The two paths

2012-02-22 L’Osservatore Romano

The role of L'Observatoire Nationale de la fin de la vie [national observer of the end of life] – founded in France by a decree of 19 February 2010 is to identify the information needs of  public and health-care professionals on the basis of the study of conditions at the end of life and to encourage medical research in this area. The 2011 report has recently been published and may be consulted on the portal of the French Government. It is the first one since L'Observatoire's birth.

The almost 300-page document, compiled by doctors, epidemiologists, nurses, psychologists and sociologists, who work in various capacities in the field of palliative medicine, is destined for the Ministry of Health and for Parliament but gives anyone the possibility of getting an idea of the situation and the problems encountered on the subject of the end of life. What stands out in the pages of the report is the scant knowledge and even more insufficient application of the Leonetti Law – the  legislative measure unanimously voted in by the National Assembly – which, since 2005, has integrated  the protection of the rights of the terminally ill into the public health code.

Even before this serious omission, however, was the marked delay in acquiring knowledge of the principles of palliative medicine itself and hence of that “troisième voie” which makes it possible to rule out with humanity and competence the disproportion of treatments and the false solution of euthanasia: the overall number of trained health-care professionals with post-graduate degrees in palliative treatment – the report stresses – “so far remains low”. The situation is even worse if one considers freelance doctors alone: of these, only 18,809 (15 per cent of the total 122,778) obtained funding for access to the training and among them only 432 (just over 2 per cent) chose this subject (the end of life) in which to qualify.

In the face of all this, certain elements in the current debate leave particularly perplexed those who for years have nursed sick people nearing the end of their life. Marie de Hennezel, a psychologist and writer well known not only in France for several works of reference in the area of palliative medicine, wrote in an article in Le Monde of 17 February entitled: “Let us begin to apply the law before discussing euthanasia”. In this article she also states publicly that she has recently been relieved of her role as a member of the coordinating committee of L'Observatoire of the end of life. “The Leonetti law is still badly applied and the French are suffering from this”, the specialist writes, advocating as a priority “concrete actions for a better understanding and application of the law” in the face of an attitude, even in L'Observatoire, that is excessively descriptive and hardly functional.

How could it be possible that a country such as France, which has one of the most accurate, detailed and modern bodies of legislation in this sector, not put “every effort into teaching this law badly known to the public and to general practitioners”, Marie de Hennezel wrote, “by organizing forums in all the health-care structures”? Why is the recent debate with a view to the upcoming presidential elections seeing a re-emergence of the euthanasic temptation, even in the presence of a law which, among other things, permits anyone able to express his or her own disagreement with regard to treatment deemed extraordinary to renounce it?

The cultural revolution proposed by the French psychologist is moving in the direction of greater respect for the rights of terminal patients, paradoxically the same people as those invoked by the champions of euthanasia. The two paths, however, diverge: on the first one walks to the end in the exercise of a vital and responsible freedom, on the second one is left alone, with the illusion of being free to choose death.

Ferdinando Cancelli