The Following material (apart from the last article) was by Nancy Cattan, translated by Jane Hanks, and previously appeared in the Nice-Matin
I changed my mind on assisted suicide
As a high-profile euthanasia case was going through the courts NANCY CATTAN, a journalist on the Riviera newspaper Nice-Matin, talked to people who have been acting in a legal grey area over the ending of life – and says it made her reassess her own views on assisted suicide
I WAS against assisted suicide. On principle rather than for philosophical reasons or religious conviction. You shouldn’t meddle with life. You should allow it to end naturally, when the time comes.
But what did I know about that moment when all hope has left you, of the psychological torments an illness can sometimes inflict, the impossibility of deciding for yourself when “the end” should come?
Nothing, like many of those who are sure they have the right answer. The people who I met while preparing these articles didn’t convince me I had to be in favour of it. But they made me doubt. Today if someone asked me if I was for or against assisted suicide I would reply “I don’t know”.
Since 2005, the Leonetti Law has offered a framework for end-of-life questions, with the merit of responding to an infinite number of different and complex situations.
It gives the right to “let die” by authorising doctors to administer pain-relieving drugs to ease suffering with the “secondary effect of shortening the life” of a patient who “is in an advanced or terminal phase of a serious and incurable disease.”
Even so, President Hollande promised a bill to “complete and improve the law” after a “citizens’ discussion” (diverse working group) was held and concluded in favour of “legalisation of medically assisted suicide.”
In this case medical staff would no longer decide, but the patient: he or she would take the lethal medication after a doctor has declared that they were not in a state of depression.
Assisted suicide in the strict sense is based on a fundamental principle: that of the freedom of the individual.
The idea is society should organise itself to allow assisted suicide in order to respect that principle.
What should we think?
My investigation does not intend to answer that question.
Instead it tells the exceptional story of a few individuals who went outside the law to satisfy the wishes of a man who was at the limits of his endurance and who wished to die.
Two acted out of conviction, one out of love. We have no wish to judge them, just to listen to what they have to say.
Why I helped my sick partner to take own life
IT IS FEBRUARY 2013...Three people are together in a flat on the Côte d’Azur. A 56-year-old man who we will call Paul [the names in this article have been changed], his partner Françoise and another man. Paul will die in a few minutes’ time. He has been asking to end his life for several months. Since the day they told him he was suffering from a neurodegenerative disease. Incurable, irrevocable, invalidating and without hope. He knew immediately what lay ahead for him; so he asked his wife to respect the promises they had made to each other some years earlier – “to help the other to die, if the need arises.”
When that time came, she did not shrink from doing it.
FRANÇOISE thought long and hard before she agreed to meet us. She is not an activist. She simply describes herself as a “free woman”. And in love, madly in love with her partner.
To the point that she wanted him to be next to her right up to his last breath. Even when he was in physical decline, incontinent, and paralysed.
“But I loved him so much that I fought against my own self-interest. I did it for him.”
When I met her in a neutral setting in Nice she was not alone. She was with Georges, the man who had organised Paul’s “suicide” with her.
It was an hour before she could bring herself to talk about those final moments. First she wanted to tell us, with her eyes full of tears, about the man who she loved. “Handsome, erudite, proud…” And then, everything that had gone before the final act.
“Shortly after the diagnosis he said to me ‘I don’t want to end up helpless’.
“Very quickly he found it difficult to find his words, I couldn’t understand what he was saying very well, he had a sort of fixed smile and then he would gasp for air, fall without being able to get up again... I knew he desperately wanted to end it all …”
So why didn’t he? “He was afraid of making a mess of it. And then he wasn’t sure what the consequences of a violent suicide would be. ‘I want to make a success of my death’, he told me.”
Paul became more and more insistent. He asked Françoise “to call Switzerland or Belgium” (where assisted suicide is legal).
“So one day I did,” she told us. “They asked me if he had given written instructions. I said yes, he had written that he didn’t want doctors to keep him alive at all costs.”
The couple did not go to Switzerland. Instead they were put in contact with Georges – a man in their area who could help them [he is not directly connected with the group abroad]. He came to meet them to talk to Paul face to face.
Georges said: “His wishes were clear even though he had difficulty in expressing them, and they were perfectly formulated.
“And when I asked him ‘Why don’t you wait for death to come naturally?’ He pointed with his head to the room where his wife was. He didn’t want her to suffer the spectacle of his decline.”
Shortly afterwards, Françoise took a phone call from a doctor. “I didn’t know who he was but he was perfectly aware of the situation. The fact he was a doctor reassured me, calmed me. I thought – this is medical.”
The man gave precise instructions. He said she needed to get hold of three medicines. Ones for which you need a prescription. Which she did not have.
“I could only think of one thing: that I had to get them. I thought, I really hope I can get them…”
After about 48 hours and by dint of persuasion and “lies” she succeeded in convincing pharmacies to give her the drugs. “I pretended I was on holiday and that I’d forgotten them at home and I had to have them urgently.”
Once she had the lethal cocktail Françoise tried to put off the fateful moment. “But Paul was in a hurry” she remembers, sobs in her voice.
“Don’t you want to wait?” she pleaded with him. But he couldn’t take it any more, he did not want to wait any longer.
And so, in February 2013 after contacting Georges, he came to their home. “We chose the day at random. It wasn’t an anniversary.”
The procedure was well worked out. Georges asked Paul several times if he really wanted to die. His reply was clear. He took the first medicine – which did not kill him, as intended.
The same question about his wish to die was put to him again, to which he replied with the same certainty.
Fifteen minutes later a second medicine was given to him, which he swallowed. This too was not fatal, which he knew. Death would come with the third medicine.
“He was conscious. However, he took it without hesitation. And his face relaxed. I wonder if I will have the same courage as he did if, one day, I have to face the same situation.
But at the time I could only think of one thing: ‘am I doing my best for him?’”
Very soon, Paul “went to sleep”. “I thought, ‘It’s finished, he can’t get any worse’.”
As Georges had advised her, she waited several hours before calling the GP. “It corresponded to the time period in which they could have tried to resuscitate him.”
Even though she did not stop crying all the time she was speaking to us, Françoise said and repeated that she has no regrets. And today, now the man she loved so much has gone, she says she no longer fears anything.
People are really afraid of physical degradation
VAUCLUSE GP Dr Bernard Senet has been helping people die for 25 years. At first it was just patients he knew. Since retiring he gets calls from strangers from all over France and “manages” two or three such “cases” a week. He agreed to talk as he would like France to “follow Belgium and authorise assisted suicide, euthanasia and sedation at the terminal stage.”
Who contacts you?
Usually it’s the patients themselves, less frequently the family – one of their relatives is in hospital at the end of their life and they feel the Leonetti law is not being applied. A phone call to the hospital is usually all that is necessary to resolve the situation. Three days later the family phones me to say “Thank you he or she has passed away.”
What does your “participation” in
assisted suicide involve?
After I’ve had the person’s medical file sent to me, I make sure the illness involved is incurable and irreversible. I also ask for written proof the patient wishes to die. Without that I refuse to intervene.
When I have these I explain what medicines are needed, taking into account weight, respiratory diseases etc.
What if the person cannot
People who wish to die always find a way to express themselves even if it is only with their eyes.
But fortunately most have drawn up instructions earlier to express their wishes. If they haven’t, and luckily this is rare, the situation is very difficult as in the case of Vincent Lambert.
Opponents of euthanasia argue once people have pain relief they no longer ask to die.
Even if more than 90% of pain can be treated, there is still pain that is difficult to control. But above all, people need to understand that what makes people frightened is their physical degradation: incontinence, emaciation – and dependence on others.
Have you ever have had doubts?
I have never doubted the seriousness of the illness, the imminence of death or the wish of the person to die. The only question I have ever had to ask myself is whether the person has died too soon. If he or she should have been there longer for the benefit of their family.
I’m thinking in particular of the case of a father of five children. Knowing his death was inevitable he contacted me. His wife didn’t want him to die. But he knew what lay ahead and was worried that he would no longer be capable of taking medicines and so wouldn’t be in a state where his death could be assisted.
This situation caused great pain. Cases like this are one reason why the law must change.
What do you mean?
If this man could have been sure that he could have been helped to die within a legal framework, even when he was incapable of doing it himself, he would not have had to choose suicide.
With palliative care families can find reconciliation among themselves beside the dying person. With assisted suicide that is not possible.
That is true. And we must be aware of that. In fact, in Belgium where assisted suicide is authorised, the family situation is taken into account, together with checks on financial elements involved.
At the moment all that can be done when there are family disagreements is to make sure the patient is aware of the situation.
Have you ever been in trouble with the law?
Only once. I had advised a woman suffering from a nervous system disease. The husband agreed but on the day the woman didn’t take enough of the medicine and her death was prolonged. She was breathing badly. Her husband panicked and phoned the Samu. The patient couldn’t be saved, but the Samu doctor denounced the husband for non-assistance to a person in danger. I received a visit from two gendarmes. But in the end neither myself nor the husband were charged.
This article and the one above first appeared
in the Nice-Matin. Translation by Jane Hanks
Euthanasia cases reopen the debate on end-of-life
by OLIVER ROWLAND
THE HIGH-profile acquittal of a doctor accused of poisoning seven elderly patients and controversy over whether a man in a coma for six years should be maintained alive have reignited debate on the “end of life”.
The cases of Dr Nicolas Bonnemaison and Vincent Lambert (in a vegetative state for six years after a motorcycle accident) have prompted the government to ask two MPs to propose new laws this year in response to calls for more legal clarity over “end of life” issues, including whether or not to legalise “assisted suicide”.
Nine out of 10 people want euthanasia to be made legal – as is the case in Holland, Belgium, Luxembourg and Switzerland but not France – according to a survey for the polling form BVA.
The 2005 Leonetti Law allows doctors to ease the suffering of terminally ill patients even though a treatment might have the side effect of shortening life but stops short of allowing the deliberate ending of life. It also says doctors should not act with “unreasonable obstinacy” and that treatments can be stopped (or not used) if they are “useless”, “disproportionate” or just “artificially keeping someone alive”.
People can also write a document, les directives anticipées, in which an adult in full possession of their mental faculties, can explain what they would like to happen if they are terminally ill and unable to decide for themselves, with regard to the limitation or stopping of treatments.
It can be lodged with a named doctor or a “trusted person” whose opinion should be prioritised before that of any other non-medical person.
Now the author of the Leonetti Law, UMP Party MP Jean Leonetti, and Socialist Alain Claeys have been asked to draft a new law on the end of life, including the “precise circumstances in which easing suffering may lead to shortening life, while respecting the person’s free will”.
Their ideas must be submitted by December 1 for an MPs’ debate before the end of the year.
Leonetti remains firmly opposed to euthanasia, saying if suffering is eased appropriately, most people do not want to die. Claeys, however, has stated that “no subject will be excluded”.
The issue has arisen after Dr Bonnemaison, an A&E doctor, was cleared of ending the life of seven terminally ill patients through poisoning (the term “murder” was not used) after admitting administering lethal doses to ease suffering. The prosecution has appealed.
Doctors’ professional body the Conseil de l’Ordre, has upheld a decision to strike him off based on professional rules that a doctor making decisions based on the Leonetti Law should consult with colleagues, not act alone. He has appealed against this and would in any case have the right to reapply after three years.
In the Lambert case, the top administrative court the
Conseil d’Etat ordered his “treatment” could be ended, citing the Leonetti Law – the “treatment” being giving food and drink.
This was supported by Mr Lambert’s wife but not his parents, who applied to the European Court of Human Rights, which ordered he be kept alive.