In France, everything is political, even death. One might think that President Emmanuel Macron has enough problems to solve without opening the moral and political Pandora’s Box of euthanasia and/or “assisted suicide”.
During the presidential election campaign earlier this year, Macron promised new legislation on the subject. On Monday, he announced that a Citizen’s Convention will be created next month to report by the end of March on a possible new End of Life law – the fifth on the subject in France in 24 years – by the end of 2023.
The President’s announcement produced an immediate volley of abuse from his political opponents, Left and Right.
Macron was, they said, desperately looking for some kind of legislative monument to his time in the Elysée Palace. He was trying to distract attention from the crisis which threatens the French health service this winter.
A comprehensive law on the End of Life was passed only six years ago, they said. It was still poorly understood by the public and patchily applied. Why now? Why change the law again so soon?
Macron’s timing was forced partly by an independent report, published on Tuesday by France’s principal watchdog on medical ethics, the Comité consultatif national d’éthique (CCNE). The 40 strong committee – with eight dissenting voices – recommended, with many qualifying adjective and clauses, that French law on Life and Death should be revisited yet again.
Forgive me if I go into some detail. It’s a tricky subject.
The existing French law from 2016, the Claeys-Leonetti law, forbids both euthanasia (a deliberate act by a medical practitioner to shorten life) and assisted suicide (the provision of drugs by medical staff to allow a suffering patient to take his or her own life).
The law does, however, state that terminally ill patients have a right to “sleep before they die, so as not to suffer”. Anyone with only a short time to live has a right to “deep sedation until death”.
Tuesday’s majority report by the medical ethical watchdog said that this six-year-old law was no longer in line with advances in medicine and society. Permanent sedation was not suitable for people who might survive for many months.
“Respect for the right to life should not oblige people to endure lives that they find intolerable,” the ethics committee concluded. “There is no obligation to live.”
It suggested that France should consider going further down the legal road – or various roads – already taken by Switzerland, Belgium and the state of Oregon in the United States.
Consideration should be given, with many legal and ethical safeguards, to allow “access to assisted suicide” for “adults with grave and incurable illness producing great suffering” who are expected to die in the “medium term”.
“Euthanasia” – a deliberate act by a qualified doctor – should also be considered for suffering patients who are too physically or mentally incapacitated to end their own lives. A statement authorising such an act would have to be signed while the patient was still able to do so. In such cases, a final decision would be made by a judge.
If followed, these cautious recommendations would make French “End of Life” law amongst the most liberal in the world – but not quite so liberal as in Belgium or in Switzerland. The Franco-Swiss film director Jean-Luc Godard, who died this week aged 91, is reported to have taken advantage of the legal Swiss right to assisted suicide.
The proposals by the ethics watchdog and Macron’s Citizen’s Convention will doubtless be muddled and misrepresented in the months ahead. Life and Death, and the frontier between them, are difficult subjects at the best of times – open to both honest confusion and deliberate falsification
All the more reason, you might think, to leave such issues alone, if you are a President without a majority in the National Assembly and a traffic-jam of other more pressing problems to address.
In a briefing with Elysée correspondents on Monday, President Macron said that he was “convinced” that it was time to act because “inhumane situations” still existed. He said he had no ready-made answers to questions which were “anything but easy” .
In March, Macron praised the existing Belgian law which allows assisted suicide and euthanasia (even for minors). On Monday, the President said that the Belgian model was “not necessarily the one to follow exactly”.
He said that he hoped that the citizens’ convention would come up with a “text” which could go to parliament for amendment and maybe to a referendum by the end of next year.
One of the strongest arguments against a new law is that France has not yet properly absorbed the existing one. The 2016 law insists that all patients near the end of life have a right to permanent relief from suffering.
And yet France has yet to create the medical capacity to make that possible. Palliative care remains a poor relation in the French health service. The Inspectorate general of Social Services reported recently that 62 percent – almost two in three – of dying patients in France do not get the end-of-life care that the law prescribes.
The medical ethics committee’s report this week said that there should be NO change in the law until palliative care in France offered the terminally ill the means of dying in peace and dignity without suicide.
On the other hand, many people who have lost an elderly loved-one to a prolonged illness (me included) know that there is sometimes a well-meaning hypocrisy or deliberate grey zone in palliative care. The difference between “deep sedation” and euthanasia, between sleep and death, is often mercifully indistinct.
Maybe it is best left that way; or maybe people should be given some control over their final days. It is a horribly difficult question. President Macron is perhaps right to raise it again.
But please, please spare us a referendum. The subject is far too complex and emotive for a referendum, which would generate an avalanche of conspiracy-mongering and Macron-hating nonsense on the internet. If anyone decides to change the law (again), it should be parliament.