Lhe debate on the end of life and active assistance in dying arouses massive support among the French, and an equivalent fear among many caregivers, supported by their minister, François Braun. To the point of wondering if improving palliative care and legalizing active assistance in dying are the right answer, if, also, the terms of the debate are the right ones, and if, finally, the initial observation is valid.
Everyone is beautiful – citizens’ convention, National Advisory Committee on Ethics for Life and Health Sciences, politicians – insist on the essential improvement of palliative care, it escapes no one that the tension concerns above all the questions of euthanasia and assisted suicide. Polls, forums, looks abroad, media cases, all-out wrath of caregivers, everything crystallizes on this point. But how can we miss the following paradox: there is a major problem in France in 2023, that of male death and unequal access to decent end-of-life care, which affects many people in the nearly 680,000 annual deaths. And there is a minor public health problem, that of access to active assistance in dying.
However, the stake meets the support of the public. At the citizens’ convention on the end of life, 75.6% of participants wanted it to be legalized. A survey carried out by the IFOP in 2022 on behalf of the Association for the right to die with dignity indicates that 94% of French people are in favor of it. In the country lhaving legalized, it represents between 1% and 4% of deaths8% in Quebec. However, no one marches, sign in hand, for quality end-of-life medicine.
Isolation or relentlessness
If we reduce the focus to the most publicized cases, degenerative or accidental neurological damage represents a few thousand cases each year: 2,300 motor neurone diseases (including a majority of Charcot’s diseases), 1,200 spinal injuriess, to which must be added the much more numerous cases of dementia. But the causes of death are quite different, led by cancer and cardiovascular diseases, for which tobacco (75,000 deaths per year) and alcohol (45,000) are heavy contributors. Above all, 300,000 patients require palliative care each year, to which approximately two-thirds access, according to lawyer Martine Lombard. Abyssal gap in proportions, therefore, an absolute public health problem on the one hand, emblematic but rarer cases on the other, and yet citizens focus on the second.
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