The Academy of Medicine published a controversial advice on 13th July 2023 on the end of life, concluding with a conditional authorisation for assisted suicide. A member of its ethics committee denounced forcing through its acceptance and claimed the invalidity of any such vote.
The controversy is twofold in both its content and its form.
Breakaway from the professional code of ethics
Under the title “To favour a dignified and pacified end of life: responding to inhuman suffering and protecting the most vulnerable”, the ethics committee of the Academy of Medicine wished to express an opinion in order to contribute to the debate in the event that the “legislator should accept active assistance on dying”.
After recalling that “the duty of respect for human life and not to abandon the most fragile is an essential pillar for life in society, the authors recognise that the current law is adequate for those people whose life expectancy is threatened short-term. The advice then proceeds to deploy arguments to exclude euthanasia which is a transgression of the Hippocratic oath “I shall never cause death”, transcribed in the professional code of ethics.
The thinking concerns essentially assistance for suicide, and its potential legalisation in order to “abbreviate the suffering of a hopeless existence” in cases where life expectancy is threatened in the medium term. These situations are not clearly explained. Paradoxically, it is stressed that “the persons concerned (seriously ill, handicapped, and their family circles etc.) are less convinced and aim primarily for better accompaniment” rather than the “active assistance in dying” expressed in opinion polls.
Several dangers are highlighted:
- For patients, the very nature of the request, a call for help or a real wish to die and the persistence of the territorial inequality of access to palliative care.
- For society, to have to accept to cause death and in particular to transfer to carers an act which most of them do not wish to perform.
- For those suffering from handicap: “Breaching the boundary of suicide assistance is a breakaway and a transgression which goes against our normal conception for solidarity and respect for life”. The academics insist on the violence which may be felt by the handicapped to “no longer be authorised to live”. Quoting the call by the Soulager mais pas tuer (relieve without killing) collective, and the statements by the president of Poyhandicap, the advice underlines the duty to protect such people as well as those who suffer from impaired discernment.
In order to counter such dangers, the authors propose supervision of the suicide assistance which would be akin to that operating in Oregon where the doctor prescribes the product but without administering it, following a collegial evaluation “after a request by the person who is capable of discernment and benefiting from palliative care”. This excludes psychiatric disorders, depressive states, loss of discernment, and minors. In their opinion, that would be the lesser evil, “the term “assistance” signifying close accompaniment and relief for the person enduring an existence without hope, through an approach which is respectful of any hesitations on whether or not to go through with the request”.
The fact that certain eminent members of the Academy of Medicine propose to abdicate any relief for certain patients by causing their death and to exclude them from suicide prevention is of particular concern. In complete contradiction with the appeal by professional psychiatrists, psychoanalysts and psychologists published on 7th July, which recalled that “the prohibition from participating closely or indirectly in causing death guarantees the security of relationships and fosters inventiveness and imagination”.
It is also regrettable that the Academy of Medicine should feel obliged to imagine the legalisation by the government of “active assistance in dying” as an inevitability which one must accept. Could one imagine that same Academy debating on the conditions for removal of the death penalty if the government so decided ?
Suspicion on the invalidity of the vote
One of the members of the ethics committee has however just challenged what was presented as a majority vote on the 27th June by 60 votes for, 24 votes against and 10 abstentions. Professor Patrice Queneau has denounced the conditions of the debate on the matter which was not subject to an entire session and was presented at the same time as two other reports and other communications, all this prior to the suspension of the work by the Academy for their summer recess.
Professor Queneau explains the confusion which prevailed at the moment of the vote: it was proposed that the text should be modified. According to him, the agreement voted for was to introduce modifications to the text and not the advice as such.
This gives cause to reconsider the true validity of the advice.