Several studies have been released over the last twelve years to estimate the number of euthanasia requests in France. These studies are sometimes quoted in the current debate on the end of life and its legal framework. Thus, the CCNE (National Consultative Ethics Committee) in its notice No. 139 uses as a basis a study conducted in the Jeanne Garnier palliative care centre to justify its about-turn in favour of euthanasia and assisted suicide. In that study, dating from 2014 the initial requests for euthanasia expressed by patients treated in palliative care are estimated at 3%.
The analysis note which we are publishing analyses in detail the 4 studies conducted in France between 2010 and 2022, some of which also distinguish between initial requests for euthanasia and persistent requests, i.e. repeated over time by the patient in person.
INED 2010 study
The oldest study, undertaken by INED was conducted on doctors rather than patients. The main conclusion of the study was that “according to the doctors interviewed, 16% of the deceased, at one moment or other, expressed a wish to accelerate their death, but explicit requests for euthanasia remain extremely rare in France: they concern 1.8 % of deaths, i.e. 44 persons out of a sample of some 2,200 persons subject to a medical decision at their end of life.”
Initial requests for euthanasia expressed by patients in palliative care
The study conducted at the Jeanne Garnier medical centre in 2014
The approach for this study was different. The wishes for anticipated death and explicit requests for euthanasia were counted on the basis of notes recorded by the carers (nurses, psychomotricians, psychologists, therapeutists) in the records of patients admitted in the palliative care centre (81 beds) during the 2010-2011 period. The data were classified under 3 categories, “Euthanasia requests”, “Suicidal tendencies” and “Other death wishes”.
Out of the 2157 patients studied in that palliative care hospital, 9% (195) expressed a wish to die, 3% (61) of which made an initial request for euthanasia, 1% (15) had suicidal tendencies and the remaining 6% (119) other death wishes. These 195 patients were essentially women (65%), the duration of their residence was significantly longer (24 days median) and their consumption of tranquillisers (88% compared with 66%) and antidepressants (55% compared with 36%) was higher than with other residents in the palliative care centre.
Extension and updating of the previous study from 2018
The previous study was updated for the period 2014-2017 with an extension to include the Besançon CHU hospital. Among the authors featured, was Régis Aubry, a member of the CCNE who had voted in support of notice No. 139.
Out of almost double the number of beds (151) than in the study conducted at Jeanne Garnier (81), the initial requests were fewer: 31 compared with 61. If one considers an assumption of a regular rate of occupancy of the beds in palliative care, this represents 0.7% of euthanasia requests among the patients in palliative care.
Persistent requests for euthanasia
The studies also provide an estimation of the persistent requests for euthanasia.
In the study conducted in 2014, among the 61 requests for euthanasia recorded initially by the carers, only 6 (10%) persevered with their requests by repeating their requests for euthanasia.
In total, the persistent requests represent 0.3% of the patients in palliative care. The remainder of the study then focuses on these 6 patients maintaining their request qualitatively only. In the end, only two patients maintained their request for euthanasia until their death.
The 2018 study also provides details of the evolution of their requests (maintained, abandoned, ambivalence). These could vary according to events, personal experience and interactions. […]. The study noted that “The feeling of ambivalence, which is intrinsic to the wish to die, may mask and alter the way the urge to live or die operate.The reaction of the carers and their understanding also affect the repeated expression of the request and the form of rhetoric employed. We noted their variations following interactions with their carers and family members and following events associated with their disease”.
Finally, a recent study conducted with health workers in Burgundy, Franche Comté, and published in 2022 provides more detail of the context surrounding the infrequent requests for euthanasia.
It transpires that:
- Male patients maintain their requests for euthanasia more than female patients.
- Craftsmen, tradesmen, company directors are represented twice as often in the reiterated requests.
- The clinical characteristics do not reveal any significant differences apart from 3 particular cases:
- There are many more patients whose symptoms deteriorated in recent months, among the requests that disappear than among the persistent requests. This over-representation may indicate that the dynamics of deterioration may influence the initial expression of the request for euthanasia but once that expression is past, the adaptation of palliative care enables the establishment of a stability of symptoms.
- Painful symptoms are slightly greater for persistent requests than for abandoned requests.
- Neurological disorders are more represented in the persistent requests than in the abandoned requests.
Conclusion
The studies available show that, among the patients at their end of life, requests for euthanasia remain infrequent. According to the data collected from patients, initial requests for euthanasia may be estimated at between 0.7% and 3% of them. An older study by INED estimated that explicit requests for euthanasia concern 1.8 % of deaths. Persistent requests are even fewer in number, around 0.3% according to the study conducted in 2014. The quality of care provided, the attentiveness of carers, the family and social-economic context… are other influencing factors for such requests and their persistence.
More than ever, the urgency is to provide relief and accompany those at their end of life.
