Rumours had spread rapidly online after the French government adopted a decree on March 28 changing the rules on the use of the powerful sedative drug Rivotril.
The MEP of the Rassemblement National, Gilbert Collard, shared the “news” on his Twitter account, with that Tweet alone being retweeted (shared) 2,300 times.
The Tweet read: “Covid-19: A decree from March 28, 2020 authorises euthanasia to get rid of old people who are cluttering up the hospital. Listen to this interview on Radio Shalom, it explains everything! And to say that we pretend to be the country of human rights...”
But there is no suggestion that the decree of March 28 had ever authorised the drug to be used to euthanise elderly patients, with medical experts from across the country explaining and clarifying the new rules on Rivotril, and stating that they do not allow for euthanasia.
Euthanasia remains illegal in France.
Clear conditions
The new decree allows for the injectable form of the drug Rivotril to be prescribed “as a sedative for [Covid-19] patients as a form of palliative care”, said Olivier Guérin, president of the elderly care association Société Française de Gériatrie et Gérontologie (SFGG).
It also allows for town pharmacies to offer the drug - under prescription - for “patients with or at risk of contracting the SARS-CoV-2 [coronavirus that causes Covid-19], where their clinical condition justifies it”.
Before this, the injectable form of Rivotril was “only able to be given out by hospital pharmacies”, said Mr Guérin.
The decree is very clear on the conditions in which Rivotril may be used.
It says: “[The prescribing doctor] must conform to extraordinary and temporary protocols”, and may only use the drug for patients experiencing “dyspnea (shortness of breath)”, or as palliative care for patients in “respiratory distress, as defined by [palliative care authority] la Société Française d’Accompagne et de Soins Palliatifs (SFAP)”.
The drug is intended to help ease end-of-life care - whether at home, in an elderly care home or a hospice - for patients who “cannot be taken to intensive care”; and is only to be used after a group decision by all attendant doctors, said pharmacy association la Fédération des Pharmaciens d’Officine.
The decree came two days after professional elderly care association le Conseil National Professionnel de Gériatrie (CNPG) wrote an open letter to health minister Olivier Véran, asking him to put in place nine measures to “ease the impact of the Covid-19 infection on elderly, dependent people living in elderly care homes or at home”.
One of these measures included a demand to make drugs such as Rivotril available outside of hospitals.
The CNPG wrote: “[These drugs] are essential to ensure the dignified care of asphyxiating respiratory distress of the very many residents, not able to be hospitalised, who will die in their care home.”
Difference between sedation and euthanasia
SFGG president Professor Guérin - who is also professor of geriatrics at the CHU hospital in Nice (Alpes-Maritimes, Provence-Alpes-Côte d'Azur) - explained that administering end-of-life care is not the same as euthanasia or hastening a patient’s death.
He said: “Administering Rivotril to a patient does not mean that we are stopping their care. It is actually the opposite; when their situation deteriorates, and in certain circumstances, it is a way to ease their suffering by placing them in a state of sedation when their respiratory distress becomes unbearable.
“It is absolutely not a drug intended to practise euthanasia. It is out of the question that we would sedate patients who require hospitalisation [for further treatment].”
French health authority La Haute Autorité de Santé has also explained that deep sedation is to “ease continued suffering”, in contrast to euthanasia, which is a response to the patient’s “request for death”.
Deep sedation is a way of “deeply altering the consciousness” of a patient by using “a sedative drug with suitable dosages”, and is the “natural evolution of the illness”.
In contrast, euthanasia would cause death by using a drug at a lethal dose and would cause the immediate death of the patient.
Euthanasia is illegal in France.
A law of April 22 2005 - dubbed the “Leonetti law” - aims to provide a context for end-of-life medical care without legalising euthanasia. It allows the patient to request, within a defined setting, the end of medical treatment that is too invasive or aggressive, and instead use palliative care to ease suffering.
