First of all, please know that the following remarks are deliberately articulated around a Western, European, even French vision of the end of life through the ages and the current political context. If several surveys describe French people as mostly in favor of the legalization of a form of assisted dying, this perspective raises a sensitive debate. It is about the choice of the moment and the way in which a person can die, a death without suffering and surrounded by loved ones who seem to correspond to thearchetypearchetype of a “good” death these days. But this has not always been the case: each era has its own representations, and their perspective allows us to better understand the current political and health situation.
A history of religion, medicine and social sciences
In medieval Christian France, it was the priest who accompanied the end of life. The dying person must be in a sufficient state of consciousness to allow him to receive communion, but must at the same time die with certainty, extreme unction being able to be received only once. Another subtlety: on the one hand, this sacrament is supposed to relieve the sick physically, morally and spiritually, and on the other, suffering is interpreted as a state of rapprochement with Christ and agony as a fight between angelsangels And demonsdemons who decide the paradise or hell that awaits the patient in danger of death.
Euthanasia, assisted suicide, SPCJD: what are the differences? Thibaut Ponamalé takes stock in this episode of Futura Flash. © Futura
In the 19th centurye century, the arrival of medical sciences disrupted this conception centered on religion. From now on, it is the doctor who accompanies the dying, and the suffering is partially alleviated. This goes hand in hand with theemergenceemergence of a form of lying in supporting the dying and their loved ones, in order to avoid confronting complex questions. The dying person is thus doubly unconscious: morally, from the illness affecting him and from the imminence of death, and physically, from the administration of analgesics mainly based on opium. This use of analgesics increased at the beginning of the 20th centurye century, and a new question then arises: is it better to relieve pain, at the risk of shortening life, or to use the tools of modern medicine to prolong it, at the risk of dysthanasia? At the same time, advances in medicine are increasing life expectancy, and chronic illnesses such as cancer are becoming more and more numerous, extending the time of agony, and thus redefining the contours of death.
In the 1960s, the debate around therapeutic relentlessness and the question of euthanasia emerged in Anglo-Saxon countries, by junior healthcare personnel. They report heavily sedated, terminally ill patients who appear to be suffering physically and mentally. From this observation arises a new global vision of pain: palliative care, supposed to address all end-of-life pain without plunging the patient into a passive state, through awareness work. Then came the 1970s, where the human and social sciences wanted to lift the taboo in modern societies around death and its conditions, whose technicality and medicalization have led to a form of dehumanization. This crisis continued in the 1980s, with the use of lytic cocktails: although unadmitted, these practices gave rise to the notions of assisted suicide and passive and active euthanasia.
What Semantics Teach Us About Legislation
These terms, supposed to define and frame death, are regularly used throughout the rest of History. Given the sensitivity of the subject in question, a little semantics is necessary. Let us note in passing that the debate on the end of life is far from being a French specificity: in the other Member States of the European Union, euthanasia also constitutes an important social issue, framed by very varied laws, ranging from total authorization to its criminalization in all circumstances. Let’s see what happens.
Active euthanasia refers to intentionally ending a person’s suffering. A doctor or a third party can inject a substance directly resulting in the death of the patient. This method is, for example, authorized in the Netherlands, Belgium, Luxembourg, Spain and Portugal. Passive, or indirect, euthanasia occurs when the medical team in charge of the patient decides not to take measures to prolong life. Death can occur from drug administration painkillerspainkillers or after disconnection from a respirator. Finally, assisted suicide, or medically assisted suicide, refers to killing oneself with the help of a person who provides a means to do so. The means must, however, be taken by the sick person themselves, otherwise it is active euthanasia.
French law prohibits active euthanasia, however the Leonetti law of April 22, 2005 authorizes a patient, when he judges that the treatment administered to him results from “unreasonable obstinacy”, to refuse said treatment, even if this refusal exposes him to death. The legislation offers this right to medical teams if the patient is unable to express his wishes and continuing treatment no longer makes medical sense. The Claeys-Leonetti law, passed on February 2, 2016, adds the possibility of formulating “advance directives”: a terminally ill patient whose prognosisprognosis vital is engaged in the short term may require deep and continuous sedation until death. This text, which is the last one in force on the subject in France at the moment, ignores patients sentenced in the medium or even long term.
Should the current law be changed?
On September 13, 2022, an opinion from the National Consultative Ethics Committee (CCNE) was published, paving the way for legalization of assisted suicide, provided that palliative care and access to deep sedation are developed. Following this, the first citizens’ convention is launched in December 2022: 185 citizens are drawn at random, their conclusions being used to guide the government. On March 10, 2024, President Emmanuel Macron announced in an interview with The cross And Releasea bill which could be presented to the Council of Ministers in April 2024, with a view to a first reading in the National Assembly on May 27, 2024 according to the words of Prime Minister Gabriel Attal.
This proposal for a “French model of assisted dying” is part of the social reform marking Emmanuel Macron’s second five-year term. It’s about a ” possibility of requesting assistance in dying under certain strict conditions ”, which is based in particular on the development of palliative care, renamed “supportive care” including a “palliative care” sector. As it stands, the text specifies the conditions under which a person can request assistance in dying, emphasizing their capacity for discernment, which takes precedence over the advance directives of the Claeys Leonetti law. “ It is not the patient alone who can decide to end his life », Says Catherine Vautrin, the Minister of Labor, Health and Solidarity, in an interview given on France Inter Tuesday 12 March. She contests the use of the terms “euthanasia” and “assisted suicide” by her opponents, highlighting the pillars of the new law as it stands: explicit request and reappointment of the patient, conditions of state of health, incurability, of gravitygravity and refractory suffering, and finally unanimous agreement from the medical team.
From the evolution of representations of death over time to the dominant conception that the French have of it today, the end of life is above all a personal question, the subjective dimension of which makes it undeniably complex to politicize. .
