Thursday, January 28, 2016

France approves terminal sedation legislation.

By Alex Schadenberg
International Chair - Euthanasia Prevention Coalition

Paris protest against euthanasia (June 24, 2014)
Politicians in France have been debated the legalization of euthanasia for many years. 

In January 2011, the French Senate rejected a euthanasia bill by 170 - 142. During the 2012 election President François Hollande promised to legalize euthanasia but since then Hollande has faced strong opposition to his plan. In June 2015, France's Senate rejected a bill that permitted euthanasia by dehydration and in October 2015, a French court decided that Vincent Lambert should continue to receive food and fluids.

The Associated Press has now reporting that French lawmakers approved a bill that allows "terminal sedation" but not euthanasia. 

According to the media report the French government approved a bill that allows doctors to sedate a person, upon request, who is nearing death, and withdraw life-sustaining treatments including nutrition and hydration (food and water). According to the article:
The new law will allow patients to request "deep, continuous sedation altering consciousness until death" but only when their condition is likely to lead to a quick death. Doctors will be allowed to stop life-sustaining treatments, including artificial hydration and nutrition. Sedation and painkillers will be allowed "even if they may shorten the person's life." 
The bill will also apply to patients who are unable to express their will, following a process that includes consultation with family members. 
The methods can involve medicating patients until they die naturally of their illness or until they starve. Some doctors, however, say it may be more human to euthanize.
I have not read the bill, but if the bill allows doctors to intentionally cause the death of a person by dehydration, when the person is not otherwise dying, then the act is "slow euthanasia" or euthanasia by dehydration. If the bill clearly limits sedation and dehydration to people who are actually nearing death, then the act is closer to palliative sedation.

The European Institute of Bioethics outlined three main concerns with the legislation:
1. The new law introduces end of life in its Article 2 to an extent that many Health professionals denounce as dangerous. "Artificial" nutrition and hydration is referred to as medical treatment and not care. As such, it can be stopped at the patient's request or following a collegial procedure if the patient can not speak. 
2. Article 3 establishes a new "right of continuous deep sedation [...] until death." Many parliamentarians, health professionals, lawyers and patient organizations have denounced this fuzzy measure as unclear in its framework and conditions it poses, which could lead to a form of masked euthanasia. Indeed, the criteria often appear subjective. The terms "commits its short-term prognosis" or "likely to cause unbearable suffering", are not defined by law. The law can then be applied to a variable conditions which creates genuine legal insecurity. 
3. We strongly denounce that ... advance directives become binding and come to impose the doctor "except in life-threatening emergencies [...] and when directives are manifestly inappropriate or inconsistent with the medical situation." The risk is that it causes a shift in the role of the doctor, possibly imposing acts contrary to the doctors ethics and his conscience.
I am concerned that the bill defines food and fluid as a form of medical treatment. Food and fluid are not medical treatment but rather normal care.

I am also concerned, that the bill allows doctors to sedate and withdraw food and water from a person who is incompetent based on an advanced directive or based on the decision of a proxy. I fear that the protocols established in this bill will be followed, when a person is deemed incompetent even when the person is not otherwise dying. 

Acts of sedation and dehydration can be ethically the same as euthanasia when the intent is not based on palliating symptoms but rather causing death.

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