End of life and euthanasia: Breakdown of the consensus in the French Senate (decryption)
Through a solemn vote, the senators approved at its first reading, the bill to provide equal access for all to accompaniment and palliative care and rejected the bill for “assistance in dying” amidst great confusion.
Several senators and observers regretted the fact that the bill on administered death was examined before the examination of the text intended to reinforce access to palliative care, which was relegated to second level despite its priority need.
The bill on “medical assistance in dying” emptied of its substance
The text debated by the senators was that amended by the Senate social affairs commission. The reporters submitted a text which aimed at “compromise” and opened the door to administered death in the event of life expectancy being threatened in the short term. The decryption by Alliance VITA of this text revealed a hazardous confusion between euthanasia and deep and continuous sedation until death. Moreover, although the text was presented as being restrictive, it in fact sanctioned death provoked intentionally as a response to suffering, thus contributing to distort the very meaning of care.
This confusing posture gave rise to a dramatic turn of events during the examination session:
- The senators first of all deleted article 4 which established the conditions for access to assisted suicide and euthanasia by 144 votes for and 123 against. The vote was the fruit of a convergence of opposite opinions: some opposed to the very principle of administered death, others on the other hand seeking a return to the conditions previously established by the General Assembly.
- They then redefined article 2 which established “Medical assistance in dying” by assisted suicide and euthanasia. This central article of the proposed bill stated: “At the request of a person satisfying the conditions mentioned at article L. 1111-12-2 to avoid suffering as well as unreasonable therapeutic obstinacy, a doctor may prescribe a lethal substance such that the person can self-administer it or, if he/she is physically unable to do so, may have it administered by a doctor or a nurse”. This passage was deleted by the senators and replaced by: “Any person has a right to the best possible relief of pain and suffering. Any person may enjoy such right until death without any intervention intended to cause death or to provide assistance in dying. In the event of refractory suffering such as mentioned in article L. 1110-5-2, the doctor has an obligation, with the consent of the person, to implement appropriate available means, in the context of the acquired scientific data, even if such means are liable to diminish awareness or to shorten life, insofar as their exclusive objective is the relief of suffering. Such right is enforceable and constitutes one of the components of the right to the relief of suffering mentioned in articles L. 1110-5 and L. 1110-5-2.”
The text was thus emptied of its substance. However, the senators retained articles 11, 14,15, 16, 17 which referred to “medical assistance for suicide”. The final text was therefore partially incoherent even if the debates provided the benefit of confirming that there was far from consensus on the idea of legalising the administration of death.
The bill on palliative care was easily adopted
The text on palliative care was adopted by a resounding majority with 307 votes for, 17 against and 17 abstentions, thus maintaining the majority of the provisions adopted by the National Assembly on first reading. The creation of “Accompaniment and palliative care homes” was confirmed by the senators. These would be intermediate establishments between home and hospitals.
They “are intended to accommodate and accompany those in need of palliative care which cannot be provided at home and not requiring treatment in a palliative care unit. Moreover, they can accommodate those needing palliative care as a relief for their close relatives. They also provide accompaniment for assisting and mourning relatives.”
The Senate included paediatric palliative care in the missions for the new territorial organisations.
Two measures were deleted by the Senate, and they are to be re-examined by the National Assembly at the second reading:
- An enforceable right to palliative care. The senators considered that such a measure would lead to mere financial sentences against the State whilst missing the main objective of truly influencing the improvement of access to palliative care.
- The call for the government to establish a multiple-year programming law to ensure and preserve the means to be allocated to the development of palliative care. Even if such measure may seem symbolic, the provisions in the law will only be applicable if the human and financial means are ensured and secured by a programming law at the initiative of the government.
The debates at the National Assembly as well as the Senate have shown a broad consensus on the development of palliative care, in stark contrast with the divisions which would be generated by the legalisation of assisted suicide and euthanasia.
Dangerous acceleration of the legislative process
The government has chosen to accelerate the parliamentary calendar by scheduling the second reading by the National Assembly of the proposed bill on so-called “assistance in dying” by assisted suicide and euthanasia. In our present fractured society, the priority should be to encourage appeasement.
However, the debates in the Senate have revealed the absence of political consensus, as indicated by the dissensions which exist within society on the subject. Recent opinion polls have shown that the French public are concerned about the impact of euthanasia on the most fragile and that a vast majority expect politicians to give priority to care and a health system operating properly.
Alliance VITA calls upon the government to suspend the debate on euthanasia and assisted suicide and to assign priority to care, in particular through a programming law for the development of palliative care. It is calling on MPs to oppose any form of assisted suicide and euthanasia and to vote for the reinforcement of palliative care.
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