Almost 3 years after the Clayes-Leonetti law was voted, on Wednesday, November 28th, the French National Center for End-of-Life and Palliative Care (“CNSPFV”) published a report which provides an evaluation of the implementation of the continuous and deep sedation until death (CDSUD).
Entitled “Difficulties encountered in implementing continuous and deep sedation until the patient’s death” the report is based on approximately 15 hearings, including that of a Belgian doctor. However, the French Society of Accompaniment and Palliative Care (“SFAP”) was not even auditioned. This report should therefore be considered with caution since this is not a scientific report nor an objective analysis.
The report includes seven incongruities:
- The continuous deep sedation until death (CDSUD) is a new legal quagmire which has complicated the possible use of end-of-life sedation instead of making it easier.
- Amalgams are still prevalent between euthanasia vs. continuous deep sedation until death.
- Palliative care personnel have been delegated to implement continuous deep sedation, although they may not consider this care to be appropriate for their patients at the end-of-life.
- The fact that the patient himself may request continuous deep sedation blurs the roles between doctors and patients and could be ethically questionable.
- There is a risk that time-frame between the patient’s request and the physician’s implementation may not conform to the good clinical practice guidelines.
- No measures have been taken to facilitate this type of sedation for general practitioners in urban areas, faced with insufficient treatment, logistics, information and training, as well as organizational and personnel constraints.
- There are still huge disparities from one care unit to another, depending on the sites and the medical particularities.
Claire Fourcade, as vice-president of the French Society of Accompaniment and Palliative Care (“SFAP”) which tallies 10,000 caregivers and 6000 volunteers, responded: “In its report, the National Center implies that continuous deep sedation was the unique objective. But in practice, the goal is to comfort patients with all the means we have available, not to establish a ‘quota’ for sedations”. She notes that it is regrettable that the report was written without consulting the SFAP”. She asserts: “The medical teams are ready to use the available sedation techniques, whether deep or not , reversible or not, whenever it is necessary”.
As the Head Physician in Palliative Care at the Languedoc Medical Center, in Narbonne, Claire Fourcade also emphasizes the need to clearly make the difference between sedation and palliative care: “According to the law and the National Health Authority there is a clear distinction between the two. And today, confusion is maintained by those with a hidden agenda or those who are misinformed on the issue. “
In April 2016, many concerns were raised within palliative care settings when Véronique Fournier, who is partly responsible for this report, was appointed on the sly to chair the National Center for End-of-Life and Palliative Care. She is in favor of practicing what she refers to as “palliative euthanasia“, an formula continues to foster great confusion.
Alliance VITA has repeatedly warned against the risks of euthanasia in the interpretation of the Claeys-Leonetti law. In an endeavor to remove some ambiguities, in March 2018, the French National Health Authority (“HAS”) issued recommendations for good clinical practice for implementing “continuous and deep sedation until death”.
These recommendations specify strict conditions and guidlines for implementing this type of sedation. Nonetheless, in their statement the “SFAP” emphasized: “When dealing with intricate human situations, sedative practices cannot be standardized nor curtailed to following a protocol. They vary immensely, from anti-anxiety drugs and minor tranquilizers to continuous deep sedation until death, as specified by the 2016 law. These practices must be adapted to the specific needs of each patient.”
