February 10, 2005

The right to die or the choice to live? (published in Obiter Dicta, Law Society)

On December the first 2004, French legislators passed a bill legalising what they claim to be a "passive" form of euthanasia, with proponents stressing its differences from the practice now permitted in some other European countries. Unlike the situation in the Netherlands and Belgium where doctors aren’t criminally liable for actively ending the life of a patient, the French legislation deals mainly with acts of omission. Described as the "patient's rights" bill, provisions will empower doctors, acting at the request of patients (or a written order to be followed in case they become unconscious) and their families, to end medical treatment that is maintaining the patient’s life artificially.

Under this new law, doctors wouldn’t be penalised for administering – at the request of patients suffering from extreme pain – excessive doses of medication, even if the drugs have a secondary and subsequent effect of hastening death. The bill further seeks to limit ‘unreasonable persistency’ in treating the terminally ill. “When medical acts appear useless, disproportionate or serve no other purpose than the artificial support of life, they can be suspended or not undertaken” said Philippe Douste-Blazy, current French health Minsiter. In the rare event that the patient and the doctor disagree, "the law gives patients the option of appealing to a board made up of other doctors in order to reach a decision".

With 548 votes out of 551 in favour (3 abstentions), the draft bill successfully passed in the National Assembly at the end of last year and will go for a final vote in the Senate before April this year. The French health minister stressed to the deputies earlier that the proposed legislation would not "legalise the right to give death" as he argued that "a humane and dignified death is possible without having to fall back on euthanasia". Jean Leonetti, a centre-right deputy who headed the parliamentary commission responsible for the draft bill, admitted that the part dealing with patients refusing life-sustaining treatment was the most controversial. However, draftsmen included safeguards requiring additional medical consultation and a period of reconsideration by the patient. "The debate was timely because we have been asking ourselves questions about the technical advances of medicine" Leonetti said. "This legislation is one that allows dying but does not allow killing. That is how it is different from euthanasia," argued Leonetti, who visited Belgium and the Netherlands earlier to study their euthanasia laws and their applicability within the medical and social dimensions. It could therefore be contended that what French legislators are trying to achieve is a law that gives patients the right to die over the choice to live.

The euthanasia debate in France gained momentum in September 2003, when the mother and doctor of the 22-year old former fireman, Vincent Humbert, claimed to have “helped him die”. An accident left Vincent a quadriplegic, deaf and unable to speak. His case gained public attention after he wrote to President Jacques Chirac asking him for the right to die. The president responded that he did not have the legal right to do so and instead encouraged him to “regain the ‘taste of life’”. Some may argue that President Chirac’s request was somehow more difficult to achieve than the favour demanded. However, one must understand that these delicate situations should only be perceived subjectively as it may be an extremely difficult –yet achievable- task for a quadriplegic, deaf and mute person to regain an optimistic approach towards life.

Dr Frederic Chaussoy, Humbert's former doctor, admitted disconnecting his patient's life support after the mother Marie Humbert administered a near lethal dose of sedatives. “My true crime was to have admitted in public what many of us [doctors] commit in secret” said Dr Chaussoy, implying that the practice is not uncommon in French hospitals. And it surely is not. The French health Minister, a doctor himself, pledged “an end to the hypocrisy” as he claims that nowadays over “150 000 people are ‘disconnected’ from their machines although there is no legal framework to say how it should be done”. Dr Chaussoy has now been placed under formal investigation over his patient’s death and faces the prospect of a court trial. However, supporters of the Bill denounce his prosecution, and say that it would have been avoided under the new law. They say that the legislation would have enabled Dr Chaussoy to end artificial feeding at M Humbert’s request and give him morphine in the final days of his life.

However, ‘right-to-die’ campaigners say that the Bill does not go far enough. They want France to follow the Netherlands and Belgium, where euthanasia is partially legal, or Switzerland, where doctors can help the terminally ill to commit suicide by procuring lethal medicines for them. Humbert’s mother is among those campaigning for mercy killing to be fully legalised. She said, “Vincent did not want to go slowly, without knowing what was happening to him. He wanted to go at once, on the day he made the decision”. Régis Aubry, chairman of the French Association of Palliative Care, expressly disagrees with the concept of euthanasia as he believes that “there is a fundamental difference between respecting the wishes of someone at the end of their life and the act of helping that person to die”. This conflict of interests between different groups in society makes it extremely difficult for any legal system in a democratic state to legislate on good terms with public policy, especially when the issue is a controversial one.

But how could this law possibly be enacted without causing complications in the criminal law? Well, the French thought it through. Answer: the French penal code will not be modified. The act of ending a person’s life will thus continue to be punishable by law. However, the new law will modify the medical code of ethics and the public health code in order to institute ‘the right to die with dignity’. It is interesting to observe that in a country where 6.5% of the population live below the poverty line no measures are taken to enforce a ‘right to life with dignity’. Although not expressly admitted by legislators, this law would unarguably be of great value economically. From an economic perspective, the monetary cost of an ‘euthanized’ patient would realistically prove to cost considerably less than if the patient were to be kept on artificial life-support. To illustrate this theory, consider the fact that hospitals have limited resources available in a given period of time. It could therefore be suggested that resources that were previously used to maintain patient’s lives artificially could then be redistributed more efficiently towards other patients in greater need.

‘Assisted suicide, mercy killing, euthanasia’ is a controversial issue everywhere in the world, with on the one hand liberals promoting such rights and on the other religious groups loudly disapproving it. However, according to the IFOP, 88% of the French population appear to be in favour of the bill. In England, euthanasia is regarded as murder, a crime that can result in a life sentence, and assisted suicide is punishable by up to 14 years imprisonment. Although it is submitted that the aim of a ‘patient’s rights’ bill is to give more freedom of choice to the patient, it could be argued that there is little choice for a patient facing death. In a moment of despair, the pledge to ‘die sooner’ is actually a cry for help and hope. In my opinion, by accepting euthanasia, one is actually refusing to consider the true demand of a patient: to live!

- One comment Not publicly viewable

  1. A breath-taking article that focusses on the crucial issue of euthanasia… to live or to die?... that is in fact the real question and in this, shall we say masterpiece approach to the subject, written by an author that has taken his masterful craft of being an academician to a far far away level, the question is approached and answered in such a formidable way that it simply takes its arguement into a new realm of cognitive and cerebral level.

    18 Feb 2005, 00:43

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