THE EVENT
In an animated debate where the different conceptions of freedom and “fraternity were vented, the MPs completed the examination of the first section of the end of life bill which concerns palliative care, “accompaniment care” and the rights of patients, and began to examine the second section which introduces the possibility of “assistance in dying”, i.e. resorting to assisted suicide or euthanasia.
THE FIGURES
On Monday 3rd June, Catherine Vautrin, the minister, estimated at “between 3,000 and 4,000 the number of people each year who experience the situation described by the bill“, i.e. who meet the various eligibility criteria mentioned in article 6. Nevertheless, she gave no indication concerning the data used as a basis for such claim which therefore appears quite unreliable. In its conclusions issued in March 2023, the mission to evaluate the Claeys-Leonetti law had recorded a crying lack of quantitative data on the end of life.
SUMMARY OF THE DEBATES UP TO 6th JUNE
Examination of the first section of the bill on palliative care, “accompaniment care” and the rights of patients took up the entire first week of the time allocated for the examination session. After validating the principle of an “enforceable right” and introducing in the text a multiple-year programming law (refer to decoder #3), the MPs voted for a doubling of the budgets allocated in the ten-year strategy for accompaniment care, against the advice of the government.
According to the presentation of the amendment submitted by the communist MPs, “the effort” announced by the government in the ten-year strategy would “in fact equate to remaining at a constant level for the coming ten years and beyond”. Currently, the French Audit Office estimates that 50% of French people who need palliative care are unable to have it. This is the reason why this amendment doubles the budget allocated by the ten-year strategy.
Article 2 concerning the creation of “accompaniment establishments“ was adopted despite opposition by the LR and RN MPs, who denounced them as “Death homes“. Indeed, the minister Catherine Vautrin had specified during examination by the special commission that “assistance in dying” could be practiced there. The LR MP Marc Le Fur mentioned the number of ETP (equivalent full-time) doctors quoted in the impact statement, at a mere 0.2, i.e. one day per week, thus denouncing the absence of medical presence in such establishments.
Nevertheless, an amendment by the socialist MP Jérôme Guedj was adopted against the will of the government and of the reporter to rename these establishments as “palliative and accompaniment care homes”. Additionally, the MPs confirmed that the creation and management of such homes would be restricted to the non lucrative sector through the rejection of an amendment by the reporter Didier Martin.
At article 4, the MPs adopted an amendment by the government to back down on the possibility of recording a choice for “assistance in dying” in advance directives, in the event of an irreversible loss of conscience. This measure had been added by the special commission, whereas among the criteria adopted at article 6 for resorting to “assistance in dying” is the ability “to express one’s free and enlightened will”.
The minister Catherine Vautrin recalled the government’s will that the patient should be able to express his/her will “in a free and enlightened manner” “not only at the moment of requesting assistance in dying, but also throughout the procedure, up to the moment when, as the case may be, he/she resorts to it.”
On Monday 3rd June, the MPs started to examine the second section on “assistance in dying” (title II). The debates were quite animated. The opponents to the text tried to introduce the terms “euthanasia” and “assisted suicide” in the text, instead of “assistance in dying”.
Renaissance MP Astrid Panosyan-Bouvet heckled the minister and the reporters who opposed the use of such terms in the text : “What are you afraid of ? Why do you not want to admit the truth?
Look on the internet at the titles of the laws adopted in Holland, in Australia – you will find the English translation –, or even in Switzerland. They refer to assisted suicide and euthanasia : in Australia, they speak of “physician-assisted suicide” and “voluntary euthanasia”. Why the need to invent Gallicised terms to qualify the end of life ? ».
Nevertheless, all the amendments to change the terms were rejected. An amendment by a communist MP, suggesting to change Title II to “Right for assistance in dying” was also rejected.
The MPs debated at length on article 5 which defines “assistance in dying“, through till Thursday 6th June. They upheld the principle that the patient self-administers the lethal substance (assisted suicide). Only in the event of physical incapacity may the lethal substance be administered by a third party.
On Thursday 6th June, by 43 votes “for” and 42 “against”, the MPs deleted the possibility for a close relative to administer the lethal substance, against the advice of the government. The MPs defended several identical amendments mentioning the emotional trauma and psychological burden that such a task could represent for a relative or family member.
The examination of article 6 on the conditions of access for “assistance in dying” started on Thursday 6th June.
As expected, the government attempted by amendment, to reintroduce in the text the condition of “life expectancy threatened in the short or medium term“, which had been replaced by the special commission by the wording “in an advanced or terminal phase”. To that end, the minister Catherine Vautrin quoted the advice by the National Council of the Order of Physicians and the National Medicine Academy.
In a statement dated 3rd June, the National Medicine Academy had denounced the “unsuitable and dangerous” nature of the term “advanced phase”, considering that once “threatened life expectancy” is removed, there is a risk of including those suffering from diseases which, although incurable, it is nevertheless possible to survive them for a long time”.
Nevertheless, the MPs from all sides, including from the Renaissance group, as well as the Chief Reporter Olivier Falorni expressed their strong opposition to any reintroduction of the notion of “medium term“, which is considered as indefinable. Finally, the amendment by Géraldine Bannier (Modem) was adopted, which describes the criterion as “a serious and incurable condition, threatening life expectancy, in an advanced or terminal phase“.
During the special commission, the text had been modified such that psychological suffering alone could not provide access to “assistance in dying“. It had to be associated with “physical suffering”. During the session, the MPs reintroduced the initial version of the text, which calls for “physical OR psychological suffering” associated with the condition for eligibility for access to “assistance in dying“.
OUR ANALYSIS
Unquestionably, the MPs worked on overall improvement of the first section of the bill by reintroducing palliative care which corresponds to a practice which is well-defined and recognised internationally, as opposed to “accompaniment care” which does not refer to any scientific definition. The creation of an “enforceable right“, the inclusion of a ” programming law” and the doubling of the budget of the ten-year strategy are all measures which will commit the State to a real effort to provide the French people with access to palliative care.
One can also delight at the removal from the text of the possibility of expressing a choice for “assistance in dying” in advance directives, even if the debate is bound to return naturally during the examination of the second section on “assistance in dying“.
By a single vote, the MPs chose to protect close relatives by excluding them from administering the lethal dose, which will however be left to a doctor or nurse in the event of physical incapacity of the patient.
Examination by the MPs of the conditions for access to “assistance in dying” resulted in a considerably expanded device:
- A condition of a threatened life expectancy but with no time factor
- Physical OR psychological suffering.
The new version under elaboration no longer corresponds to the government’s intention, the latter being powerless to have its amendments adopted. These debates clearly show the impossibility of establishing a strict framework from the moment that assisted suicide or euthanasia are legalised.
OUR FAVORITE CONTRIBUTION
Two important columns appeared this week in Le Figaro to express the concern of the sick or those suffering from handicap and their relatives :
- In a column published on 4th June, parents of mentally handicapped people call explicitly for the prohibition of euthanasia and assisted suicide for those suffering from intellectual deficiency.
- On 7th June, Caroline Brandicourt (the spokeswoman for Soulager mais pas tuer) and Isabelle Mordant gave a warning about the risk that suffering patients will be condemned by the law on the end of life, due to the absence of palliative care accessible everywhere.
OUR ALERT CALL
The amendment by LR MP Annie Genevard, which proposed prohibiting organ donations by any person having benefited of “assistance in dying” in order to avoid such donations inciting a form of altruist administered death, was rejected, for the reason that it would create an inequality between citizens – whose organ donation is an assumed principle – and act as “an additional obstacle to assistance in dying”.
