“Active assistance in dying is primarily a debate between healthy people”
Minister of Solidarity and Health from 2017 to 2020, Agnès Buzyn speaks for the first time in the national debate on the end of life launched by Emmanuel Macron in September 2022. Professor of medicine, the former hematologist now adviser master at the Court of Auditors suggests changing the Claeys-Leonetti law of 2016 only for people with neurodegenerative diseases.
How do you view the national debate on the end of life?
On topics like this, for everyone to form an opinion, we must not fall into useless and dangerous polemics, and I know this all the more since I was Minister of Health. If I express myself today, it is through my professional practice. And if I feel a certain caution about active assistance in dying, it is primarily because of my experience as a caregiver… Faced with cancerous diseases, I have noticed in twenty years of practice that more patients closer to death, the less they ask to die and the more they ask that we find a treatment that can relieve them and prolong their life. Unfortunately, I have seen hundreds of people at the end of their lives. I don’t remember any sick people asking me to die.
I gradually acquired the conviction that this question of the freedom of the moment of death essentially arises when one is not faced with death. It occurs when you are still in good health and you want to keep this freedom to choose your destiny, when you aspire to be in control of your life, and your end of life. The debate on active assistance in dying is, in my view, primarily a debate between healthy people.
What do you think of the application of the Claeys-Leonetti law today?
It is insufficiently applied due to the lack of enough caregivers able to implement it. Priority should be given to training them in pain relief and expanding the teaching of palliative care. Since there is a lack of doctors in France, thought should be given to the possibility of training in palliative care nurses with “advanced practice” qualifications, so that they can act without a doctor necessarily being present.
The application of the Claeys-Leonetti law [qui permet la sédation profonde et continue jusqu’au décès uniquement pour les malades qui vont mourir dans un délai court] is also heterogeneous. This law actually triggers sedation at different times during treatment. In some teams, it is implemented extremely strictly. In other words, deep and continuous sedation until death is offered as a last resort, only to people in pre-mortem situations.
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