Citizens' convention on the end of life: are the French really informed?

On September 13, the National Advisory Council on Ethics published an opinion entitled “Ethical issues relating to end-of-life situations: autonomy and solidarity”. In the process, President Emmanuel Macron announced the organization of a citizen debate in order to obtain proposals on the subject. It's about discussing active assistance in dying. The Citizens' Convention which will debate it will begin its work on December 9, while, according to a recent study, the French are ill-informed on the subject.

A recent opinion published by the Ethics Council (CCNE) consider the possibility of active assistance in dying, while recalling the importance of developing the supply of palliative care. On other occasions, the organization had advocated the possibility of euthanasia, for example in his opinion 63 of 2000 speaking of commitment to solidarity and the exception of euthanasia. However, in 2013, the Council underlined in its report 121 that maintaining the ban on doctors “deliberately causing death” protects people at the end of life, and that it would be dangerous for society if doctors could take part in “causing death”.

In addition, various opinions and reports from the organization have already underlined the lack of information for medical personnel and the public. Thus, opinion 121 noted the ignorance of the Leonetti law of 2005 aimed at avoiding euthanasia on the one hand, and therapeutic relentlessness on the other:

"It is hardly surprising that the law - when it is called upon to profoundly renew the care of end-of-life patients - is unknown, little or badly applied when its adoption has not been accompanied by an adequate training policy for health professionals and that the information (at the initiative of the public authorities, but also of the media) has not allowed sufficient appropriation by the citizens. »

The French mostly indifferent to their end of life, but in favor of euthanasia

according to a BVA survey for the for the National Center for Palliative and End-of-Life Care, carried out between September 23 and October 1, 2022, the majority of French people do not feel concerned by the subject and even find it difficult to define it, 30% of them thinking that it is about the last years of life .

Only 23% of those under 35 feel concerned, whereas it is, for example, most affected by road fatalities with the over 70s. In fact, only 45% have thought about what they prefer and only 43% have discussed it with their loved ones. 22% say they avoid the subject with a doctor.

Above all, 57% of French people are unaware of the possibility of advance directives which allow you to express your wishes in the event that you are unconscious or unable to express your wishes. 65% of respondents have a precise idea of ​​what the concept of trusted person is, while 23% think they know what it is but do not have a precise idea. But this lack of interest does not prevent responding massively in favor of euthanasia during polls on the subject.

Therefore, an IFOP survey by self-administered online questionnaire on October 4 and 5, 2022 for the ADMD (Association for the right to die with dignity) indicates that 78% of people want the Citizens' Convention to encourage a change in the law with the legalization of euthanasia or medically assisted suicide. The figure is 61% among practicing Catholics, the faithful of other confessions are not specified. Unlike abortion or the death penalty, this is the subject where the divide is the least marked.

The high percentage in favor of euthanasia and assisted suicide is constant, especially since they are presented as dignified deaths in the face of lives that have become unbearable, while information on palliative care is incomplete and centers specialists are seen as places of death.

Without knowledge of the palliative care offer, respondents tend to prefer to consider such an outcome, especially since no one wants to die without dignity. Fiction has fed the debates, but also the media story in various cases such as that of Chantal Sébire who asked in 2007 that President Nicolas Sarkozy intervene in her favor, when she wanted to die. In addition, fictional or media accounts do not state the accuracy of the means used to shorten life.

A complex debate

In an article titled "End of life: good use of surveys", the newspaper La Croix gives the floor to Doctor Vincent Morel, head of service at the University Hospital of Rennes and president of the scientific council of the French Society for Support and Palliative Care (Sfap). The doctor urges the French to decipher the polls "to understand what is complex in the answers of our fellow citizens".

Nourished by biased media representations and polls which can be oriented and which underline terms such as “incurable disease, unbearable suffering – which refer, in healthy people, to a dramatic representation of the end of life that is not always adjusted to the realities that are experienced by patients and healthcare teams", the French express themselves in an abstract way. However, observes Dr. Morel, “in palliative care services, only 5 to 6% of people can express, at a time, the wish to die, but one in ten persists in their request for euthanasia”.

In a press release, the Sfap indicated last October 13 that 85% of palliative care players, volunteers and professionals, say they are against any form of active assistance in dying, and that 83% of them say that this type of gesture cannot be considered like a treatment.

Jean Sarpedon