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Bioethic information and analysis newsletter

Following Letter

N°56 - August 2004

En fin de vie. Répondre aux désirs profonds des personnes *
by Dr. Bruno Cadart
* At the end of life. How to respond to people's deepest wishes

A guide to accompaniment
Accompaniment of people at the end of their lives is neither a technique nor a fashion, nor a new method for "treating death". There are no magic recipes, but there are some references which may help us to understand the questions asked by the sick and aged at the ends of their lives.
In this book, the author, Dr Bruno Cadart, who is also a theologian and priest, does not attempt to find a reason for suffering, but rather to explain the way in which the sick person's family circle will live with them until their death.

Based on a doctoral thesis in medicine titled "Analysis of a few questions raised by the implementation of accompaniment of the dying in long-stay geriatric wards" this book is a true guide to accompaniment which is both practical and enthralling.
The chapter on the treatment of pain was updated in 2004 in an attempt at countering all the misinformed objections which continue to seep into public opinion and which mean that even today, patients continue to suffer in a way which is totally unacceptable either in hospitals or at home.

Some essential questions
Written in collaboration with patients, their families, associations and a whole medical team, this book is all the easier to read in that its thinking is unfurled through some thirty narratives and considers a number of essential questions : How to take into account all the needs of the patient ? What leads to relentless medical therapy and how can it be avoided ? What is euthanasia and what is it that leads up to requesting it ? How to respond to it ? What words to use with the patients and with their families ? How not to content oneself with treating the pain, but to follow a "spiritual" path, enabling the patient to give a meaning to what they are going through here and now ?

Events endured to the very end
Most of these reports and events lived through, concern patients at the end of their lives, or who are seriously ill. One should read in particular four narratives concerning the accompaniment of patients for whom the major problem was not physical pain, but gradual paralysis leading, over a few months, to death by suffocation without being able to communicate. This disease, amyotrophic lateral sclerosis (ALS) or Charcot-Marie-Tooth disease, is often taken as an example to call for the legalisation of euthanasia.

For medical teams and a broad section of the public
This book will enlighten both professional medical teams and a much broader cross-section of the public, and shows the essential aspects of the prohibition of euthanasia in order to be able to endure the accompaniment. It will also help the sick as well as their families and the caring teams, especially nurses. It also provides in an appendix, a list of Internet sites which may be used to obtain information on the treatment of pain and on palliative care.

En fin de vie. Répondre aux désirs profonds des personnes by Dr. Bruno Cadart in collaboration with Dr. Annick Sachet and Dr. Pascale Fouassier. Publisher: Editions Ressources, 20

Réflexions sur... Mourir dans la dignité *  by Dr. Bruno Cadart
* Thoughts on ... Dying with dignity

Another book by Dr. Bruno Cadart is worthy of note. It is a theological degree dissertation titled "What dialogue is possible between the Association for the right to live in dignity (A.D.M.D.) and the Roman Catholic Church on the concept of dignity?"

Two concepts of "dying with dignity"
The author attempts to clarify the debate between two fundamentally opposed schools of thought. On the one hand the associations which are promoting euthanasia or assisted suicide under the heading of "dying with dignity". On the other, those fighting for accompaniment of patients along the lines of palliative care and in application of the prohibition of euthanasia. Whether one is a believer or not, what are the stakes in the debate on euthanasia ? What concept of dignity is assumed by each of these positions ?
Bruno Cadart presents the A.D.M.D. from what it says of itself. He explains his philosophy and concept of dignity.

How to dialogue without being fooled
This book presents the A.D.M.D.'s stoic concept of dignity compared with the Catholic Church's concept of the dignity of Man, as expressed in Gaudium et Spes. The right to die which, spontaneously, appears as an element of freedom, in fact imprisons man insofar as he of his own accord destroyed his humanity and cut himself off from the divine. Conversely, the prohibition of suicide and of euthanasia is liberating. It opens mankind to a new dimension of others, unsuspected by himself, and opens it to the divine.
The same book brings food for thought, which is essential to those who wish to go beyond the simplistic impassioned presentations and who wish to better understand the stakes of euthanasia as defended by those who support the movement for palliative care, as defended also by the Catholic Church.
At a time when in France, the debate on euthanasia is taking shape, it is urgent to understand the philosophical foundations of the different positions in order to be able to dialogue without being fooled.

Réflexions sur... Mourir dans la dignité by Dr. Bruno Cadart. Publisher: Editions Ressources, 20

Nous t'avons tant aimé. L'euthanasie, l'impossible loi * by Bernard Debré
* We loved you so much. Euthanasia, the impossible law

A majority of French people would be in favour of a law on euthanasia. But are they truly aware of the definition of the term "euthanasia»? "Euthanasia is often supported ... except when one is personally confronted with it!" observes Professor Bernard Debré in his book which describes the diversity of situations to show how it could not possibly be controlled uniformly by any law.

Dying with dignity
It is not death that is undignified, it is the absence of accompaniment. That is the strange paradox of the 21st century: the presenting of euthanasia as progress, whereas at last we have the means to eradicate physical pain and in many cases even psychological suffering. How could a law not be ambiguous when one appreciates the double meaning of the term "dignity»? And who has the right to decide not only about the dignity of another person, but also the means to be employed to ensure that dignity? And finally, surely the main question concerns our own dignity? What we dislike about old people, the infirm, is surely that they are beneath our own dignity?
"Is it not a fact that they are beyond our criteria and that they force on us the unbearable image of our own future ?"

The predictable deviance
The first deviance generated by a law on euthanasia would be financial: given that the last year of every French person's life costs more to the community than their entire previous life, why not do away with that last year? Then comes the eugenic deviance, with the list of pathologies which would justify euthanasia: severe handicap, senile dementia, cancer, terminal phases of aids etc. And why not trisomic children, fat people, ugly people etc.? Surely such a State eugenistic deviance could encourage, among others, a criminogenous deviance of society, even without considering the greater jurisdictionalisation of a society, suddenly becoming an empire of suspicion : was this patient exterminated by compassion or because his neighbours were fed up with waiting for the end of their life annuity ? And the clinic manager, whose only concern is to free some beds in order to increase the profits of his establishment, could he not have extorted a signature from that old man?

Destroying the sanctity of pre-natal life
At the other end of the chain, at the beginning of life, on the other hand, Bernard Debré adopts a position in support of using the embryo and foetus. The author explains that the genetic revolution gives us the immense power of modifying life, from conception to birth; he approves both the authorisation of abortions and research on supernumerary embryos, so-called therapeutic cloning and the conception of "medicine babies", so long as society is capable also of defending the weakest and the handicapped children whose parents have chosen to let live. "It is birth which now founds society man, whose life becomes sacred in that it is a link of society." Which we may be allowed to regret...

Nous t'avons tant aimé. L'euthanasie, l'impossible loi by Professor Bernard Debré, publisher : Le Cherche Midi - 2004

A scientific cry of anger
This book is a scientific cry of anger denouncing the most terrible acts of violence committed against women, acts which are committed against third world women and which are carefully concealed for financial and demographic reasons.
First of all obstetric violence : 600,000 women die every year during childbirth due to lack of medication. On the other hand, money arrives in lorry-loads for the dissemination of hazardous contraceptive methods which are unheard of in France, Depo-provera and Norplant, for experimentation into anti-pregnancy vaccines and to impose, often regardless of the most elementary rules of medical ethics, a Quinacrine-based chemical sterilisation method. The book finally denounces the acts of violence committed against women's bodies as a sexual object, from mutilations to prostitution, from pornography and women's bodies being sold for spare parts, to the dealing in ovules and hiring of wombs... The author concludes finally on scholastic discrimination and lack of schooling for girls, possibly the worst form of violence due to the structural adjustment programmes imposed by the IMF which requires poor nations to economise on health and education.
The author initially practised as a midwife in Algeria, and subsequently became a doctor specialised in epidemiology (social medicine).

Violences et corps des femmes du tiers-monde, le droit de vivre pour celles qui donnent la vie, by Jacqueline des Forts. Publisher : Harmattan - 2002