Assisted dying: MPs debate criteria, almost unchanged

The second week of discussions on the end of life began on Monday, May 19 at the Palais-Bourbon, with one of the most divisive articles of the bill on assisted dying . The fourth. Or, for those who are not familiar with the text ardently defended by the deputy (Les Démocrates) Olivier Falorni: the one describing the five cumulative criteria to be met to be eligible. "Balanced" conditions, asserts the general rapporteur. Sufficiently "strict" for part of the hemicycle; too "vague" and opening the door to abuses, argued the opponents of the text. Overall, they did not have a good cause. With the exception of one subject that has long agitated the National Assembly: the consideration of psychological suffering.

To request assisted dying, the current text sets out several conditions. There is age (18 years) – approved Saturday evening – and nationality (French or stable residence). You must also be suffering from “a serious and incurable condition, whatever the cause, which is life-threatening, in an advanced or terminal phase” . The version from the commission provided for the presence of “physical or psychological suffering” , “either resistant to treatment, or unbearable depending on the person” if they have decided not to receive or to stop their treatment. Protest from parliamentarians: this wording could suggest that psychological suffering alone could make the request eligible. “We have alerts from psychologists, psychiatrists, psychoanalysts […] their daily role is to convince their patients that there is [a way out for them]. "We would send the wrong message," said Annie Vidal (Ensemble pour la République) – who is also co-rapporteur of the bill on palliative care. "There is a fluctuation in willpower, psychological suffering can be constant or temporary, it is a significant element," added her LR colleague Thibault Bazin.

Not enough to convince Olivier Falorni, nor the Minister of Health, Catherine Vautrin. "Psychological suffering in itself does not in any case open the right to assisted dying, it must be linked to the serious and incurable condition," repeated the general rapporteur. An argument supported by the minister: "We are in the context of a patient in a care pathway," "suffering from a serious and incurable condition that threatens their life: I do not want anyone to think that we are only looking at psychological pain. " Another objection from LR Philippe Juvin , keen to point out the risk of including patients with psychiatric disorders: "A schizophrenic who makes multiple suicide attempts is serious, incurable !" The implication: these attempts would be life-threatening. "That makes no sense," dismissed Olivier Falorni.

The deputies nevertheless approved two amendments, brought by Horizons, Liot and LR parliamentarians: at this stage, psychological suffering must therefore be "constant" and cannot, "alone" , "in any case allow one to benefit from assisted dying" . Against the advice of the government and the rapporteurs, therefore. Because throughout the debates, Olivier Falorni maintained his position, without concession: "The current version is the best possible writing", with a "patiently woven balance" . Catherine Vautrin's position is broadly identical.

The government's only amendment, approved earlier in the day and supported by the rapporteurs, aimed to clarify another sticking point: the definition of the "advanced phase" of the condition. The minister's addition consisted primarily of repeating the definition put forward earlier this month by the High Authority for Health : the advanced phase is "the entry into an irreversible process marked by the worsening of the sick person's health, which affects their quality of life."

A satisfactory definition for some; still too vague for others. "Do we want to open [assisted dying] to people at the end of their lives, or those who still have several years to live?" inquired Philippe Juvin. "But under what conditions could [they] live? Under what conditions would we want to force them to live if we know they are going to die?" protested Stéphane Delautrette. According to the Socialist Party representative, the "real question" is that of " suffering. " "You want us to impose [it] on these people [...] as long as they are not in agony. I think that is not humane. "

The last criterion, being "able to express one's wishes freely and with full knowledge of one's wishes," was examined on Monday evening. It was kept as is. Some parliamentarians wanted to add the assurance of prior access to palliative care (or even to care at all). The argument brought together elected officials from both the right and the left, while medical deserts, long appointment times, and the state of public hospitals have become a chronic problem without improvement for years. Yannick Monnet (Democratic and Republican Left) even argued for making it a criterion in itself. His socialist colleague, Dominique Potier, agreed, pointing out the risk of "republican inequality," that those without access to care might resort to assisted dying for lack of anything better. The rapporteurs of the text and the minister judged that this element is contained in future provisions of the text.

These amendments were all rejected. As were those aimed at excluding all persons under judicial protection, suffering from psychiatric disorders or intellectual disabilities. Protection for the most vulnerable , argued their defenders. A risk of stigmatization, replied Olivier Falorni. Once again, the general rapporteur was keen to emphasize the balance of his text (beyond just Article 4): as it stands, people must be deemed "capable" of expressing their free and informed will , the procedure "provides for the reiteration of the will", and excludes any person "whose discernment is seriously impaired by an illness during the process".

Despite the disagreements, the tone remained consistent with that of previous days: calm. A few protests were made here and there in a rather sparsely populated chamber, and there was criticism of the hundred or so amendments tabled by Gérault Verny—signs of possible obstruction, which the Ciottist MP denies—but no outbursts. Monday's various votes still need to be confirmed by a vote on the entire article. 1,446 amendments to the entire text still need to be examined. Debates resume this Tuesday afternoon.