2024-03-25 04:20:05
In 2002, Belgium adopted a law decriminalizing euthanasia, with very strict conditions. Practicing as a palliative care doctor for thirty-five years, I have agreed, with the care teams, to support people who express this request, at home or in hospital. In 2023, 101 French people were euthanized in Belgium. Receiving requests from France myself, I read President Macron’s project carefully.
This “assisted dying” proposed seems to me to respond to the wish of our contemporaries in “rich” countries: to be able to manage, with their medical team, their end of life. Since its beginnings, palliative care has worked to ensure that death is no longer denied, hidden in our care pathways. But, faced with the end of life, people need to be respected in their anxieties, within the limits that seem acceptable to them. Palliative care teams listen, and they can often help create the conditions for a peaceful death. But, as President Macron says, this is not always possible.
So, assistance in dying becomes necessary so that the person and their loved ones feel safe. But what help? The conditions proposed to obtain it seem close to those of Belgium. However, I would like to point out two differences. On the one hand, we did not exclude patients whose death was not expected in the short term, given the difficulty patients face with certain neurological or psychiatric pathologies and the powerlessness of doctors to provide relief. On the other hand, the place and role of doctors seem very different to me.
The importance of the “community of care”
In both cases, it is certainly the doctors who decide to agree to provide the requested assistance, if the conditions are met. But in Belgium, contrary to what is planned for France, the doctor concerned – most often a doctor caring for the patient, general practitioner or specialist – accompanies his patient until the end. He does this not only by taking the advice of colleagues, the healthcare team and loved ones, but above all by continuing the dialogue as well as the care, and by preparing the moment of the act with all attention and vigilance. required.
Also read the column | Article reserved for our End of life subscribers: “The patient’s wishes have priority and they must be assisted when they are formulated with conscience and consistency”
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Even if I know that it is a particularly difficult act – as expressed by our fellow resuscitators or others faced with situations at the extremes of life – how can we imagine a break in care, an abandonment of the patient, which would have received your prescription with its lethal products to swallow? This seems to me to be contrary to our ethics. In Belgium, we wait until the last moment to collect the products ourselves from the patient’s pharmacy. Often, moreover, the patient died before: with palliative care, he tolerated his situation, but he was reassured: if life became hell, we could help him die a little earlier.
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