On April 1, 2023, France’s National Council of the College of Physicians (l’Ordre des medecins) released a statement called “Fin de vie et rôle du médecin” (End of life and the doctor’s role), which is the result of nine months of reflection by its departmental and regional councils.
End of life and the doctor’s role
End of life and role of the doctor: return of the consultation
This morning, during its General Assembly, the National Order of Physicians presented the results of its consultation on the end of life. For nine months, all of the departmental and regional councils have looked into this question and more particularly into medical assistance in dying.
This consultation began last June with a questionnaire sent to departmental and regional councils. During the seminar of the National Council on the end of life last November, these results fueled the debates. After an initial drafting work coordinated by the ethics and deontology section of the national council, hearings of external organizations and learned societies on palliative care were carried out to deepen the subject.
End of life and the doctor’s role
The Order of Physicians, after the survey carried out with the departmental, regional and interregional councils, after a seminar devoted to the end of life, wishes to express itself upstream of a possible modification of the law on the end of life, and thus respect an announced schedule.
The Order of Physicians therefore expresses itself on the Claeys Leonetti law in its current version and on the role and place of the doctor in the event that a law relating to assisted suicide and/or euthanasia is tabled in Parliament.
The Order is against any possibility of setting up an active assisted dying procedure for minors and people unable to express their will.
End of life and role of the physician in the context of active assistance in dying
The Order of Physicians considers it imperative to allow better application of the Claeys Leonetti law, and necessary to acquire all the means that would allow the law to be fully effective: to make devices efficient in medical, medico-social establishments and at home throughout France, facilitate medical and medico-social support for end-of-life patients and their families, promote the training of health professionals and paramedics, free up time for attending physicians to accompaniment of their patients, promoting a better knowledge of doctors on the care of end-of-life patients.
To this end, the Order of Physicians will contribute to the development of palliative care and support, and knowledge of current regulations.
If the law were to change towards the legalization of active assistance in dying (euthanasia and/or assisted suicide), the College of Physicians intends to assert from now on that it will be unfavorable to the participation of a physician in a process that would lead to euthanasia, the doctor cannot deliberately cause death by administering a lethal product.
In the event of legalization of assisted suicide, the College of Physicians intends to formulate requirements regarding the role and place of the doctor. Thus, the College of Physicians:
- Would demand a specific conscience clause which would guarantee the independence of the doctor, including in a health establishment, and which could be highlighted at any time during the procedure. The doctor should be able to continue to follow the patient, even after having invoked this clause. If the doctor no longer wishes to take care of his patient, he should refer him to a doctor likely to take care of him;
- Believes that a doctor should be the professional who collects the patient’s request for active assistance in dying at the end of life. This doctor should be the treating/referring doctor (specialist doctor in general medicine or specialist doctor taking charge of the pathology) if he does not assert his conscience clause;
- Believes that assessment, decision of eligibility for active assistance in dying, and accountability should be collegial;
- Considers that in the college thus constituted, the treating general medicine specialist and the referring specialist doctor should systematically be members if they did not assert their conscience clause; in the latter case their opinion will be requested;
- Recommends that the attending general medicine specialist be part of the entire procedure, unless he asserts his conscience clause;
- Is unfavorable to the active participation of the doctor when taking the lethal product by the patient. However, the order of doctors considers that the doctor who would not have asserted his conscience clause could remain present and accompany his patient until his last moments (1);
- Believes that the law will have to protect the doctor who would participate in the procedure of active assistance in dying.
1 – Article 38 of the code of medical ethics: “The doctor must accompany the dying person until his last moments, ensure by appropriate care and measures the quality of a life that is coming to an end, safeguard the dignity of the patient and comfort those around him. He has no right to deliberately cause death.”