There is no right to death

MP Jean Leonetti is one of France’s most influential politicians on medical ethics

30 April 2011
By Oliver Rowland

Cardiologist, MP, mayor and hospitals chief Jean Leonetti has found himself in the headlines regularly in recent months, quoted on topics from bioethics and euthanasia to the future of his political grouping Le Parti Radical.

He was the rapporteur for France’s existing “Leonetti Law” on care of dying patients as well as for a bioethics bill now under debate. He opposed a proposal by some senators to legalise euthanasia this year. Connexion spoke to him in Antibes where he
is the town mayor.

The current law aims to balance keeping people alive at all costs and actively ending life...

Yes, and it is quite similar to the British one. We often use the English terms “cure” and “care”. You never stop care but you can stop cure if it is disproportionate. The law says “never abandon, never allow suffering” and allows that you can in some circumstances administer drugs to prevent pain that might have the side-effect of making the person die sooner. It’s similar to ideas about palliative care developed at Saint Christopher’s Hospice in England: even when you can no longer save the person, you must be there for them.

Is it the idea, as a doctor, of causing death, that shocks you?

Yes, it’s contradictory because it is an abandonment of the patient, and in a society where we are always looking at savings it is a danger to present this alternative. A doctor’s job is to care. He must not abandon the patient or let them suffer. That is what the immense majority of dying people I have met wanted. They were not asking to be killed.

There have been famous cases like Vincent Humbert [who wished to die after being paralysed in a road accident]…

He had three-quarters of the brain destroyed and had seven heart attacks and this was a case of trying too hard to keep him alive, which can cause complications and suffering. People ask to die for three reasons, firstly physical suffering, and unfortunately doctors sometimes hesitate to administer strong painkillers at the end of life like morphine, for cultural reasons. They may be worried about toxicity or that you can become dependent or that it alters your state of mind, though this is becoming less common.

Secondly, abandonment. Unfortunately dying people are often abandoned by medical staff who think they’ve done all they could, and by loved ones who stay away from the place of suffering. Third, is the feeling that life has no more meaning, which is usually linked to the same factors. Rather than asking “What do we do with people who ask to die?”, we should ask “Why do they ask to die?”.

Even so, should people not have a right to ask to die?

In the UK there was the case of Diane Pretty [who wanted permission that her husband could end her life if she became too ill]. It led to a ruling by the European Court of Human Rights that there is a right to life, but not an equivalent right to death.

Perhaps there is also a risk of people feeling pressurised?

In Holland and Belgium they kill people who just feel tired of life. In Switzerland 20-30% of the people they cause to die, though they may have multiple illnesses, are not terminally ill. In an increasingly selfish society there is a risk people might be, subtly, made to feel they’ve had their time and it’s time for them to go.

So you are pleased the new proposal did not go through?

Yes. However the debate will always remain important.

In your system, palliative care is crucial. Does it tend to leave a lot to be desired?

It’s the foundation and we are lagging behind on this including raising support from the wider community. In the UK there are far more volunteers who visit the dying. People say to me “you are against euthanasia because you are Catholic”, but the British are not in favour either.

Why do we need for a new bioethics law?

The British tend to think case law should make the law and we think acts of parliament should pronounce on everything. There are inconveniences with both. In bioethics, Britain tends to think the state should not interfere in people’s individual decisions. On surrogate mothers for example, British politicians say: “We don’t forbid it, but we don’t pay for it.” France prefers to regulate it and say “We forbid it”. The risk is of commercialising the human body. In France we do not think a womb is a receptacle for rich people to rent to have a child.

You proposed an amendment for prenatal checks on certain genetic anomalies not to be systematic any more. Do you think the public understand why?

I think not, or at least those that got upset. In the near future we will be able to predict a huge amount of things about a child. With a blood sample from the mother towards the end of the first month of pregnancy you will know all risks, not just trisomy [a genetic illness that was a focus of the controversy] but for example, whether the person might be at risk of prostate or breast cancer. We risk eugenics, especially here where everything is reimbursed. People may want to be tested for everything
and say “I want the perfect child or I will have an abortion”. We must say “No, we can’t test for everything, for everyone”. What’s more, most illnesses are due to external factors more than genetics.

I said tests must only be done for medical reasons. This was interpreted as me saying it was up to each doctor whether or not to do a test. I meant scientific studies should have shown it was reasonable to do it.

Is it one of the “French exceptions” that there are parties within parties, like Le Parti Radical, to which you belong?

It’s above all a specificity of the Parti Radical, to be a party associated with the large formation of the presidential majority. It is more than 100-years-old and is based on Republican values and laicity and it is seen today as the more left-wing part of the (centre-right) UMP.

There is debate as to whether or not you should leave…

Within the UMP there is a mosaic of different sensibilities, some very right-wing and others closer to the centre. Successive crises, financial, economic, social, geopolitical, nuclear… have raised questions over this arrangement. The issues are more pressing since the president of the Parti Radical, Jean-Louis Borloo came out of the government, despite his strong political actions in social housing and the environment [Overseeing 2007’s Grenelle Environnement summit and its follow-up]. There was a rupture because he was sounded out as a possible prime minister and did not get the job. He has been voicing opinions that differ slightly from what is usually heard from within the UMP, trying to respond to questions of insecurity, immigration, authority and order.

Since this interview, the head of the Parti Radical, Jean-Louis Borloo, announced he was leaving the UMP, however not all party members are in agreement, including Mr Leonetti. While the UMP is in some respects moving further right than they would like, he said, it is best for the Parti Radical to continue to be an influence from within, at least until the presidential elections. Otherwise there is a risk of playing into the hands of the centre-right’s opponents, he told national newspapers.

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