Portugal, The Law on Euthanasia is Judged Unconstitutional

Portugal, The Law on Euthanasia is Judged Unconstitutional

by | February 3, 2023 | European legislation, Euthanasia and Suicide, News

On 30th January 2023, The Portuguese Constitutional Court again rejected a law to legalise euthanasia. The President, Marcelo de Souza, had submitted to the court the text adopted on 9th December, as he considered it to be unclear on some particular points and that it created legal insecurity.

A first law adopted in January 2021 under the full Covid pandemic had already been declared unconstitutional and sent back to parliament to be re-written. A second revised text was adopted on 5th November 2021 before being vetoed by the President in November 2021. Indeed, the text included in particular a legal uncertainty concerning the qualification of the sicknesses eligible for euthanasia, sometimes described as “serious” in certain articles and fatal or incurable in others. The text did not go any further due to the dissolution of parliament in December 2022.

As in 2021, the law invalidated by the Court, is the result of a compromise combining proposals submitted by the Socialist party, the Left block (extreme left), PAN, the animal protection party, the Greens and the Liberal initiative party.

The constitutional judges considered that there was a severe lack of definition concerning the precise scope of the new law. Indeed, the legislator decided to characterise suffering by listing three characteristics – physical, psychological and spiritual – linked by the conjunction ‘and’. This leaves room for diverse interpretations. In other words, in order to have access to euthanasia, should these characteristics be considered as cumulative or separate?  the President therefore returned the text to the Republican Assembly (Parliament) for rewriting without promulgation.  Since 2021, this law has been forced through: in January 2021, the debate was held during the full pandemic. Even worse, the law is supported by all the left parties at the expense of solidarity and accompaniment inasmuch as palliative care is very poorly developed and the health system is fragile.

Parliamentary Mission on the End of Life: Alliance VITA Auditioned

Parliamentary Mission on the End of Life: Alliance VITA Auditioned

by | February 2, 2023 | End of life, Euthanasia and Suicide, News

On 30th January 2023, several Alliance VITA representatives were auditioned by the parliamentary evaluation mission for the French National Assembly on the Claeys-Leonetti law.

This audition was attended by Tugdual Derville, the Alliance VITA spokesman, and Doctor Olivier Trédan, Head of an oncology medical department in an oncology centre in Lyon and medical advisor to Alliance VITA. They took part in a round table alongside Jean-Marie Le Méné and Lucie Pacherie, respectively the President and lawyer for the Jérôme Lejeune Foundation.

On the basis of the experience of carers who are members of the Alliance VITA network and that of its SOS Fin de Vie (End of life) and Thadéo help lines, the speakers began by outlining the general policy defended by Alliance VITA which rejects both therapeutic obstinacy and euthanasia as two red lines not be crossed.

Speaking as an oncologist, Doctor Olivier Trédan provided a testimony on the benefits of advance directives which “enrich the discussions between carers and patients”. Nevertheless, they must not be granted full authority and it is important to establish a “therapeutic alliance” between doctors and their patients, based on mutual trust.

Deep and continuous sedation until death may be necessary in some extreme cases but it is preferable to choose a “proportional sedation”, which is reversible, in order to allow the patient to continue to interact with family members. Indeed, the vast majority of end-of-life situations mainly require the comfort and calming presence of close family members.

Over the last seven years, Doctor Trédan has noted major improvements in end-of-life accompaniment: development of palliative care teams, integration of living areas within hospitals, creation of relief structures for helpers and their families. The 5th national development plan for palliative care is still in progress.

Tugdual Derville highlighted three possible deviations of the current law:

  • The risk of masking euthanasia by a biased use of deep and continuous sedation, in the absence of the criterion of intention in the 2016 law but also in violation of the precious references specified by the HAS (High authority for health)
  • The risk of loss of trust between carers, patients and their families in the event of excessively rigid application of advance directives. They must remain updatable and non-opposable in order to favour the therapeutic alliance with the patient or the patient’s person of confidence, without especially leading to obviously inappropriate treatments.
  • The general risk of making this law a stage law (rather than a barrier law) by challenging the “prohibition to kill”.

On this last point, Tugdual Derville warned against the wood of the claimed “assistance to die” hiding the forest, in particular all the questions which appear every day when having to accompany a person during their end of life. The priority should be for better care for those who are both aged and isolated, threatened with “social death”. Moreover, the current debate, by challenging the prohibition to kill, weakens in particular those suffering from illnesses considered as “eligible” for euthanasia or assisted suicide (such as for example Charcot’s disease or ALS), as well as those suffering mentally, as shown by the messages received by the SOS fin de vie (end of life) help line. In the event of serious illness, it is the difficult social circumstances rather than the therapeutic dead ends which lead to requests for euthanasia. The examples from abroad show that, “once the lock is breached, nothing can stop the slippery slope” and the practice of sedation becomes confusing and ambiguous.

In conclusion, the current debate on the end of life leads Alliance VITA to

  • Alert on the risk of damaging the relationship of trust between carers and patients
  • Reaffirm that the prevention of suicide can suffer no exceptions. The exclusion of certain categories of patients would constitute discrimination.
[Press release] Abortion in the Constitution: Alliance VITA Deplores the Vote by the Senate

[Press release] Abortion in the Constitution: Alliance VITA Deplores the Vote by the Senate

by | February 1, 2023 | Abortion, News, Press Releases

Abortion: Alliance VITA deplores the vote by the French Senate

The Senate has just adopted the bill aimed at introducing a “right” to abortion in the constitution by modifying the initial text to register in the constitution the “freedom for women” to resort to abortion. Alliance VITA deplores this vote which does no favours to women nor to democracy. Alliance VITA denounces the incoherence of the Senate which rejected the text in commission and had already rejected the first similar bill in November 2022.

Constitutionalising abortion represents a breakaway from the principle of respect for life registered under article 16 of the civil code. As an example, it is conceivable that it will therefore become possible to demand an abortion right up to the pregnancy term or according to the sex of the unborn child, which is prohibited in France as in many other nations. Furthermore, this could lead to challenging the conscientious objection clause for medical teams and further threaten the freedom of expression on a social and humanitarian matter which remains a painful taboo.

In France, the number of abortions remains at a high level, with 223,300 abortions recorded in 2021 and a record rate (15.5 abortions per 1000 women between 15 and 49 years of age in 2021). Additionally, whilst France is battling with economic difficulties, a report by the DREES (French Directorate of Research, Analysis, Evaluation and Statistics) has established that it is the poorest women who abort most (2020 report). Abortion is therefore a marker of social inequality, which should act as a warning for the public authorities.

How can one be satisfied with such a situation? Registering abortion in the constitution would be the last stage towards the commonplace use of an act which puts several lives at risk.

“Our society is gradually turning its back on the distress and the situations some women are confronted with and such political gesticulations are masking the reality and preventing the establishment of a true means for preventing abortions allowing those who so wish to fulfil their pregnancy” concluded Caroline Roux, Deputy General Manager of Alliance VITA.

Press contact
contactpresse@alliancevita.org

2023 Alliance VITA Bioethics Conference: Living in the Real World 4th Session : A Future to Weave

2023 Alliance VITA Bioethics Conference: Living in the Real World 4th Session : A Future to Weave

by | February 1, 2023 | Bioethics, News

Some 8000 participants in the Alliance VITA Bioethics Conference gathered in 190 towns throughout France and abroad on 30th January for the fourth instruction session titled “A future to weave”.

The digital revolution has considerably modified the relationship between man and time and space, enabling him indeed to abolish physical distances but whilst subjecting himself to an ever faster rhythm of life. Beyond such upheavals, there are some realities which remain and will continue to remain profoundly human: in reality everything is linked and we are all connected to one another, the consent to reality and the human links constitute a treasure to be promoted for the future we weave.

After the introduction by Tugdual Derville, the co-initiator of the current debate on human ecology, regarding the position of man today in nature and the fact that ecology is always human since it is carried by mankind, Professor René Ecochard opened the session. A research doctor, epidemiologist, Professor Emeritus at University Claude Bernard in Lyon, author of several books on human ecology, he spoke of the link between the human and environmental dimensions of ecology and declared generational difference and sexual difference as the pillars of human ecology. According to him, integral ecology constitutes an awareness that everything is interlinked. He also recalled the reality of man, a being incarnate, unified, body-soul-spirit to be considered as a whole.

Next Jeanne Bertin-Hugault, a psychologist in charge of the Alliance VITA SOS Bébé help line invited the participants to think about how to consent to reality. In a situation of bereavement, one must first consent to the loss in the knowledge that the attachment links woven at the start of life modulate the way in which we adapt. Bereavement being a wound to attachment, “the gravity of the bereavement is dependent on the degree of attachment with the person.” The consent is not merely passive. In order to consent to the reality one must receive it through a double motion of acceptance and decision. Finally Jeanne suggested three concrete themes for consenting to a “reality sometimes constraining and frustrating, which does not really correspond to our plans and projects”: first name the reality to better understand it, then let go, and finally, accept the reality of here and now.

The co-founder of Wanadoo and ex-manager of a start-up acquired by Apple, Philippe Dewost, then questioned the place of digital technology in the future we weave. For the author of In Living Memory – A History of the Digital Adventure, even if the promise of metaverse is as yet imperfect, we will not be able to do without digital technology to face up to the current challenges. “From its earliest beginnings, digital technology has met the expectations of every one of us to be able to create or maintain links while abolishing the constraints of distance, time and cost.” But Philippe Dewost also stressed that “Mankind will always remain more efficient than artificial intelligence in its abilities for large scale inspiration and for ensuring a simple presence to accompany the most vulnerable.”

Finally, the session was concluded by Bertrand Vergely, a philosopher, and his reflections on thinking for tomorrow. In 2018 he wrote The Destruction of Reality – Has the Programmed End of Humanity Already Begun?, he pointed at the disappearance of reality by substitution: “we substitute reality with artificial reality” and added that “the characteristic of our time is to refer everything to the individual and our ability to call real what we declare and what we want.” However, the individualism which pervades our society “transcends the four limits which protect us: the difference between man and machine, man and animal, man and woman, virtual and real.” Nevertheless, the testimony by the philosopher inspires hope, considering that “there will always be unexpected, unforeseen and beneficial events, which occur in reality.”

This ended the Bioethics Conference, with its wealth of learning and testimonies for “Living in the real world”. The lectures will very soon be made available on the Alliance VITA YouTube page.

Feedback from the 4th Session of the Citizens’ Convention

Feedback from the 4th Session of the Citizens’ Convention

by | January 27, 2023 | End of life, Euthanasia and Suicide, News

The members of the Citizens’ Convention reconvened between Friday 20th and Sunday 22nd January, for the second session of the deliberation phase. During this session, successive round tables were organized involving carers, associations and representatives of foreign states.

An international round table which revealed deviations

In response to the requests of certain citizens wishing to hear about foreign experience other than from Belgium and Switzerland, a new round table was arranged on the Friday afternoon, where only states having legalised euthanasia or assisted suicide were represented. Those taking part were Théo Boer, an ex-member of the euthanasia supervisory committee in Holland, Michel Bureau, president of the end of life care commission in Quebec, Joelle Osterhaus, manager of the psycho-social services in a palliative care unit in Portland (Oregon), in the United States, and Francesca Re, a lawyer for the Luca Coscioni association, which is militating for euthanasia in Italy.

In Quebec and in Holland, the statistics presented indicated a considerable increase in the number of cases since legalisation, which is even more impressive in Quebec where euthanasia was legalized in 2015. Deaths by euthanasia currently represent 5% of the total number of deaths in Holland as in Quebec, and 10.9% of deaths of people suffering from cancer in Quebec. In Holland, where deaths by euthanasia have reached 20% of deaths in certain areas, “the increase appears to be still growing”, whilst the number of violent suicides is also increasing.

Théo Boer, the author of a column published in Le Monde last December, warned of the difficulty of containing requests for euthanasia within a strict framework. “I believe that not one state in the world has managed to maintain the practice within the limits of their initial objectives. Wherever euthanasia has been legalised, the logic is the same. Why is euthanasia allowed for A and not for B?”.

In Oregon, the law limits assisted suicide to patients suffering from a disease in its terminal phase, with a life expectancy of less than six months. However, the figures presented by Joelle Osterhaus reveal that the main reasons for requesting assisted suicide in Oregon are the loss of autonomy (93%) as well as “a reduced capacity to take part in activities which make life agreeable” (89%).

The means implemented for end of life accompaniment

The members of the Citizens’ Convention then took part in another round table on “the means implemented in the context of the Claeys-Leonetti law and the 2021-2024 palliative care plan”.

After the presentation by Louis-Charles Viossat of the report by IGAS (Inspection Générale des Affaires Sociales: General inspectorate for social affairs) published in 2018, Olivier Mermet and Bruno Richard, drivers of the 2021-2024 national plan for the development of palliative care were able to present the details of the plan.

The questions asked by the members underlined the lack of ambition of the plan, with its meagre budget of 180 million euros, compared with 1.7 billion euros for the fight against cancer. Thus, for example, the plan covers the creation of a mere three posts as palliative medicine instructors.

Round table on refractory suffering

The third and last round table of the week-end concerned refractory suffering and included both doctors and patient associations.

The different contributions highlighted the progress being made in pain relief and the possibility of resorting to deep sedation in order to avoid refractory suffering. Nevertheless, there remains a proportion of patients, even if small, whose pain cannot be relieved. In such situations, doctor Stéphane Picard, an algologist, pleaded for the “moral contract” established with patients, which commits carers not to abandon them and to remain with them right up to the end.

The various speakers insisted strongly on the crucial importance of accompaniment. According to Francis Jubert, a coordinator of palliative care teams in the home, “staying close to a deeply sick patient, is a form of natural sedation in full consciousness.” Because quite apart from physical pain, one cannot neglect the burden of psychological and existential suffering.

Thus Nathalie Maka, a member of the Charcot Solidarity Collective, gave a testimony of the suffering associated with Charcot’s disease, both for the person directly concerned and for the patient’s family. She expressed the feeling of abandonment experienced by patients in the absence of any medical or psychological supervision immediately after announcement of the diagnosis. Patients suffering from ALS are not sufficiently cared for either in hospital or at home. The isolation can lead patients to ask to die. The organisation of better care should be made a priority.

In view of the shortcomings of the care system for patients being left to their solitude, Francis Jubert launched an appeal for solidarity: “It is up to you to motivate yourselves to be more present for patients in end of life situations.”

Finally, a member asked the ex-president of the French Federation of Psychiatrists, Jean-Jacques Bonamour du Tartre, for his opinion on the possibility of authorising assisted suicide for patients suffering from psychiatric pathologies. Mentioning the fluctuations over time of such requests, he stressed the responsibility of psychiatrists to eliminate suicidal thoughts: “Our work, is to avoid people resorting to suicide and we have quite a task on our hands!”

346 proposals on the end of life

At the end of this fourth session, the citizens registered 346 preliminary proposals and began to attempt to establish them in order of priority.