In their final report, the 184 citizens call out with one voice to the Government on “unequal access” to palliative care in France. They position themselves in majority for an opening of the active assistance to die and draw the contours of it. The act could only be carried out in the presence of a health professional, at the hospital, in an nursing home or at home. Caregivers would benefit from a conscience clause not to perform the acte.
After 9 working sessions and 27 days of debate, the Citizens’ convention on the end of life presented its conclusions and adopted its final report. Organized by and at the Economic, Social and Environmental Council (Cese), it brought together 184 citizens drawn by lot illustrating the diversity of French society, to answer the Prime Minister’s question: “Is the end-of-life support framework adapted to the different situations encountered or should any changes be introduced?”
Overall, the participants agree on one observation: the current end-of-life support framework is not adapted to the different situations encountered.for two main reasons: on the one hand, unequal access to end-of-life support And on the other hand, the absence of satisfactory responses to certain end-of-life situations, particularly in the case of refractory physical or psychological suffering.
Faced with this observation, improving end-of-life support means:
- developing home support;
- guarantee the necessary budgets to make this support effective;
- strengthening palliative care for everyone, everywhere;
- support better training of health professionals on palliative care;
- better inform all citizens and intensify research and development efforts to better manage suffering and develop future remedies;
- improve the organization of the end-of-life care pathway.
In addition, the Citizens’ Convention positioned itself mainly (75.6% of voters) in favor of Active Assistance in Dying, “the most appropriate modality to respect the freedom of choice of citizens, make up for the shortcomings of the current legal framework, in particular the limits of deep and continuous sedation and put an end to the situations of hypocrisy observed. » It explores the situations giving access to helpnoting that “the patient’s will, which must be respected in all cases, is the prerequisite for any access to Active Dying Assistance”. The main criteria worked on were: discernment, incurability, vital prognosis, suffering (refractory, physical, psychological, existential), age.
For citizens, discernment must be systematically taken into account and analyzed, so as to ensure the free and informed will of the patient. This discernment can be expressed directly or indirectly, via advance directives or the person of trust.
The participants in the Convention proposed methods for implementing these pathways:
- Listening to the request, which must guarantee that the will expressed is free and informed;
- Complete medical and psychological support including an assessment of the person’s discernment;
- Validation subject to a collegial and multidisciplinary procedure;
- An achievement supervised by the medical profession (even in the case of assisted suicide) in a place chosen by the person (a medical structure, home, an EHPAD, etc.) and in compliance with the conscience clause of health professionals ;
- A monitoring and control committee to ensure compliance with the defined procedure.
• Report of the Citizens’ Convention on the end of life, April 2023, in pdf on the Cese website