what could the access route to “active assistance in dying” imagined by the citizens’ convention look like?

This is a first draft of a “French” model. The members of the citizens’ convention on the end of life voted on Sunday, March 19, a series of proposals outlining what could be the path to access to “active assistance in dying” (AAM) in France, if the Parliament gave the green light to euthanasia or assisted suicide. 71% in favor of such authorization under conditions, the “conventional” have designed a strictly framed course, subject to a collegial procedure and supervised by a control commission.

These 184 citizens, drawn by lot in the fall and meeting regularly since December, wish to limit the risk of deviations and, above all, to ensure that each person eligible for the scheme can benefit from all possible care before the examination of the AAM request. In their eyes, this outcome can only be a solution of “last resort”. The absolute priority must be to improve end-of-life support, in particular by developing palliative care, when many shortcomings currently exist.

For franceinfo, five citizens present the stages envisaged in this course of euthanasia or assisted suicide. There is no question of the public who could benefit from it, this particularly sensitive point still having to be voted on at the convention, at the end of March.

Step 1: pre-request

A person wishing to benefit from active assistance in dying must make an initial request to a health professional, whoever it is (doctor, nurse, caregiver, physiotherapist, pharmacist, etc.). Only the patient can initiate the request, with one exception: “In case of unconsciousness or inability to speak.” In this case, the request may come from the person of trust designated by the patient or from the examination of his advance directives, in which he would have expressed his wish to benefit from AAM.

The pre-request marks the start of a patient support procedure throughout the process, which “must include one or more medical appointments as well as psychological follow-up”, according to the proposals approved by the citizens. These meetings aim in particular to ensure that “all options have been tested and failed” before arriving at this wish of AAM. “We cannot force people to follow therapies or benefit from palliative care”, explains Anton, a 22-year-old worker in the Yvelines and member of the citizens’ convention. According to him, “The idea is that no one says to themselves: ‘I don’t have access to certain care near my home, so I might as well get it over with.'”

Step 2: the official request

The request must be repeated and formalized before a doctor, whether a general practitioner or another practitioner, in an office or in a hospital. During his journey, the patient must be “informed of the steps of the process” And “of the consequences of his decision”. Half of the members of the convention also want the patient to be “informed of the primacy of assisted suicide over euthanasia”.

This proposal aims to “do not put pressure on caregivers” responsibility for the lethal act, explains Françoise, a 58-year-old former Bordeaux nurse, whose “the Christian faith is opposed to killing”. On the same line, Jérôme, a research technician in secondary education in Bressuire (Deux-Sèvres), suggests that euthanasia should be reserved for people who find themselves “incapacitated” to perform the lethal gesture, for example in the event of a deep coma.

Step 3: Assessing discernment

To verify that the applicant fully understands the journey in which he is engaged and the scope of his request, an assessment of his discernment must be carried out before it is too late. The proposals voted on by the members of the citizens’ convention specify that this evaluation “may be based in particular on the opinion of the family and accompanying persons”but only in such a way “optional”.

“Overall, we are against the fact that the family interferes in the choice of the patient, which belongs to him”, defends Fatna, 61, training manager in a large company in Pau (Pyrénées-Orientales). Relatives should not be involved in the course “Only at the request of the patient”believe the citizens, who nevertheless propose “psychological support” for relatives and the medical profession.

Step 4: repeated request

To guarantee its solidity, the official request for AAM formulated before a doctor “must be repeated after a period of reflection”mainly defend the members of the citizens’ convention, who did not wish to set a specific deadline. “It shouldn’t be too long, so that a person at the end of life is still in a physical and intellectual state to reiterate their request”says Louise, 87, director of research emeritus in biology in Paris.

“We could imagine a modularity of the delay according to the patient’s profile, with a shorter reflection period if the vital prognosis is engaged”, Anton suggests. There is, however, consensus on one point: at any time during the course, and up to the last moment, the patient is free to change their mind and renounce their request for AAM.

Step 5: the collegial procedure

After the repeated applications a jury intervenes. A “collegial and multidisciplinary procedure”composed of caregivers and possibly external personalities, must be put in place to “validate the conformity of the request and thus record the final decision” to grant or refuse an AAM. This validation “is based on the respect of a certain number of criteria”, which the members of the citizens’ convention have yet to define during their last working session, from March 31 to April 2. On a personal note, Jérôme, 44, defends an AAM reserved for people whose vital prognosis is engaged, suffering from an incurable disease and physical pain that cannot be relieved. If the application is rejected, an appeal could be considered, even if the question has not been put to a citizen vote.

In addition to this collegial procedure, an independent control commission must “verify compliance with the procedure” throughout the course and “ensure the traceability of acts”. It must also meet after the act of AAM to ensure that no deviation has been committed. “When there is an attack on life, one can imagine all the excesses”warns Louise, hence the requirement expressed within the citizens’ convention to “control at each step, even if it can perhaps slightly delay the process”.

Step 6: active assistance in dying

If the patient sees his request for AAM validated, and if he still wishes, he can benefit from it in the place of his choice, at the hospital, in nursing home or at home. He can be surrounded by his relatives and must necessarily call on a health professional, present to administer the lethal substance (in the event of euthanasia) and to react in the event of an incident. No question, therefore, unlike Switzerland for example, of letting the patient perform an act of assisted suicide without being supervised by a caregiver.

A carer who refuses to participate in such an act can invoke a conscience clause. In this case, he or his establishment are required to refer the patient to another professional. A “list of volunteer professionals” could even be transmitted to the applicant, but this proposal is subject to debate. “For me, it’s up to the doctor to direct his patient to another doctor, and not up to the patient or his relatives to end up with a list, and the burden of begging from professionals so that one of them accepts “, defends Fatna. “We want this to be done as humanely as possible.”