“The debate on the end of life comes down to questioning what treatment means”

“The debate on the end of life comes down to questioning what treatment means”

Régis Aubry, member of the National Ethics Advisory Committee, in Paris, September 13, 2022.

Professor Régis Aubry is co-rapporteur of the opinion of the National Consultative Ethics Committee (CCNE) which, in September 2022, paved the way, with caution, for the legalization of active assistance in dying, under strict conditions.

The debate on the “end of life” has aroused many reactions among associations, learned societies, healthcare organisations, etc. And the collective calls for caution resonate strongly. Does this surprise you?

On the contrary, it is very healthy for health professionals to question themselves and be vigilant. The debate on the end of life, as it has been opened, amounts to questioning what care means. Behind the general question of active assistance in dying, two questions are posed: can the act of care go as far as administering a lethal product to a patient? And can the act of caring go so far as to accompany a patient in his suicide?

I don’t have many doubts about the second approach: when someone formulates a request for assisted suicide, not exploring it, not listening to it, would be for me the opposite of care. On the other hand, it seems to me quite normal that the fact of administering a lethal product, in other words, of intervening oneself in the death of others, raises questions. This runs counter to the principles of palliative care. The fact of not killing is enshrined in the Hippocratic oath.

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Do we have a survey, an overall picture of the positioning of caregivers?

To my knowledge, there is no exhaustive quantitative data, nor any work of a sociological nature which would aim to meet health professionals in their particular approach to the end of life. Currents of opinion are expressed; we read or hear positions taken, forums or petitions.

The few works that have focused on the practice of euthanasia, among our neighbors who have decriminalized it, have shown that it is an ambiguous act, which weighs on the psychological and emotional level. Caregivers can perform one or two euthanasias in the year. Plus, it gets complicated. This feedback reinforces the distinction that we make, within the CCNE, between these two forms of active assistance in dying. [euthanasie et aide au suicide].

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Is there, in your opinion, a specificity in the positioning of caregivers compared to the rest of the French? These, if we stick to the polls, are mostly in favor of changing the law…

The French are conceptually in agreement with the idea that one can control one’s end of life, this is what these polls say. I would add that the French people surveyed are not sick. The few research works in which I participated with the National Institute of Demographic Studies, those which we have on nurses and the practice of sedation, show that the more a patient sinks into the disease, the more he tends to change his mind. It is quite easy to talk about end of life “from a distance”. The carer involved necessarily has a different vision from that of another citizen.

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