Arte mare and medicine
Dr. Mais, geriatrician, featured
As a prologue to the upcoming Arte Mare festival whose theme is medicine, Dr. Patrick Mallais, geriatrician, spoke on “These sick people who govern us”. A timely conference, at the Bastia library, at a time when deputies and senators must examine the future law on the end of life.
Are the leaders of our countries aware of their pathology? If so, how do they and those around them react? Are these great people of this world much better cared for than ordinary citizens? There you have it, two questions formulated by Doctor Mallais. Demanding the best was the attitude of King Baudoin of Belgium. It was bad for him, the pontiff he had chosen had lost his hand… It would have been better for his majesty to have used an intern experienced through his regular practice in the operating room!
As for the rulers and high-ranking officials whose friendly circle detected problems, Doctor Patrick Mallais referred to revealing examples. John Paul II was afflicted with tremors that were impossible to conceal. Parkinson’s disease, his left hand and one of his legs no longer responded. Brain degeneration in Parkinson’s disease can lead to cognitive impairment. The symptoms only can be treated. Well supported medically and with morphine, the Pope could appear in public.
Jacques Chirac had several ailments. Struck by a stroke, he was blind in one eye. He had angiopathy, and was also affected by a dementia pathology with progression over around ten years. In 2005, when his people knew his situation, he was elected President of the Republic. In the Gaullian constitution the head of state takes care of foreign policy and above all it is he who activates the nuclear button. This is where the problem lies!…
Ronald Reagan during these two terms, the first of which began in 1984, suffered from Alzheimer’s. His ability to speak was greatly impoverished by the use of repetitive words. Nancy, his wife, kept an eye on things, but a wife’s power and goodwill have limits.
George W Bush, Jr., had not completely overcome his alcoholism. We could detect the signs of his addiction. Should this be attributed to the invasion of Afghanistan and the American intervention in Iraq?
John F Kennedy suffered from ankylosing spondylitis which causes intense back pain. To overcome them he took a lot of medication and doses of morphine. These medications are attributed with part of the Bay of Pigs disaster… which resulted in a victory for Castro.
Another famous patient is François Mitterrand, whose prostate cancer was made public when he was hospitalized in Cochin. A particularly well-supported president who was given palliative care very early on to curb the negative repercussions of their condition. Conclusions drawn by Doctor Mais: this type of care should be open to all.
Questions about the current law being debated in parliament gave rise to many reflections in the room of the central library of Bastia, where the conference took place. Will this law promote euthanasia? If so, who should administer it? Will it have negative repercussions and further restrict the field of palliative care?
In times of austerity and budgetary restrictions, what will be left to supplement the rather favorable provisions for the extension of palliative care?
What about those who govern us, who are free from disease, yet exhibit problematic and disturbing behaviors?
Michèle Acquaviva-Pache
INTERVIEW WITH DOCTOR PATRICK MÉTAIS
Why did you choose to specialize in geriatrics?
Basically I am an emergency doctor, so I must be able to make a diagnosis in complex situations… like a Doctor House! A geriatrician must establish a special relationship with his patient who he must see as a whole. I unravel the complexity of situations and that takes time.
What are the pathologies that you encounter most often in Corsica, are they different from those that you have observed on the continent?
It is the brain problems that lead to dementia. As Corsica has an increasingly aging population, I encounter many of these cases. Added to this are the people who come to retire here. Dementia is insidious. Those who suffer from it very often don’t realize it, but those around them do. These patients must be accompanied because there are no medications. The role of the doctor is to clearly explain what is happening to caregivers. Brain diseases have repercussions that affect the whole family. On the continent also, the more elderly there are, the more dementia there is, especially after age 95.
What diseases do not disable the leaders who govern us?
Digestive and osteoarthritic pathologies although the heart and organs need a body that functions well. I always notice: there are no worse retirees than those who are eaten up by their sofas! That said, I have met brilliant centenarians who are often marked by unusual historical events.
As for politicians who are diagnosed with serious pathologies during their mandates, should they not resign?
It’s not for me to say. The doctor only has an advisory role.
What are the diseases that impair mental faculties?
All cardiological and neurological diseases because the patient’s blood flow is decreasing. Then come lung diseases for the same reasons… Don’t forget aging in general.
Was François Mitterrand fit to govern despite his cancer?
I haven’t examined it… So I can’t answer… But if we refer to his speeches, to his comments, to these political choices, he was at the helm. He retained his intellectual abilities.
Does the work of the Citizens’ Convention on the end of life seem valid to you?
This Convention of citizens chosen by lot represents an interesting work dynamic. It is a shame that his thoughts were not confronted with the opinions of caregivers: doctors, nurses, caregivers, health technicians, leaders of associations that deal with this type of problem. This would have made it possible to have a broader vision of the field. The palliative care association, which brings together around a hundred doctors, could have contributed the benefits of its experience. Citizens’ convention on the one hand and caregivers on the other could have formulated useful proposals for health policies.
What are the safeguards to ensure that a law on the end of life does not go off the rails?
The Claeys-Leonetti law established safeguards to avoid abuses. The law debated in parliament is, in my opinion, too close to the current provisions in Canada and Belgium, the slippages of which are very worrying. I maintain that causing death is not treatment. The doctor must above all understand why the patient wants to shorten his life and if possible move towards palliative care. Any decision concerning the end of life must be collegial on the part of caregivers. However, in the law currently before parliamentarians, anyone can decide if dying is the solution. The Belgian and Canadian cases are worrying. Assisted suicide in Switzerland involves another philosophy since the patient administers the lethal potion or infusion himself and does so in complete lucidity.
In Corsica can we benefit from palliative care everywhere?
There is a palliative care service in Ajaccio. In Bastia there is follow-up care at the Zuccarelli clinic and a specialized team can intervene at home. But of course these possibilities are insufficient compared to the needs.
What is the role of the doctor in assisted dying provided for in the new law that will be passed?
For the moment none… Not asking our doctors for our opinion is a historic mistake. This is the result of years and years where, for accounting reasons, the numerus clausus was practiced in medical faculties, which reduced the number of doctors. At the same time, prerogatives have been reduced to us professionals. Faced with an increasingly aging population, we need a health policy that is not limited to high technology. Regarding the end of life, the collective vision of the entire healthcare team is essential. As for me, I will not kill and I reject in advance any crime of obstruction that would threaten doctors if they do not want to euthanize their patients.
What do you think of the Church’s reaction to anything that can precipitate the end of life?
End of life is a social problem. All bodies of the nation must be able to intervene on this subject.
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