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Bioethic information and analysis newsletter

Following Letter

N°75 - March 2006

On 26 February 2006, the judge of inquiry from Boulogne-sur-Mer put an end to the Humbert report non-suiting Marie Humbert and the anaesthetist who caused the death of Vincent Humbert, who was left tetraplegic after a road accident.

Accepted felonious homicide

By reaffirming the absolute character of the prohibition to kill, the judge confirmed that the material and legal element of the infraction was well constituted. Actually, no one contested that the young man’s mother had injected barbiturates in his son’s feeding tube with the intention of killing him. As this euthanasia failed, Doctor Chaussoy, head of the intensive care unit of the heliotherapy centre in Berck-sur-Mer, after having unplugged the artificial respirator, administrated potassium chloride, a lethal product which caused Vincent Humbert’s death. This injection is really in contradiction with article 38 of the code of medical deontology which reminds that a physician has no right to deliberately cause the death.

Liability waiver

However, taking into account the mental element of the infraction, the judge considered that he could be the cause of a liability waiver due to the “constraint” (affective blackmail, media pressure) which acted on the actors of this homicide. Then the magistrate decided that there was no reason to refer the affair to an Assize Court and that the Humbert’s affair was definitely closed. If Doctor Chaussoy is pleased about it, he claimed responsibility and affirmed that today, he would act the same way; Marie Humbert, herself, regrets the decision, because she would have preferred that the justice agreed she was right.

A subtle decision

The reasoning of the judge of inquiry leaves us perplex because he left an arbitrary part as for the medical body as for tribunals and let think that euthanasia can be accepted through a back door. Is it not worrying that a magistrate renounces before a tribunal to judge an act as serious as a felonious homicide?

If this decision, which is circumspect, has at least the merit of calming things down and of wanting to close the debate on euthanasia, it does not prevent Marie Humbert to carry on fighting for the recognition of the exception of euthanasia for similar cases. She already announced that a bill in this direction would be introduced to the Parliament within the next weeks.  

Euthanasia, therapeutic obstinacy: definition reminder

Euthanasia is an action or an omission with the first intention to kill an ill patient to eliminate the pain. Euthanasia is an imposed death as opposed to natural death.

Therapeutic obstinacy

It is the continuation of a heavy treatment which becomes disproportionate regarding the benefit given to the patient. The law called Léonetti of 22 April 2005 prefers to talk about irrational obstinacy.

The distinction between euthanasia and the interruption of disproportionate care is essential. “The doctor has no right to deliberately cause the death » but he must “avoid any irrational obstinacy in the investigations or the therapeutic” (art. 37 and 38 of the code of medical deontology). Instead of maintaining a treatment which proves its inefficiency, the doctor must do his best to allow the patient to have access to palliative care. 

Palliative care

To accompany ill patient and to use analgesics to relieve the pain, even if it consists in taking risks that can be sometimes fatal. Here the purpose is not to kill the patient.

Active/passive euthanasia

The distinction between active euthanasia and passive euthanasia is not necessary and skews the debate. Either there is euthanasia by action or omission (by injecting a lethal product or by refraining from administrating a useful treatment), that is to say a wish to put an end to the patient’s life, or there is a wish to accompany the patient by reducing his/her pains (by stopping the therapeutic obstinacy to give palliative cares).

« Euthanasia of exception »

Notion proposed by the National Consultative Bioethics Committee in order to allow, in certain exceptional cases, causing the death of an ill patient (Report n°63, 27 January 2000). We remember that abortion only had to be performed in hospitals to respond to an exceptional situation, today it often replaces contraception... Such an easement would not shield euthanasia in a society where life expectancy is increasing with its pains and its multiple dependencies. Today, the ADMD (Association with the right to die with dignity) militates, with Marie Humbert, for a law in favour of "exception of euthanasia".

Abortion is prohibited in South Dakota

On 6 March 2006, South Dakota Governor promulgated a law which bans abortion in all cases except when the life of the mother is in danger. From July 2006, a doctor who aborts a woman will be liable to 5 year jail and 5000 dollar fine.

Assault against Roe vs Wade Judgement

The new law goes against the judgement of the Supreme Court of the United States in 1973 (Roe vs Wade) which authorized abortion in the name of the respect of woman private life. South Dakota Governor declared: « we launch a direct frontal assault on Roe vs Wade Judgement », by comparing the prohibition of abortion to the abolition of racial segregation by the Supreme Court in 1954. As long as it will not reconsider its decision of 1973, the Supreme Court does not recognize to the States the capacity to legislate on abortion. The promoters of the new adopted law in South Dakota hope that its contradiction with the jurisprudence of the Supreme Court will allow it to pronounce in favour of life, by annulling its jurisprudence. The pro-life side relies on the recent nominations of two supreme judges, John Roberts and Samuel Alito.

Other laws in preparation

States as Georgia, Ohio, South Carolina, Tennessee, Mississippi and Indiana are also preparing texts calling abortion into question. The end of Roe vs Wade jurisprudence could leave to each state the task to legislate on abortion issue.

The RU 486 abortion pill: calling for vigilance for women

The abortion pill, also called RU 486, is the object of numerous debates worldwide because it is far from being inoffensive for women health. We remind that the mifepristone (RU 486) is prescribed in the case of a non-hospitalized and non-invasive pregnancy termination (IVG) before the 49^th day of amenorrhea.

Seven death recorded in 2004

Between August 2001 and January 2004, seven deaths have been reported in Canada, in the United States, in United Kingdom, in Sweden and in Spain. To this date, the Food and Drug Administration (FDA), the American Agency in charge of drug control, already received 676 declarations of side effects associated to the mifepristone, amongst which 17 extra-uterine pregnancies, 72 serious haemorrhages and 7 cases of serious infections.

2005: first official alarm
The scientific journal New England Journal of Medicine published ⁽¹⁾ in December 2005 an article about 4 young women who died after a pregnancy termination using the RU 486.

An autopsy and bacteriologic researches have been performed on post-mortem sampled tissues from patients. In none of them, the autopsy revealed "products of conception" in the uterus, giving to understand that this complication is not associated with an incomplete abortion. Besides, the results showed an endometrial infection with Clostridium sordelli.

Vigilance in the United States
For the time being, the authors of the publication and the FDA recommend the vigilance for the physicians and the modification of the instructions for the mifepristone to prevent patient from this serious complication.

In the United States, those who call the full market approval for the mifepristone (in 2000) into question, point out that, as 460000 pregnancy terminations using a drug have been performed during these last years in USA, the risk of death by toxic shock syndrome is 1/100000 and maybe more. However, this frequency is above the mortality observed after early surgical abortion (before the 8^th week of gestation) which would be 0.1/100,000.

Debate in Australia and in Italy
The RU 486 is legal in 35 countries as Great Britain, France (since 1988), the United States, Greece, Spain and New Zealand.

In Australia, the Parliament voted in February 2006, the suppression of the prohibition of the abortion pill RU 486 despite the opposition of Prime Minister, John Howard and of Health Minister, Tony Abbot.

In Italy, militants try to obtain the authorisation of the abortion pill RU 486. Health Minister, Francesco Storace, authorized it and then suspended it in September after a first experimentation in Turin. Significant pressures have been made on the minister so that he authorises it again. Toscana authorizes its hospitals to prescribe the RU 486 without Ministry green light. However, according to a parliamentary report, hesitations on pregnancy termination, whatever the method, are still numerous, including in medical body.

March 2006: new alarm
In a communiqué from last 17 March, the Food and Drug Administration warned again against the RU 486 after the death of two other women who used it. Although the causes of the death of these women are not confirmed, the FDA called the manufacturing laboratory, Darco Laboratories. The Agency reminds that all physicians and their patients must be aware of their risk incurred by using RU 486 and asks women who used it to be particularly vigilant for side effects.

The Family Planning also calls for prudence.

1 - Fischer M et coll. : « Fatal toxic shock syndrome associated with Clostridium sordelli after medical abortion. » New England Journal of Medicine 2005 ; 353 : 2352-60