End of life, the Convention focuses on the discernment of minors, the elderly and the mentally ill

Was the vote that closed the 6th session of the End of Life Convention, Sunday February 19, premature? Were the 184 participants ready to answer the cascade of questions – eleven in total – submitted to them by the governance committee which has supervised the work of this citizens’ assembly since its installation in December? This is the question that arises as the 7th session opened on Friday 3 March was an opportunity for the members of the Convention to look again at the delicate subject of the discernment of minors, the elderly and the mentally ill.

Should active assistance in dying – euthanasia or assisted suicide – be opened up to minors and adults alike? Should the possibility of access to euthanasia be reserved for people capable of expressing a free and enlightened will? On these two crucial points, the opinions expressed during the previous session had been marked by a high proportion of abstentions.

As the time to finalize the recommendations approaches, it therefore seemed useful to the Governance Committee to devote an additional hearing to these subjects. This brought together, at the end of the Friday afternoon, three experts – a pediatrician specializing in cancer, a geriatrician and a psychiatrist – for an hour and a half of exchanges with the participants among the most fascinating that we have heard so far. here in the hemicycle of the Palais d’Iéna, seat of the Economic, Social and Environmental Council which hosts the Convention.

“Understanding the reasons for the request”

“Can a person with a mental illness still make a decision? Mohammad begins. “It depends, replies Saena Bouchez, psychiatrist at the Lariboisière hospital in Paris. Not every mental illness abolishes the patient’s ability to choose. But certain pathologies can cause problems of discernment. The role of the psychiatrist is precisely to assess, using the diagnostic tool of the interview, whether this is the case or not. »

“To get straight to the point: when can we validate a request for euthanasia of a psychiatric patient? “, insists Alexandra. “Our job is first to understand the reasons for the request and to look for ways to improve the patient’s quality of life. In my specialty, we still lack well-established criteria to define a refractory disorder that could justify a request for euthanasia,” replies Saena Bouchez calmly.

“Are there a lot of requests for death among sick children? “, continues Romain. “After 30 years in the profession, the old pediatrician that I am can assure you that it is exceptional for a child to want to die. On the other hand, it may happen that some ask for the cessation of treatments that have become too painful to bear, ”admits Jacques Grill, pediatrician at the Gustave Roussy Institute in Villejuif. “But be careful: a request can be ambivalent. A lot is decided in the relationship of trust that develops between the young patient, his family and the caregiver,” he adds.

Loneliness, “the real pathology of our society”

“And in the elderly? “continues Roman. “Requests for clear and repeated death are just as rare”, specifies Sophie Moulias, hospital geriatrician. “What these people suffer from is, of course, sensory and autonomy losses due to old age, but above all isolation, loneliness which is the real pathology of our society”, she underlines . “You can think about changing the law, what patients need is humanity. And what prevents us from being human, it is not the law but the lack of human beings”, specifies Jacques Grill, very applauded.

Precise and direct questions from the participants, clear and pedagogical answers from the great witnesses, the session will thus largely exceed the schedule listed in the program, delaying dinner time accordingly. Will it have allowed citizens to get a better idea of ​​the issues and risks of opening up active assistance in dying to these particular populations? We should check it this Saturday March 4, 2nd day of session 7 reserved for group work to take up these questions, and which must end with a new vote, scheduled for the end of the day, to try to clarify positions.

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