“The debate on euthanasia must be part of an ethics of discussion”

Lhe Covid-19 pandemic has revived the observation of too often poor care at the end of life. The inadequacy of palliative care, its ignorance on the part of the public and of many doctors and caregivers have become more apparent than ever. The conditions of death both in the hospital and in an accommodation facility for dependent elderly people (Ehpad) were logically denounced as undignified. But the dying person is never unworthy: it is the absence of adequate support. The dedication of the professionals of these structures makes the weakness of the means allocated to this last form of care, benevolence and compassion even more inadmissible. Is this a reason to think that euthanasia is the cure?

Periodically, this issue resurfaces in public debate and is the subject of a bill that has so far been doomed to failure due to the opposition of the majority of parliamentarians. Yet, in survey after survey, a significant proportion of the population is in favor of legalizing euthanasia. Could French society tolerate this democratic paradox indefinitely? This is the subject of the debate convened by the President of the Republic, which will form part of the continuation of the recent opinion of the National Ethics Advisory Committee.

Will France’s position be increasingly isolated in Europe, surrounded by countries that have legalized this procedure: those of the Benelux for many years, Spain recently and Portugal probably in the near future? As for Switzerland, assisted suicide is legal there.

intolerable suffering

Such debate should be part of an ethics of discussion capable of reaching, if not consensus (too often synonymous with self-censorship), at least a reduction in the intensity of dissent. The positions of supporters of euthanasia and those of opponents, who affirm the pre-eminence of the palliative approach, have evolved over time. The former long underestimated the role of palliative care and often saw the choice as only one between horrific suffering or euthanasia. The latter sometimes wanted to believe that palliative care solved everything.

We must pay tribute to those who have worked to develop a palliative culture and ensure a dignified and peaceful end of life for many patients. However, they all recognized certain complexities: many requests for euthanasia disappear when the pain in all its aspects (physical, moral, possibly spiritual, but also the suffering of loved ones) is effectively addressed; likewise, for the patient, knowing that it is possible to resort to medical help in dying (in countries that authorize it) allows him to face the end of his life with more peace of mind. However, supporters and opponents are well aware that, even during perfect palliative care, some patients still express, with complete autonomy and independence, a strong wish to die.

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