DECODER #3: THE FRENCH NATIONAL ASSEMBLY HAS ADOPTED AN “ENFORCEABLE RIGHT” OF ACCESS TO PALLIATIVE CARE
THE EVENT
Since Monday 27th May 2024, the French MPs have been examining in public session, the bill on the accompaniment of the sick and the end of life. The text contains two sections.
- The first section (Title I) aims to reinforce “accompaniment care” palliative care and the rights of patients.
- The second section (Title II) establishes the possibility of “assistance in dying”, i.e. assisted suicide or euthanasia.
The MPs completed their examination of article 1 on Wednesday 29th May, seeking stronger guarantees for access to palliative care. They then ratified an “enforceable right” to palliative care (article 1 b) and introduced a “programming law for palliative care”, against the government’s will.
THE FIGURE
3360 amendments were submitted for the public session debate.
SUMMARY OF THE DEBATES FOR THE FIRST THREE DAYS
Through numerous amendments submitted by the left or the right, the MPs decided to improve access to palliative care and to combat territorial inequalities. Thus, an amendment completes the title of the 1st section with the words “Throughout French territories”. Within the text of article I, amendments have added the words “guarantee” and “guaranteed” to the text. According to the new wording, palliative care and accompaniment are intended to “guarantee overall and local care for the patient.”
An amendment submitted by the communist MP Pierre Dharréville clarifies what is meant by accompaniment care, which refers to palliative care and “support and comfort care“, to meet the physical, psychological, social and spiritual needs of the person.
Several other amendments also reinforce the support for family members, for example the amendment by Julie Delpech (Renaissance) who added “psychological and social support or the amendment by LIOT MP Laurent Panifous which calls for support for the entourage following a death. Among the other additions, the organisations specialised in chronic pain will have to be associated with the accompaniment of the sick, a representative will be appointed in each department of public health establishments, and an information booklet will be provided to each patient.
Article 1, considerably reinforced and enriched, was thus adopted on Wednesday afternoon, with 123 voting for and 55 against. The MPs in the LR and RN groups largely voted against this article 1, considering that accompaniment care is too vague in the absence of adequate clarification and could include “assistance in dying”. An amendment by Christophe Bentz, an RN MP, who suggested explicitly excluding euthanasia and assisted suicide from accompaniment care, was rejected.
After including in the text a recommendation from the Chauvin report on the structuring of territorial organisations providing accompaniment care, the MPs debated on an additional article to establish an “enforceable right” to palliative care, just as there is an enforceable right to housing. This article establishes the possibility of appealing to an administrative jurisdiction if a person “whose state of health so requires” and “has asked for palliative care” and has not been offered “a proposal for palliative care”. An amendment by MoDem MP Nicolas Turquois proposed its deletion.
Health minister Catherine Vautrin and reporter Didier Martin were in favour of its deletion, referring to the delays in the courts which are not compatible with the life expectancy of those at their end of life. Finally, against the advice of the government and the reporter, the MPs rejected the amendment and adopted the additional article, with the support of some Renaissance MPs.
Through two amendments, one by LR MP Thibault Bazin, the other by the socialist MP Jérôme Guedj, the MPs also included in the law the principle of a “programming law for palliative care”. Thibault Bazin explained that the current bill does not anywhere specify the funding required for the development of palliative care, and that only a programming law would enable “the State to make funding commitments spanning several years.”, as already exists for defence and the law.
The government and the reporter were both opposed to this programming law. Catherine Vautrin objected that “programming laws concern only State funding and not Social Security funding.” According to her, the social security funding law (PLFSS), which is adopted each year, should establish the budget for sanitary and social action. The MPs finally adopted these two amendments, once again with support from a few Renaissance MPs.
OUR ANALYSIS
Despite the efforts by MPs to strengthen the guarantees for access to palliative care in article 1, the notion of “accompaniment care” introduced in this article remains vague. The government opposed the amendment which proposed to specify that the said accompaniment care would exclude euthanasia and assisted suicide.
Consequently, it is plain to see that the intention is to include “assistance in dying” within care, in a continuum with palliative care, whereas euthanasia or assisted suicide are clearly incompatible with palliative care and completely disrupt the relation of trust between doctors and patients by lifting the prohibition against killing. The minister in fact acknowledged that euthanasia and assisted suicide could be conducted in “accompaniment establishments” created under article 2 of the bill.
In truth, the text states that “assistance in dying” may be performed anywhere, in the home just as in retirement homes and health establishments, including in palliative care wards.
Catherine Vautrin has regularly sought to reassure concerning the will of the government to provide access to palliative care for the entire French population, in particular through its ten-year strategy for accompaniment care. However, the government wished to delete from the text the principle of an “enforceable right” to palliative care. Philippe Vigier a government MP (MoDem), even argued, by recognising the current powerlessness of the health system: “Have you even considered, even for a second, what would happen if an enforceable right to palliative care were to be established? There would have to be an enforceable right to medical appointments, for access to care! But finally, have you considered the state of this nation?”
The government also opposed the introduction of a programming law, which would have enabled the State to make funding commitments. Could the ten-year strategy therefore be a mere communication stunt? The current text does not include any funding arrangements and a programming law is the only possible means for providing them. Hence, one can truly question whether the first section of the bill on “accompaniment care” could merely be a device to ensure the acceptance of the second section on “assistance in dying“, as has been suggested by several MPs.
Last September, MPs from all sides asked through a column for the bill to be split in half in order to separate “assistance in dying” from palliative care”.
The debates on the programming law were an opportunity for questioning the minister Catherine Vautrin on the programming law for old age, intended as part of the “aging well” law promised in November 2023 by the previous Prime Minister Elisabeth Borne, for adoption scheduled before the end of 2024. Last January, Catherine Vautrin stated she had appealed to the Council of State on the subject due to a constitutional difficulty.
During the animated debates on Wednesday evening, the minister admitted however that the General Secretary of the government had in fact never forwarded the request to the Council of State, resulting in a general outcry in the chamber. Not only is the government incapable of making funding commitments for palliative care, neither has it held its promise on old age. In that context, the MPs on the right and the left expressed their concern regarding the legalisation of “assistance in dying” which could become the only solution in the absence of access to care.
OUR FAVORITE CONTRIBUTION
At the beginning of the examination of the text, Pierre Dharréville, the communist MP for the Bouches-du-Rhône, gave a vibrant presentation of the reasons for his opposition to the bill:
“When can one consider that a life is no longer worth living? When can society allow itself to decide that, and to act in consequence? As if dignity is lost because one is too sick, too handicapped, too diminished. It is essential to proclaim equal dignity for all humans irrespective of their state of health. To change our view.“
OUR ALERT CALL
The minister admitted during the debates that her so-called appeal to the Council of State on the programming law on old age had in fact never been forwarded…This admission damages confidence in the government and throws doubt on its will to accompany old age with dignity, whereas the bill on “assistance in dying“, on the other hand, has suffered no delays.
