End of life, what is continuous deep sedation?

What is deep and continuous sedation until death? How is this key device of the Claeys-Leonetti law of 2016 applied? Is this an unnamed euthanasia? Can we make it evolve? It is to answer these questions that on the first day of the 5th session of the Convention on the end of life, Friday February 3, the 184 citizens drawn by lot were treated to a masterful presentation by Professor Régis Aubry, recognized specialist in the subject.

A remedial course on deep sedation

To tell the truth, this is not the first time that the members of the Convention have broached this subject. Since the launch of the works, at the beginning of December, they have already had the right to a presentation by the former deputy Alain Claeys, co-author of the 2016 law; two workshops under the aegis of the National Center for Palliative and End-of-Life Care (CNSPFV), an organization affiliated with the Ministry of Health; and several round tables with nursing staff.

It is on the basis of these hearings that the participants developed, during the previous sessions, seven proposals aimed, for some, at broadening the conditions of access to deep and continuous sedation. Inconsiderately, for lack of expertise on the subject? This is what some citizens felt who asked the governance committee of the Convention to set up, all matters ceasing, this remedial course, prior to the vote on the proposals scheduled for the end of the evening.

Deep sedation reserved for three situations

It is 4:40 p.m. when Régis Aubry, director of the Besançon University Hospital (Doubs) and member of the National Consultative Ethics Committee, takes his place on the proscenium of the hemicycle of the Palais d’Iéna, seat of the Economic Council, social and environmental who organizes the work. It takes him less than ten minutes to recall the fundamentals. “Deep and continuous sedation until death consists of plunging the patient into a coma using a drug – midazolam – whose sedative and anxiolytic effects alter consciousness and which is generally combined with analgesics to treat physical pain. “, he begins.

Important clarification: according to the law, the device is reserved for three specific situations. First, to patients with serious illnesses who only have a few days or hours to live; then, to those who ask to stop treatments that keep them alive, for example artificial nutrition or dialysis for kidney failure; Finally, if the patient is unconscious and his condition is considered hopeless, the medical team can also decide to proceed with deep and continuous sedation in the name of refusing unreasonable obstinacy, another name for therapeutic relentlessness.

Avoid painful agony

“In any case, it is a question of avoiding painful agony, not of shortening life as is the case with euthanasia”, concludes Professor Aubry. In the assembly, the questions fuse immediately. “Are we sure that this sedation prevents all suffering? asks one. “And if the person does not die after a few days? », Worries another. “Why is this practice reserved for patients whose vital prognosis is committed in the short term? “Asks a third.

For more than an hour, the expert tries to extinguish the rolling fire of questions, not hesitating to share his doubts as a practitioner. “Deciding in this area is a complicated process. This requires a lot of humility. You have to do it on a case-by-case basis, take the time to listen, continue to treat the person as a subject,” he says to applause.

The convention will consider assisted dying

The intervention visibly upset over-hasty certainties. “If we had heard this teacher before, we would have avoided many mistakes”, summarizes a participant from his bench. Therefore, the result of the ballot seems sealed. Of the seven proposals examined, four were abandoned without further ado, while the other three were scheduled for rewriting. In the hemicycle, some are trying to oppose this vote by show of hands. They are quickly summoned to comply with the majority. “We brought in an expert because it was a mess in our heads and we realize that our proposals are obsolete. OK, the vote was a little tinkered with, but not manipulated. Now we have to move forward, ”said a citizen under the applause.

Saturday February 4, the Convention members must deliberate behind closed doors on the sensitive subject of assisted dying, a formula which designates both euthanasia and assisted suicide. And this time, they will be alone to clarify their ideas.

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