From artificial feeding withdrawal to euthanasia

Publié le 30 Apr, 2008

Head of the commission for bioethics of the diocese of Fréjus-Toulon, Pierre-Olivier Arduin analyses the status conferred to artificial feeding by the end of life law currently in force. This “detail” could turn against Leonetti Law and threaten the precarious balance.

 

Treatment or care?

 

The law of 22nd April 2005 grants the patient, whether she/he is nearing the end of life or not, the freedom to refuse “any treatment”, the text expressly including in this provision the withdrawal of artificial feeding. What contest various bioethicians, the assisted feeding does not seek to thwart an organic pathology affecting this function but to alleviate a simply mechanical problem by responding to a basic need of the organism. Moreover, they suggest replacing the expression “assisted feeding” by “medical nutrition” in order to well insist on its ordinary character for the preservation of life. 

 

Therefore, in no case, here we can talk about unreasonable obstinacy or about disproportionate treatment “because precisely the medical feeding can be continued during a long time, without major side effects and with great efficacy to support patient’s life, what is exactly the definition of a proportionate care“. To let die of inanition a patient who cannot feed himself by withdrawing nutriment administration, is a euthanasia act, insofar as the death is wanted for itself as we can prevent it, without being a matter of therapeutic obstinacy. Director of the ethical centre of Cochin hospital, Véronique Fournier recognises that “feeding and hydration withdrawal can be decided with the intention to let die“1. “Rather than talking about disproportionate care, may we admit that it is the patient’s life which seems “disproportionate” due to its weak “quality” ?“, wonders Pierre-Olivier Arduin.

 

Pro-euthanasia strategy

 

This “burning” question about artificial feeding withdrawal is, since a long time, one of the levers of pro-euthanasia militants. Thus, in September 1984, during the 5th Global Conference of the associations “for the right to die with dignity”, Helga Kube, Australian, yet indicated the way to obtain the decriminalisation of euthanasia : “if we can obtain from people that they accept treatment and care withdrawal, particularly the interruption of any feeding, they will see what painful way is to die and then will accept, for patient welfare, the lethal injection“. 

 

“The Pierra’s affair”

 

It is exactly this method which has been used to shake public opinion with Hervé Pierra’s euthanasia. 

Young men with psychological fragility, Hervé Pierra regularly smoked cannabis, and then schizophrenia appeared, which obliged him to take medicines generating impotence. One day, his father who was fire chief, found him hanged and achieved to save him. But the lack of oxygenation of his brain left Hervé in a persistent vegetative state. “Of course we thought about ending his life, but we knew that we could have not survived to this act“, his mother told. But, at the same time, France debated the “right to die”, after Marie Humbert “euthanized” her son Vincent, on 30th September 2003. Then Paul and Danièle Pierra followed “to the smallest detail” the “Humbert’s affair” as well as the works of the parliamentarian Commission on the end of life. At the same time they joined the Association for “the right to die with dignity” (ADMD) and the association “Faut qu’on s’active”, founded by Marie Humbert. “We were very hopeful for Hervé’s liberation“, Mr. Pierra said. 

 

Jus after the promulgation of Leonetti law on 22nd April 2005, Pierra spouses asked the withdrawal of the feeding tube from their son, from now on accepted as a treatment that it is possible to stop. First the medical team refused, reminding that “the assisted feeding is a comfort care and not a treatment” and that “removing it will be equal to euthanasia”. After 14 months of confrontation, finally Dr Régis Aubry, chairman of the national committee for palliative care development, accepting the parents demand, enabled Hervé’s life support equipment to be disconnected. Like Terry Schiavo who died on 31st March 2005 in USA (see Gènéthique n°64), Hervé Pierra starved for 6 days before dying in dreadful convulsions. 

 

We called it a scandal of a dirty death that Leonetti law authorises“, we accuse of hypocrisy a law which refuses the lethal injection, we implicate the medical team in charge of Hervé Pierra… but, here, it is the new status of artificial feeding which is the intimate drive of this human drama.

 

Today, in France, the strategy of pro-euthanasia militants aims at denouncing the ambiguity of the current law, calling for “the fatal choice of legal euthanasia supposed to remedy“. For Pierre-Olivier Arduin, “the legislator falls into trap of approximations which make the game of their rivals“, here the supporters of euthanasia decriminalisation…

 

1. Le Monde, 19/03/08

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