“Assistance in Dying” bill: What should one think about the government amendments ?
What should one think about the amendments by the government on the Falorni “Assistance in dying” bill: Do they make the text less dangerous or are these “improvements” mere illusions?
The text, provided by the Committee on Social Affairs, under discussion during the public session at the National Assembly contains many dangerous provisions.
Firstly, the legalisation governing assisted suicide and euthanasia disguised behind the term “assistance in dying”, leads to alarming discriminations by suggesting that certain lives are worthy of eradication rather than being accompanied and given relief. Lifting the prohibition against killing constitutes a major medical and social regression which will destabilise the relationship of trust between medical staff and patients and will ruin the universality of suicide prevention.
As already stated by Alliance VITA, the unanimous demand by the French public is for access to care, whereas our nation is confronting a severe crisis in the health system.
Finally, the criteria adopted, which are widely qualified as “strict” are in reality subject to numerous interpretations. For example, what is meant by “advanced phase” when applied to a disease? The HAS (High Authority for Health) has underlined the impossibility in practice of achieving a medical consensus on the temporal evaluation of the occurrence of death. Additionally, the personal evaluation by the patient of his/her degree of suffering is registered at the very core of the criteria, including in the event of refusing treatment. The patient must: “Be subject to physical or psychological suffering linked to the disease, which is either refractory to treatments, or unbearable according to the patient when the latter chooses not to receive or to terminate receiving treatment.
The government therefore submitted several amendments aimed at a “better equilibrium”.
The expression “better equilibrium” is a rhetoric which is regularly used in bioethical debates. Thus, in 2021 during the debates on the bioethics law, known as “ART for all” the Prime Minister of the time called for “preserving the equilibria” of the bill with respect to the demand for aneuploid pre-implantation diagnoses (PID-A), the posture consisting in promoting so-called “advances” whilst accommodating oppositions. The expression, basically, refers to the play of forces between supporters and opponents. The approach is the same today: the government is not aiming for an ethical equilibrium, but rather a political equilibrium. The amendments examined here deal with the content of the text, setting aside certain amendments to the form or legislative procedure.
The first amendment deals with the choice of “method”: euthanasia or assisted suicide in article 2.
The government has called for the re-establishment of the priority for assisted suicide. Euthanasia will only be possible if the person “is physically incapable of proceeding“. Olivier Falorni, the reporter supports “freedom of choice” for the method. Conversely, MP Agnès Firmin Le Bodo, who as minister submitted the law in 2024, considered that the choice of method was “a break point for the equilibrium of the text”, and recalled the opposition of many carers for taking part in such a procedure. Catherine Vautrin, the minister, when presenting the amendment, underlined that “the position of the government, is to say: the principle, is self-administration, the exception being accompanied“.
The amendment was adopted by the MPs.
The second amendment deals with article 6, which defines the procedure to be followed by the doctor processing the request by a patient for “assistance in dying”.
The amendment adds that the doctor “if there is a serious doubt concerning the discernment of the person, must call for the advice of “a psychiatrist or neurologist (…) who is not habitually involved with the person. That doctor has access to the person’s medical file and examines it before returning his/her advice“. The government thus intends “to provide additional guarantees for the procedure by ensuring that, in the event of serious doubt on the discernment of the person, the doctor, in the context of a collegial procedure, will consult with a psychiatrist or a neurologist”. The intention is laudable. The device however is non obligatory, and is dependent on the goodwill of the doctor dealing with the request. How can one reliably determine whether there is serious doubt on the discernment of the person? No criterion, or restriction is established, and checking will no doubt be difficult. Finally, the amendment does not require that the advice of the specialist be followed by the doctor, in the event of a difference of opinion.
The third amendment also deal with a provision of article 6: the specified time between the decision by the doctor and the execution of the lethal act.
The text under discussion specifies a two-day interval, “however, that interval may be shortened at the request of the person if the doctor considers that it is appropriate in order to preserve the dignity of the latter as he/she feels”. The amendment simply calls for deletion of this provision because “the decision is sufficiently crucial for an incompressible cooling off period to be implemented”. In effect, a two-day interval is virtually absurd. In comparison, the law establishes an incompressible cooling off period of two weeks following an estimate for plastic surgery.
The fourth amendment deals with article 7.
At article 7, the laws Commission establishes that if the patient chooses a date in excess of 1 year after the decision to proceed with the administration of the lethal dose, at the approach of the date, the doctor “must re-evaluate, the free and enlightened nature of the expression of the will of the person”. The government seeks to reduce the time limit to 3 months: “This 3-month interval appears appropriate to the situation of the people concerned, in an advanced or terminal phase of a serious disease, whose condition may evolve rapidly. It ensures, at a moment close to the act, that the central condition of the procedure – namely the free, enlightened and persistent will of the patient – is indeed still satisfied“. Statements by carers closely involved with patients at their end of life are consensual: Requests to die are fluctuating, often on a daily basis, and crucially are dependent on the quality of care provided to patients. This practical feedback is in any case hidden by the text under debate and this amendment.
In a form of tacit approval, the government has not submitted any amendments on other dangerous provisions of the text:
- Family and friends remain excluded from the decision
- Only doctors and nurses have any rights through a conscience clause
- Checks are only conducted after the event
- The “Obstruction offence” (article 17) is defined very loosely as “moral or psychological pressure” on the patients concerned. As stated in the “Psychos appeal” such an offence “is liable to criminalize the professionals (doctors, psychologists, carers) and friends and family who might attempt to propose alternatives or to dissuade a patient from resorting to euthanasia, including with a view to suicide prevention”.
A door is either open or closed. Whether half-open or ajar, the risk of intrusion is approximately the same. The government amendments aim for an equilibrium which is impossible to maintain as soon as the prohibition against killing is lifted. In fact, the logic remains: Accepting assisted suicide and euthanasia for certain categories of patients, no matter if – as is already seen in foreign states – this leads to discrimination in care.
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