What does the end-of-life bill presented in the Assembly chamber from this Monday contain?

What does the end-of-life bill presented in the Assembly chamber from this Monday contain?
What does the end-of-life bill presented in the Assembly chamber from this Monday contain?

The end-of-life bill arrives this Monday, May 27 in the Assembly chamber and intends to open up the possibility for certain patients of a “help to die“, but the modifications introduced in committee raise fears even in the executive branch of a loss of “balance“.

To allow time for debates which will combine medical, legal and personal matters, the Assembly has planned two weeks of discussions at first reading. The Minister of Health Catherine Vautrin will open the ball at 4:00 p.m., with the vote to take place on “June 11“, she recalled.

The debates promise to be heated around the eligibility criteria, one of them having been modified in committee. The initial text required one to have a “serious and incurable condition with a life-threatening prognosis in the short or medium term“, to be of legal age, able to express one’s will in a free and informed manner and to present suffering that is refractory to treatment or unbearable.

But the deputies deleted in the special committee the mention of “vital prognosis engaged in the short or medium term“, preferring the notion of affection”in advanced or terminal phase“. A change approved by the Association for the Right to Die with Dignity (ADMD) and the general rapporteur Olivier Falorni (MoDem group), for whom the notion of medium term “was inoperative“.

She “risked leaving aside a certain number of patients, particularly those suffering from neurodegenerative diseases“, argued this historic defender of assisted dying in L’Opinion. Attached to the “balance” of the initial text, Catherine Vautrin warned in Le Figaro that the government would seek to return to the initial version.

The notion of ‘advanced phase‘” East “used in oncology, but does not make it possible to describe the diversity of pathologies, and it is unsafe for doctors“, she argued. “This can lead to the inclusion of many non-fatal pathologies that fall outside the philosophy of the text.“, added Prime Minister Gabriel Attal in La Tribune Sundaycalling for “guarantee its balance“.

“Shattered”

The modification is tense in the majority as in the opposition. “The original balance (…) has been disrupted“, denounced Agnès Firmin-Le Bodo, Horizons MP and former Minister of Health who participated in the birth of the text. “The president’s commitment to creating a balancing law has been shattered“, denounces LR deputy Philippe Juvin to AFP. Some LR colleagues “continue to support” the text, but others could swing towards a vote against, he warns.

And the question goes beyond traditional divisions. Most of the support for the text should come from the left and the presidential camp, but certain deputies on the left, in MoDem and in Renaissance have tabled amendments to eliminate assisted dying, like elected LR and RN officials. .

The debates should also clarify the question of advance directives. The deputies provided in committee that the patient could specify a “type of support for assisted dying“, in the event that he loses”consciousness irreversibly“.

However, the text specifies elsewhere that the patient must be “able to express one’s will in a free and informed manner“.”The patient must always confirm his or her free and informed wishes at all stages of the procedure.“, affirms Catherine Vautrin, faced with the confusion caused.

The administration of the lethal substance also raises questions. The text provided that patients administer it themselves, except those unable to do so. But an amendment from Cécile Rilhac (related to Renaissance) opens up the possibility of freely choosing to delegate this gesture to a third party.

The Catholic Church and the Protestant Federation of France deplored the developments in committee and a group of healthcare organizations estimated that “Pandora’s box (was) open“. The text is not “absolutely not unbalanced“replied Mr. Falorni.

The other major aspect concerns palliative care, the strengthening of which is requested on all benches. Thomas Ménage (RN) said he was ready in committee to vote on the text provided that assistance in dying is not “a stopgap” for lack of “effective palliative care“.

The government having ruled out any accelerated procedure, examination of the text could last until the summer of 2025, or even longer.

4 key points from the debates in the Assembly

Beyond the face-to-face between adversaries and supporters of “assisted dying“, the bill on the end of life promises intense debates in the Assembly, around the criteria for access to the system, advance directives or even the role of third parties. Some 3,300 amendments have been tabled for the first reading examination which starts Monday in the hemicycle, for two weeks.

Some deputies want to broaden the scope of the government text, others to restrict it. Examination of the text in committee has already resulted in a change in several key points, extending the number of potential beneficiaries.

“Committed vital prognosis”

To have access to “assisted dying“, several cumulative conditions are set. In particular, you must be of age, a criterion that some deputies question, some pleading for a threshold of 13 or 15 years. You must also have a “serious and incurable condition in advanced or terminal phase“, according to the text adopted in committee, with the support of general rapporteur Olivier Falorni (member of the MoDem group).

But the government tabled an amendment to return to the initial version, according to which the person must suffer from a “serious and incurable condition with a life-threatening prognosis in the short or medium term“.

Without precision and in the medical sense, the ‘advanced phase’ is too broad. This would amount to integrating inflammatory diseases (severe progressive rheumatoid arthritis for example) and a number of neurodegenerative diseases (for example the so-called ‘advanced’ stage of Parkinson’s disease or the late (or advanced) stage of multiple sclerosis“, justifies the government in the explanatory memorandum. Mr. Falorni points out the “great difficulty in establishing what the medium term is“.

On the left, deputies want to clarify that the serious and incurable condition from which the person suffers is not necessarily pathological in nature, but can have an accidental origin. On the other side of the spectrum, deputies propose limiting themselves to patients in phase “terminal“.

Advance directives and discernment

Another condition: the sick must be “able to express their will in a free and informed manner“. But when? Deputies from the left and from the presidential camp are asking to add the possibility for a patient who has lost his judgment to benefit from a “help to die“, if he has formalized this wish beforehand in advance directives.

A person suffering from Alzheimer’s disease could request access to it.for example when they no longer recognize their children“, argues environmentalist MP Sandrine Rousseau.

Conversely, some want to tighten the guarantees around discernment. LR deputies want there to always be the opinion of a psychiatrist before a medical green light for a request for “help to die“, or that there is a recording of the request before a judge.

An amendment adopted in committee provides that the patient can specify in his instructions the “type of support for assisted dying“desired in the event that he loses”consciousness irreversibly“. The government wants to remove this addition during the session.

Doctors too lonely?

In the government text, the final decision to authorize or not the use of a “help to die“is in the hands of a single doctor. In committee, an amendment proposed by rapporteur Laurence Cristol (Renaissance) clarified that the doctor who makes the decision to authorize assistance in dying will do so”as part of a multi-professional collegial procedure“.

But the right denounced a “lure“, a “collegiality Canada Dry“, the decision always ultimately falls to a single doctor, which she rejects. Other deputies, on the contrary, fear that a decision having to be taken by several people will unnecessarily burden the system.

“Volunteer”

Who will be able to administer the lethal substance to the patient? The text originally provided that the patient would self-administer it and that he could be helped by a doctor, a nurse or a “voluntary person” designated by him if he was not able to do so.

But an amendment by Cécile Rilhac (related to Renaissance) gave patients the possibility of freely choosing to delegate this action to a third party.

Deputies want to prohibit any intervention by a third party and that only the patient can carry out the gesture. Others ask that it cannot be a loved one, judging that this responsibility could be too heavy to bear psychologically.

Discussions will also take place on the minimum reflection period between the doctor’s green light and the patient’s confirmation of the request (in the current text two days, with the possibility of shortening it).

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