13 professional organizations and learned societies published a “joint ethical opinion” on February 16, 2023, entitled “Can causing death be considered as care?” These organizations bring together doctors, nurses, nursing auxiliaries, and geriatric support staff.
The specialties concerned include oncology, geriatrics, palliative care, and pediatrics. The subtitle explains the methodology of this opinion: “Interprofessional ethical reflections on the prospects for legalizing assisted suicide by euthanasia and the possible impacts on care practices.”
The opinion is a rigorous demonstration which must lead to the answer of the question posed in the title. It is interesting to follow these professionals, confronted daily with the end of life and requests for euthanasia, in this intellectual reflection nourished by their experience.
Variations of the National Consultative Ethics Council (CCNE)
The opening of the debate on euthanasia in France was marked, as with most major changes in the bioethical field, by a palinody of the CCNE. As noted in the document, CCNE Opinion No. 139 of 13 September 2022 considered that “there is a way for the ethical application of active assistance in dying,” in flagrant contradiction to its Opinion No. 122 of 30 June 2013.
The latter noted that such legislation “in light of foreign experiences [is] very difficult to stabilize,” and it “underlined the risks which result from it with regard to the requirement of solidarity and fraternity which is the guarantee of living together.” Have these drawbacks disappeared today? Still, the signatory healthcare organizations believe they have to react.
The editors point to 14 elements of the process of medically administered dying, whether assisted suicide or euthanasia, in which medical personnel must be more or less involved. Therefore, they will have to kill, more or less.
Back to the Basics of Medicine
The doctor, the nurse, the nursing assistant and all other personnel who participate in the practice of the medical arts are dedicated to care. The Academy of Medicine defines it as follows: “all measures and acts aimed at providing a person with the means of diagnosis and treatment allowing him to improve and maintain his physical and mental health.”
The obligation of care is also enshrined in the Public Health Code: the doctor, like the nurse “does not have the right to deliberately cause death.” It is the echo of the founding text of medicine, the famous Hippocratic oath: “I will never deliberately cause death.”
Faced with this obligation of care, the duty to help end-of-life patients is pressing, especially since the therapeutic or pain relief methods are now capable of considerably reducing the latter, and, in most cases of almost eliminating it.
“Currently, no country has legalized a form of administered death without including the participation of a caregiver in the process, whether to carry out the act itself (euthanasia), to carry out the prescription of a lethal product (Oregon model assisted suicide), or to carry out an evaluation and validation of the request (Swiss model assisted suicide),” analyze the caregivers.
“All of the professionals questioned categorically refuse the euthanasia process, and specifically the acts of preparation, implementation, and administration of a lethal substance,” the opinion states. If the caregiver does not have to administer the lethal substance, the opposition of the caregivers is “different.”
However, a consensus remains: whether it is euthanasia or assisted suicide, “these procedures cannot be assimilated to care,” because causing death is opposed to the very definition of care and to the entire Hippocratic tradition. They must therefore “be materially separated from medical care practice.”
Consequently, caregivers “ask the Government and Parliaments, if they decide to change the law, to leave the medical care world out of any involvement in the form of administered death.”
Affirming that they “will continue unconditionally to support all those treated,” they also call on the legislatures “to adopt a systemic and long-term reading.” “Significantly” improving the support framework for people at the end of life must be one of the priorities.
Death Demands
The signatories respond in advance to the objection of requests for death. From experience, these caregivers know “the fluctuating nature of willpower over time,” especially at the end of life. Thus, it is common “for the same person to express contradictory wishes a few days apart, on the same day, or even during the same conversation.”
They also know the underlying reasons that cause these desires to be expressed and which must be deciphered in order to help the patient: uncontrolled symptoms, persistent moral distress, request for help, recognition of suffering, need for care. They also know that the family and friends, for various reasons, can provoke this request. The conclusion of the document is very clear:
“While the health system in France is experiencing an uninterrupted series of crises, it is absolutely a priority to fill the glaring gaps in our management model. Conversely, the signatory organizations would find it incomprehensible that, by legalizing a form of medically administered death, the legislator is fundamentally transforming the definition of care and deciding to put an end to collective ethics.”
