End of life: what are the conditions for accessing assisted dying?

The end-of-life bill has finally been clarified by Emmanuel Macron and must be examined by Parliament from May.

End of life: what are the conditions for accessing assisted dying?

The end-of-life bill has finally been clarified by Emmanuel Macron and must be examined by Parliament from May. The announced measures are already causing reactions, but what does the text provide?

The outlines of the end-of-life bill have finally been revealed by Emmanuel Macron. The text which was promised for 2023, will finally be presented to the Council of Ministers at the beginning of April 2024 and will be studied in Parliament from May 27, indicated the Prime Minister on other dates in the calendar, nor given a horizon for the adoption of the text in his interview for Libération and La Croix: "On a text which raises such issues, we are not asking for urgency, there will be no accelerated procedure."

The President of the Republic, however, presented a well-crafted “fraternity law” which provides for “assisted death”. Emmanuel Macron insisted on differentiating the measure he is proposing from euthanasia which "designates the act of ending someone's life, with or even without their consent" or from assisted suicide "which corresponds to free and unconditional choice of a person to dispose of his life". “We had to go further, by demonstrating ethical standards” underlined the President of the Republic on euthanasia in certain cases.

Assisted dying can only be offered to adults as recommended by the Citizens' Convention on the end of life in its conclusions delivered on April 2, 2023 as well as the National Consultative Ethics Committee in September 2022. Several others Conditions concerning the patient's state of health will determine access to assisted dying. Patients must therefore be capable of “full and complete discernment”, which will deprive people suffering from psychiatric or neurodegenerative illnesses such as Alzheimer’s from assisted dying. They must be affected by an incurable illness, have a life-threatening prognosis in the short or medium term and present psychological and/or physical suffering that is impossible to relieve.

But the meeting of all these conditions will not guarantee that a patient will be able to resort to assisted suicide. He may request it, but the decision will be made by a medical team “collectively and transparently”. To ensure the patient's determination, a period of two days will be necessary before their request is studied, then the response from the medical team must be delivered "within a maximum of fifteen days".

A favorable response from doctors will allow the patient to benefit from assistance in dying within three months, after which a new request will be necessary. Even once the prescription has been made, the patient will be free “to withdraw at any time” specified the Head of State. In the event of an unfavorable opinion, the patient may consult another medical team or “proceed with appeals”.

After a favorable opinion from a medical team, a lethal substance will be prescribed to the patient who will be able to administer it himself, a situation close to assisted suicide. If, and only if, the patient "is not physically able to carry out" the assisted suicide, he may be helped by a third party, whether it is the "doctor or the nurse who accompanies him" or a “volunteer person designated by them when no technical constraint prevents this”, according to the bill. A scenario comparable to euthanasia carried out with the consent of the patient. The administration of the lethal product may take place at home, in a health establishment or in an Ephad.

The end-of-life bill includes a part on assisted dying, which must be the last resort, and a part on supportive and palliative care which must not be forgotten according to Emmanuel Macron. “We are going to put palliative care back at the heart of support even before the law is promulgated” he promised. A ten-year strategy for the development of palliative care must be presented by the end of March. While 1.6 billion euros is currently devoted to supportive care, “we are going to invest 1 billion more” declared the head of state.

“What is important is that, from the diagnosis and the start of treatment, the pain is taken care of and human support intervenes. For this, we must continue to deploy mobile teams which help hospital services to better take charge of the pain” indicated Emmanuel Macron. Palliative care must also be developed in pediatric services for children who will not be eligible for assistance in dying, whatever their state of health: “It is essential to improve the management of infant pain and children."

Strengthening palliative care must also involve the establishment of a “continuum with community medicine” and investment in “home support supported by care networks”. For this, “support homes which are the missing link between the hospital and the home” are being planned. Above all, the Head of State promises to provide palliative care units to the 21 departments which still lack them.