French President François Hollande approved a report on Friday recommending that terminally ill patients should have a right to “deep continuous sedation,” prompting an announcement that the text will be submitted to Parliament by January.
While stopping short of explicit legalization of euthanasia by lethal injection or of assisted suicide, the report recommends that at a patient’s request, or following his advance directive should he not be capable of expressing his will, treatments shall be stopped and sufficient sedatives and painkillers be administered in order to ensure he loses consciousness up to his death.
Critics note that this is equivalent to “slow euthanasia” or deliberate administration of programmed death, as the procedure is not reserved to those situations of acute, untreatable pain and intolerable death throws in which heavy sedation is already legal. Such a procedure is administered at the very end of life in many French hospitals, not to kill but to alleviate suffering.
The report was authored on request from François Hollande by two members of the French National Assembly: Alain Claeys, of the ruling socialist party, and Jean Leonetti, of the opposition UMP, who is also the author of the current “end of life” legislation supported unanimously by the legislature in 2005. The Leonetti Law, as it is called, already – albeit discreetly – provides for slow euthanasia insofar as it allows the pulling of feeding and hydrating tubes on persons who are not terminally ill, in order to cause death. The draft law written by Leonetti and Claeys would institutionalize the sedative procedure, extend its scope and turn it into a “patient’s right” that could be opposed to the medical team.
Leonetti and Claeys speak of a “long march towards total citizenship” which would benefit all patients “up to the last moment of their lives,” respecting their “autonomy” and their “right to decide.”
This is a direct translation of François Hollande’s promise, during his electoral campaign, that he would “propose that every adult person at an advanced or terminal stage of incurable illness, causing unbearable physical or mental suffering that cannot be appeased, should be able to demand, under precise and strictly defined circumstances, the benefit of medical assistance in order to end his life in dignity.”
That the two lawmakers should have avoided advocating “obvious” euthanasia is perhaps a sign that French approval of it is less widespread than opinion polls would suggest: the latest poll conducted by the IFOP institute in October quoted 96 percent of the French as being in favor of doctors “putting an end, without suffering, to the lives of persons with an unbearable and incurable illness if they so wish.”
The suggestion is also in line with increasing resort to the procedure even in countries where euthanasia is legal, such as the Netherlands and Belgium where “palliative,” “deep,” or “terminal” sedation are blurring the frontiers between care and killing.
According to Leonetti and Claeys, under the new law they hope to have adopted under François Hollande’s patronage in cross-party vote, terminal sedation should be available to all persons in the final stages of illness whose life is threatened at very short term, in application of the right to a “dignified and appeased” death. They quote the guarantee of obtaining “complete alteration of conscience,” a deep sleep to avoid “all suffering, including that which results from ‘seeing oneself die’.”
But the draft law is also aimed at deeply handicapped or ill persons who judge that any treatment they are receiving is “uselessly prolonging life,” either because they are “disproportionately heavy” or have lasted “too long.” In this case stopping treatment – such as pulling feeding and hydration tubes – would provoke the passage into the “terminal stage” of illness and the patient would have a right to terminal sedation up to death.
The report explicitly refers to patients in a “permanent vegetative state” and those who are “minimally conscious” as having the right to terminal sedation, either because they asked for it in their “living will” or advance directive, or because their designated representative says they would have wanted it, or because doctors, in a “collegiate decision,” judge ongoing care to equate with “unreasonable obstinacy.”
These decisions would be taken in the context of explicit prohibition of “unreasonable obstinacy” imposed on doctors by law.
In all cases, terminal sedation would go together with the cessation of all treatments – such as antibiotics, anti-coagulants, but also nourishment and hydration – making clear that its objective is to obtain death within days.
Proponents of direct euthanasia are disappointed by the Leonetti-Claeys proposal but the greater part of the French political scene has voiced its approval, saying it avoids euthanasia.
Pro-life groups such as the Fondation Jérôme Lejeune have warned that terminal sedation, insofar as it “consists in administering an anesthetic painkiller in full knowledge that it will lead to death, is an act of euthanasia.”