what does a “vital prognosis committed to in the short or medium term”, mentioned by Emmanuel Macron, mean?

In an interview with the daily newspapers “La Croix” and “Libération” on Sunday evening, the head of state said he was in favor of “assisted death” for adults with “a vital prognosis engaged in the short or medium term “. But this expression poses a problem of definition.

A first text, after months of waiting. Sunday March 10, Emmanuel Macron finally unveiled the broad outlines of a bill on the end of life, after more than a year of successive postponements and two ministerial reshuffles. In an interview given to the daily newspapers The cross And Releasethe Head of State thus said he was in favor of a “assisted dying” for adults, “capable of full and complete discernment” and having “an incurable disease and a vital prognosis committed in the short or medium term”.

These notions of short and medium term are not clearly defined by science. On the other hand, the Minister of Labor, Health and Solidarity gave some details Monday evening on France 2. As for the short term, “we’re talking about a few days or a few months”, detailed Catherine Vautrin. As for the medium term, she estimates it between “six and twelve months”invoking “reading the High Authority of Health”. But the health authority gives a different definition of “short term”already mentioned in the Claeys-Leonetti law of 2016. Based on the definition established by the French Society for Support and Palliative Care (Sfap), it limits this temporality to “a few hours or a few days”.

An imprecise definition

This definition is far from unanimous in the medical community, divided around the question of the end of life. First of all, because it remains vague in the eyes of caregivers. “What does a few days mean? Does it mean two, three, fifteen days? Will the estimate be the same for a loved one, a caregiver or a lawyer? If there is a trial, how can we define this short or medium term ?”, asks Jean Daquin, doctor and national delegate in charge of the caregiver commission within the Association for the Right to Die with Dignity (ADMD), in favor of the law going further than the project unveiled by the president.

“The expression vital prognosis engaged in the short term already puts us in difficulty for deep and continuous sedation”made possible within the framework of the Claeys-Leonetti law, points out Ségolène Perruchio, head of the palliative care department and vice-president of Sfap, opposed to the bill.

A difficult prognosis to assess

Beyond the vagueness induced by this temporality, the practitioner explains that it is impossible for a doctor to precisely calculate the life expectancy of a patient. “We can make predictions when it comes to a few hours, explains Ségolène Perruchio. On the other hand, it becomes much more complicated when it comes to a few days.” And to add: “I am unable to make a prognosis for a few months.”

Indeed, when a doctor tells a person that they have an illness, he can give them an estimate of the time they have left to live. But this remains an opinion based on statistics. “The patients in front of us are individuals, they are not averages and standard deviations”underlines Ségolène Perruchio.

In cases of cancer, vital prognoses are calculated in months rather than days. Over such a long period of time, some caregivers fear that the patient will change their mind, or even decide to die when their condition could have improved. “We sometimes see patients who were not given much time to live who stabilize. Human support plays a big role”observes Stéphanie Träger, the deputy secretary of the French-speaking Association for Oncological Support Care (Afsos).

“We are very regularly wrong about a potential estimate of life expectancy.”

Stéphanie Träger, oncologist and palliative care doctor in Paris

at franceinfo

“In six months, a patient can go through complications that will reduce their few months of life expectancy to a few hours, confirms Sophie Moulias, of the French Society of Geriatrics and Gerontology (SFGG). But he can also have a remission which will save him several years.

A law that risks being inapplicable

From a legal point of view, some fear that these notions of short and medium term will make this new law inapplicable. For jurist Martine Lombard, professor emeritus of public law at the University of Paris II-Panthéon-Assas and in favor of legislative developments on the subject, “this notion of vital prognosis engaged in the short term has already made the Claeys-Leonetti law very restricted. If we retain these notions in the text of the law, we risk beinge facing the same process.”

A fear shared by François Blot, resuscitation doctor and president of the ethics committee at the Gustave-Roussy Institute in Villejuif (Val-de-Marne), also in favor of a new law on the end of life. According to him, the presence in the text of this vague notion of short or medium term would give too much power to the medical profession, which could base a refusal of assistance in dying on this argument, to the detriment of the patient’s rights.

Both recommend a text which would not mention any temporality, as various European countries have already done. The Netherlands and Belgium are thus focusing on “refractory suffering of the patient”, impossible to relieve. A formula which would make it possible to include patients whose vital prognosis is compromised in the long term, as is the case in certain incurable diseases. “Emmanuel Macron had the merit of proposing a nuanced and acceptable law initiallyestimated François Blot. Yes, this bill is flawed. But at this precise moment, to start the debate, I’m not sure we can do better.” He hopes that the debates in Parliament will make it possible to resolve this point.