselves in an informed manner.

The citizens’ convention will present its work to Emmanuel Macron on Monday morning at the Elysée. Conscious that their mission was not to draft a future law, its members modestly say they want “to feed the reflection of the public authorities”. This does not prevent them from issuing a warning to the government, which has undertaken to “inform them of the follow-up given to their work” : “It is time for the voice of citizens to be fully heard and taken into account.”