End of life: the Order of Doctors favourable to “terminal sedation”

Publié le : 19 February 2013

 In a motion made public on Thursday 14 February and adopted unanimously except for one vote following 18 months of debate, the National Council of the Order of Doctors (CNOM) has come out in favour of a change to the legislation on the end of life, stating that "terminal sedation" ought to be made possible in certain exceptional situations. In its recommendation, the CNOM points out: "A suitable, deep and terminal sedation, delivered with respect for the patient’s dignity, could be envisaged by a committee as a duty of humanity," in the case of a "prolonged agony" or "uncontrollable psychological pain.

Reacting to the publication of this view, Prof. Denys Pelerin, honorary president of the Academy of Medicine, says he was "surprised." He denounces the fact that the Council puts "prolonged agony" and "uncontrollable psychological pain" on an equal footing. "On this question the words used are essential. What is at stake is not purely semantic, it is both ethical and legal in scope." Prof. Pelerin says that this recommendation of the CNOM "risks recreating incomprehension about what ought to be done or not done in circumstances that are always delicate and painful." The "prolonged agony", he points out, corresponds to "an end of life situation where death is already near and in which there exists no treatment likely to cure the patient. And it is precisely the role of a doctor to accompany the patient until the end." In contrast, "the uncontrollable psychological pain evoked is related to the notion of ‘stopping life’, which is not at all the same thing." Prof. Pelerin adds, "this is opening the door to medically assisted suicide. […]. The mission of the doctor is not to deliberately provoke death."     
Furthermore, the CNOM recommendation points out that "the sedation could be administered to conscious patients when ‘curative treatments have become ineffective,’ but also concerning unconscious patients when they are reduced to a vegetative existence, as well as some extremely premature infants." The CNOM adds that "this definitive putting to sleep ought to occur after persistent, lucid and repeated requests of the patient", and when the person is unconscious the decision ought to be taken by a committee. However, the CNOM does not specify the functioning and the composition of this "committee", leaving it to the public authorities to define them.
Lastly, the Order of Doctors recalls that the Leonetti law is still poorly applied and it "considers that the healthcare personnel needs to be better trained in this matter, via their initial and continuing training, and calls for a national development plan for palliative care." It insists that "an information campaign ought to be launched concerning the trusted person and the anticipated directives, which should be listed in a national register or in an accessible medium’" and insists on "the importance of the clause of conscience, both concerning terminal sedation and in the hypothesis that the legislation goes further in legalising euthanasia or assisted suicide.
While Prof. Denys Pelerin says he agrees with the "duty of humanity" invoked by the CNOM, he considers that "the Leonetti law voted by the Parliament in 2005 is not sufficient in itself, for it clearly lays down that, in an end of life situation, the doctor need not use unreasonable and futile treatment," and he expresses his incomprehension that the CNOM should come out in favour of assisted suicide while mentioning that the Leonetti law "covers most of the end of life situations.

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