End of life: “disrupted practice”, “care”… Doctors divided on assisted dying

"I can't seem to adopt a binary, militant, or partisan approach to all this, whether intellectually or as a clinician," explains geriatrician Régis Aubry, former head of the National End-of-Life Observatory.

In the National Assembly, two texts are currently being examined before a formal vote expected on May 27. One concerns palliative care, the other aims to open up - subject to strict eligibility conditions - the possibility of "assisted dying."

As the text currently stands, the main criteria would be multiple: being an adult, suffering from a serious and incurable illness, in an "advanced or terminal" phase, capable of expressing one's wishes and presenting suffering resistant to treatment. It would be up to the medical teams - doctors, nurses, nursing assistants - to decide whether to accept and then implement a request for assistance in dying by preparing the lethal substance, or even, when the patient is physically unable to perform the act - to administer it.

MPs approved on Saturday the creation of a "right to assisted death" and reinstated the principle that patients will have to self-administer the lethal substance, except when they are unable to do so.

Among healthcare professionals, divergent positions have been accumulating over nearly three years of debate. Medical organizations regularly sign op-eds opposing this text or its previous versions. One of these, from around twenty organizations published in "Le Figaro" in the spring of 2024, called on MPs to reject a law that would "profoundly disrupt medical practice."

Other columns, often signed individually, argue the opposite. "Medical assistance in dying is care," several hundred caregivers stated in "Le Monde" in 2023.

Polls, however, vary. Three-quarters of the doctors surveyed would approve of the legalization of assisted dying, according to a recent survey published by the Association for the Right to Die with Dignity (ADMD) , a leading advocate for the legalization of euthanasia.

But within the French Medical Association, known for its conservatism, only a third of doctors would be willing to help a patient die, according to an internal survey presented to MPs in April by its president, François Arnault. Still, according to him, this is already a sign of "a significant shift" in the medical world over the past ten years.

Furthermore, sensitivities vary from one specialty to another. The palliative care community appears particularly wary of assisted dying: its main organization, the SFAP, is among the most vocal opponents of the bill. However, between defending palliative care and accepting assisted dying, "there is not necessarily an incompatibility," believes Régis Aubry, former president of the SFAP.

A co-signatory in 2022 of an Ethics Committee opinion allowing conditional legalization of assisted dying, the geriatrician is wary of euthanasia, which is likely to override the patient's "ultimate ambivalence." He considers assisted suicide much more acceptable.

But there are many neurologists who support assisted dying, as they deal with numerous incurable conditions—Parkinson's disease, Lou Gehrig's disease—that gradually impair patients' abilities. "Neurodegenerative diseases come up against the limits of palliative care," says neurologist Valérie Mesnage, who treats Parkinson's patients at the Cochin AP-HP hospital and advocates for the legalization of both assisted suicide and euthanasia.

As for cancer specialists, among those most confronted with the end of their patients' lives, it is difficult to discern a trend. "There are many nuances when we talk among ourselves," reports Manuel Rodrigues, a specialist in certain rare cancers at the Curie Institute and president of the French Cancer Society (SFC).