Meeting for its first inaugural session from the 9^th to 11^th December 2022, the Citizens’ Convention on the end of life began its work by welcoming highly militant personalities to present the experience from abroad. It was however intended to be a balanced debate where all points of view would be examined, in accordance with the principles of equilibrium and neutrality.

Announced last September by the French President, the Citizens’ Convention on the end of life started work on Friday 9^th December. Organised by the Economic, Social and Environmental Council (ESEC), the French CESE, its mission is to answer the following question: “Is the framework for the accompaniment for the end of life suited to the various situations we are facing or should some changes be introduced?” To that end, 185 citizens selected at random and representative of French society in all its diversity, are to meet at the Iéna Palace, the headquarters of the CESE, for nine three-day sessions, ending on 19^th March.

According to the letter of referral from Elisabeth Borne, the French Prime Minister, it is up to the ESEC to ensure that the governance of the work by the Citizens’ Convention “illustrates the principles of equilibrium and neutrality, which are indispensable to the expression of its method.”

It was intended that the first two sessions, in December, would be devoted to the rise in competence of the citizens, who have to appropriate their mandate, through the explanation of the status quo of the end of life, without expressing any point of view. Thus, on the second day of this first session, Alain Claeys, co-author with Jean Leonetti of the 2016 law establishing new rights for people who are sick or at their end of life, came to address the Citizens’ Convention on the legal framework for the end of life in France.

On the morning of the third day, pairs of reporters presented the points of consensus and dissension within their groups. Euthanasia appeared as a question causing division within all the groups, far different from the so-called “consensus” claimed by certain French opinion polls.

The final conference of this first session was devoted to a round table including representatives from other states to describe the way in which their nations had legislated on the end of life. And there, surprise, the only two nations represented were Belgium and Switzerland, i.e. the nations which have either legalised euthanasia in the case of Belgium, or legally accepted assisted suicide in the case of Switzerland. Altogether as surprising, was the choice of people invited to describe the “factual” status quo of the legislation in their nation. For Belgium, the person called was Corinne Vaysse-Van Oost, a doctor practising euthanasia and member of the supervisory commission, but also the author of several works promoting the practice of euthanasia. For Switzerland, the Dignitas association was invited, an association which provides assistance for suicide to Swiss or foreign sick patients. From the very first seconds of their presentation, the association made it clear that it militates “both nationally and internationally for the freedom of choice and self-determination up to the last moment.”

Doctor Vaysse-Van Oost started by describing the legal background to euthanasia in Belgium. She explained the conditions to be satisfied: the patient must be in a hopeless medical state and suffering “physically and mentally constantly and unbearably” with no possibility of relief and which results from a “serious and incurable” disease.

The doctor then gave a few figures. According to her, “The numbers have remained about the same over some ten years. Euthanasia cases have increased in number but that is an absolute number, because the number of deaths is increasing. We are currently still at 2.5% of deaths. There is no upward trend”. This is a strange assertion if one considers the figures in the latest report by the supervisory commission. In 2021, the commission recorded 2,700 euthanasia cases, i.e. 2.4% of the total number of deaths. Ten years previously, the number was 1,133, which represented about 1.1% of all deaths. In ten years, the percentage of euthanasia cases relative to the total number of deaths has therefore more than doubled by gradually increasing year on year. The Belgian doctor concluded her presentation with an appraisal of the Belgian law: “Twenty years on, we note various evolutions, which in my opinion are positive.”

It was then the turn of the Dignitas association to present the situation in Switzerland. Claudia Magri, the Dignitas spokesperson, presented the association’s activities, which accounted for some 15% of the assisted suicides in Switzerland in 2021. Then she outlined the legal framework for the practice, and described the different stages involved in an assisted suicide. Following on, Irène Ta, introduced as an “accompanying assistant”, gave a witness account of the unfolding of an assisted suicide, in a soft voice: “The important thing, is to create a space where all who are present feel assured that the procedure will end well. […] We create, and I believe that we succeed practically always, in creating a space for everything to be accomplished in a calm, peaceful and reassuring atmosphere for both the family and the person involved. […] In the end, we often receive comments such as: Thank-you very much! We never imagined that at the end of a day like today, we could feel such gratitude, deliverance and relief.”

Then came the time for questions and answers. One participant asked whether the practicians see the limitations of the legal framework prevailing in their nation. For Corinne Vaysse-Van Oost, apart from the lack of independence of the supervisory commission  identified by the ECHR, and which should be resolved by a new law, the main problem is that the law does not authorise euthanasia of people suffering from dementia, in particular those suffering from Alzheimer’s disease. A few moments later, she stated that this is the main tension which exists with the current law. “We are pushing to extend the law in that direction, but doctors are reticent.” On the question of a possible accompaniment for the carers practising euthanasia, the Belgian doctor replied: “In due course, all doctors and carers will have to face up to the fact that death is part of life and that eventually, we would hope that palliative care should disappear such that all carers could be trained in the “accompaniment for the end of life.” She continued by wishing that nobody should “cry out in dismay” when a person claims to be fed up with life because they are 90 years old and blind and deaf…We are however a far cry from the “intolerable suffering” situation resulting from a “serious and incurable condition” which is engraved in the law.

It is astonishing, that when describing the end-of-life arrangements abroad, only such militant personalities were invited to speak, who presented an unambiguous appraisal of the practice of euthanasia and assisted suicide. This is all the more surprising inasmuch as the President of the Citizens’ Convention governance committee, Claire Thoury, introduced the round table by underlining that the objective was “to provide as factual as possible a presentation of what is happening in those nations.” How can one remain factual when personally practising euthanasia or assisted suicide?

One might also wonder, as did one of the pairs of reporters, why the organisers failed to invite to the round table any representative from a third nation which has followed a different legal route. Claire Thoury claimed in introduction a lack of time…We shall see in January whether another foreign experience will be presented as announced. We shall also see whether the citizen members of the Convention will be able to hear other accounts from Belgium or Switzerland, from patients and their families, or, in Belgium, from carers who accompany their patients differently, for example.

As laudable as the declared intentions of neutrality and equilibrium may be, one gets the impression, in the aftermath of this first session, that the organisers have not really complied with those instructions…which risks discrediting the Convention.