What do the two bills contain?

Like an air of deja vu … but not quite. From this Wednesday, April 9, two texts relating to the end of life will be examined by the Social Affairs Committee of the National Assembly: one relating to palliative and supporting care, the other on the legalization of medical aid to die.

In reality, this is the version of a single bill adopted by deputies at the end of last June, but split into two legislative texts. The dissolution of the lower chamber decided by Emmanuel Macron had indeed put an end to the legislative journey of the single text.

The proposal for palliative and supporting palliative care

“If all of these developments have already considerably modified the approach of the end of life, reports, studies and debates in recent years show that it is necessary to strengthen access to palliative care.” The presentation of the reasons for this proposal brought by Annie Vidale, a Renaissance deputy of Seine-Maritime is clear: it is still necessary to develop palliative care in France. “Only 48% of palliative care needs are filled,” insists the parliamentarian, citing a 2023 report.

For this, the proposal first wishes to replace the concept of “palliative care” with that “more encompassing” of “palliative and support care”. These “have the purpose of them, at the initiative and under the leadership of doctors and professionals of the care team, to guarantee global and proximity management of the sick person in order to preserve their dignity, their quality of life and their well-being.” “They are accessible throughout the national territory and their distribution guarantees equitable access to sick people,” institutes the bill.

The following articles aim to organize and make this right to palliative and support rights real. A multi -year support law for this care is also provided, as well as measures to promote the training of caregivers. Voting the necessary credits is also provided, as required.

Some 519 amendments deposited

Several other measures appear in the bill. Article 10 wants to create a new category of socio-drug establishments: support and palliative care houses. “This structure, intermediary between home and hospital, will welcome and accompany people at the end of their lives as well as their entourage within small life units which will offer global and multidisciplinary care,” specifies Annie Vidal in the presentation of reasons.

Among the other objectives of the bill, include “a wider deployment of volunteer support at the bedside of people at the end of life at home” (article 13), “measures to improve the methods of use and access to early directives” (article 15) or even “a strengthening of multidisciplinarity in the procedure for the initiation of a deep sedation of a sufficient patient” (articles 16 and 20). This bill seems relatively consensual. For the moment, some 519 amendments have been deposited.

The proposal relating to the end of life

Highly more sensitive, this bill is tabled by the deputy the democrats Olivier Falorni. Charente-Maritime’s parliamentarian had already submitted the proposal, brutally interrupted by the dissolution announced by the Head of State on June 9. “So much work, so many exchanges, so many hearings, so many deliberations could not be thrown out in the nettles,” he argues to explain the resumption of the text as adopted by the previous legislature.

Ensuring that “a very large majority of our fellow citizens await” this bill, it aims to legalize a “final appeal, that of helping to die for patients condemned by the disease but who do not want to be condemned to agony”. If the words are not used, it is therefore a question of authorizing – under conditions – euthanasia and assisted suicide in France. For Olivier Falorni, it is “a great law of freedom, that of having his death.”

This new possibility is open to article 2 of the proposal. It is thus defined that “helping to die is to authorize and accompany a person who expressed the request to resort to a lethal substance (…) so that they are administered or, when it is not physically able to proceed, has it administered by a doctor or by a nurse.” “Help to die is an act authorized by law,” it is specified.

Article 4 specifies the conditions of access to this “help”. You must be of age, French (or regular resident), suffering from a “serious and incurable affection, which engages the vital prognosis, in advanced or terminal phase” and “present a physical or psychological suffering linked to this condition, which is either refractory to the treatments, or unbearable depending on the person when she chose not to receive or stop receiving treatment”. Finally, to benefit from this aid, you must “be able to manifest your will in a free and enlightened way.”

The patient can give up “at any time”

The rest of the proposal explains the modalities of this medical aid to die. First of all, the request must be made – during a physical consultation – by the patient to a doctor with whom he has no relationship. The latter is then obliged to inform the patient of different possibilities, in particular those of palliative treatment and care. He is also required to remind the patient that he can give up “at any time” at his request and explain the methods to him. It is also the case for the doctor to verify that the patient is under the conditions provided to make a request for help to die.

This must then be examined by a “multi-disciplinary collegial procedure”, comprising another doctor who, “before returning his opinion”, examines the patient, “unless he does not consider him necessary”. The doctor’s response, after consulting the other caregivers, must come within 15 days and be notified to the patient “orally and in writing”. The patient must then observe a period of two days to decide if he continues his approach – except “if the doctor considers that this is likely to preserve the dignity (of the patient) as (the latter) designs it”. Confirmation of his request by the patient must intervene within three months, under penalty of which the whole procedure is made obsolete.

Concretely, it is still up to the doctor to determine “in agreement with the person, the doctor or the nurse responsible for accompanying him for the administration of the lethal substance.” The choice of date comes back to the sick person. If the act does not take place in the twelve months, then the healthcare professional must again evaluate “the free and enlightened nature of the manifestation of the will of the person.”

A conscience clause for caregivers

The law continues by specifying the conditions for exercising this aid to die. The protocol of the lethal act is notably specified, providing for the possibility for the applicant to interrupt him at any time. In this case, the lethal product is returned to the pharmacist who provided it, loads it to destroy it. Furthermore, even in the event that he does not himself administer the deadly substance-that is to say in the event that the patient wants to inject him himself-, the healthcare professional must remain in “sufficient” proximity (but not necessarily “alongside” of the person).

Strongly contested by many caregivers, this bill tries to take into account their concern: article 14 provides for a clause of conscience. But if they are “not required to contribute to the implementation” of medical aid to die, health professionals must on the other hand “inform the person of (their) refusal and communicate the name of health professionals willing to participate in this implementation.”

In addition, the proposal establishes a control and evaluation committee. Placed under the authority of the Minister of Health, she will notably be responsible for seizing the disciplinary chambers of the various orders of the caregivers in the event of “breach of ethical or professional rules.”

Bringing practice and information will be punished by law

Finally, the bill has a criminal dimension. “Is punished with a year of imprisonment and a fine of 15,000 euros to prevent or try to prevent practicing or learn about helping to die by any means, including electronic or online,” it is enacted. Likewise, the disruption of access to establishments practicing this aid is prohibited. The same goes for “moral and psychological pressures, threats or any act of intimidation against people seeking to learn about help, medical and non -medical staff working in authorized establishments.”

Examination by parliamentarians of this document should be more tortuous than that on palliative care. Indeed, of the 1097 amendments deposited, many want to empty the text of any substance. For example, an amendment deposited by the Republican right deputy (DR) Thibault Bazin wishes to “delete the codification of euthanasia and assisted suicide as proposed by this bill”. “In the current state of things, consider legalizing assisted suicide, such as euthanasia, does not seem appropriate,” also argues an amendment deposited by republican right deputies Philippe Juvin and Nicolas Forissier.

After their study by the Social Affairs Committee, the two law proposals should be debated at first reading in the hemicycle in the weeks of May 12 and 19. If they are adopted, the texts will then be transmitted to the Senate. They will then return to the National Assembly, unless they have adopted in the same terms. The procedure will then continue with a second reading. In the event of a new dissolution, the whole legislative journey will have to be resumed from the start.