1. New French 2016 Act for End of Life
Devalois B.1, Broucke M.2, Taounhaer S.1, Puybasset L.3, Morel V.4 1 Service de Médecine Palliative, Centre Hospitalier René Dubos, Pontoise, France, 2 USP, CHU Paris-Sud - APHP, Villejuif, France, 3 Département d'Anesthésie-Réanimation, Hôpital Universitaire Pitié-Salpêtrière- APHP, Paris, France, 4 EMSP, Centre Hospitalo-Universitaire de Rennes, Rennes, France
“Except to dye my hands with your blood, I will do all you ask to me” said Hyllos, to his famous dying father HERACLES in the first known euthanasia demand (in : Women of Trachis, Sophocles). As his dying father asked to him to hasten his death, Hylos agreed with all his father’wishes, except to actively end his life (lightening the pyre to burn him alive as he asked it to him).
Aim and approach: More and more countries adopt End Of Life (EOL) Acts. They concern 3 main axes: Medical Assistance for Dying, Medical Assisted Suicide, and Protection against Unreasonable Obstinacy. In 2016 France adopted a quite different approach than others countries (as Belgium, NL, Quebec and Canada for example). We compare French Act and others countries' acts regarding specifically these 3 axes.
Medical Assistance for Dying (MAD) : Considering benevolence, it's important to release suffering in EOL. For this aim, some countries allow doctors to practice lethal injections on demand (so-called euthanasia in Belgium and MAD in Quebec). On the contrary French Act imposes as a duty for doctors to use analgesics and sedatives at doses enough to relieve suffering, even at the risk to shorten life, but not to induce intentionally death.
Medical Assisted Suicide (MAS) : Considering autonomy, it's important to respect EOL patients' will. Some countries assimilate wishes to die as rights to die. Then, Drs must help patients to die quickly at the time they choose, either using lethal injections (Belgium, Canada after federal Carter's decision) or giving lethal preparation, taken by the patient himself (Swiss, Oregon). On the contrary French Act forced doctors to respect patients' will (including expressed through advance directives). For instance, patients with life sustaining treatment can legally obtain withdrawal and deep & continuous sedation until death occurs.
Protection against Unreasonable Obstinacy (UO) : MAD or MAS demands can be only ways for patients to refuse UO. Paradoxally, countries which legalized lethal injections or others MAS have indeed poor or even no law obligations for prohibiting UO. On the contrary, it's one of the main point of French Act, and Drs can be prosecuted if they practice UO.
In some cases irreversible sedation (deep and continuous sedation until death) : In three cases, French Act gives for EOL patients a right to get a deep and continous sedation until death :
On demand for patients with short prognostic and refractory symptoms
On demand for patient refusing life-sustaining treatments
For unabled-to-decide-for-himself patient if life-sustaining treatments are withholded to avoid unreasonable obstinacy after collegial concertation.
Regarding to French Law it’s clearly not a slow euthanasia (euthanasic sedation) but a right to sleep, and for patient not to suffer waiting death, which can last hours to days with or without sedation.
Conclusion: French Act gave 3 new rights for EOL patients: right not to be submitted to Unreasonable Obstinacy, right to be peaceful when dying even in complex situations needing sedative practice, and right to have their will respected in any cases (excepting lethal injection demands). It also allows in few circumstances to start a deep and continuous sedation until death. This approach is closer to one of fundamental principles of Palliative Care: “Not to prolong and Not to shorten life”.
QR-Code : download French Act text in English version or ask for more details