Assisted dying: patients will not be deemed to have “died of natural causes,” creation of a conscience clause

Amendments to delete the paragraph in question were approved by a narrow majority, with an unfavorable opinion from rapporteur Stéphane Delautrette (PS), and a sensible opinion from the government, meaning it did not steer the deputies in one direction or the other. The article was approved immediately. Deputy Nicole Dubré-Chirat (Renaissance), who initiated one of the amendments that led to the introduction of this provision in committee, explained that she wanted to "spare the families of the deceased from potential difficulties related to contractual commitments made during their lifetime."

But MPs from various groups have denounced the provision as "Orwellian" (Dominique Potier, Socialist Party), which "completely manipulates the meaning of words" (Charles Sitzenstuhl, Renaissance), and "distorts reality" (Patrick Hetzel, LR). "You are changing the meaning of words to impose an ideology, even if it means destroying reality," said RN MP Sandrine Dogor-Such, linking this to the refusal of the bill's promoters to include the terms "euthanasia" or "assisted suicide" in the law.

No obstacle to life insurance contracts

Stéphane Delautrette, for his part, argued that patients who died following deep and continuous sedation, as authorized by the 2016 Claeys-Leonetti law, were deemed to have died of natural causes. But Charles Sitzenstuhl recalled the difference between the two procedures, highlighted by the High Authority for Health, particularly with regard to the "result criterion."

Deep and continuous sedation is "continued until death due to the natural progression of the disease." While euthanasia "[…] causes the immediate death of the patient," he quoted.

Health Minister Catherine Vautrin, for her part, pointed out that it was specified later in the text that "assisted dying was not an obstacle to the conditions of life insurance contracts." She suggested "taking advantage of the parliamentary shuttle" of the text, which must then be examined in the Senate, to improve this point. One possibility would be to add "two boxes" to the list of apparent circumstances of death, one for deep and continuous sedation and one for assisted dying.

Conscience clause for doctors

In the evening, MPs largely approved (by 126 votes to 10) the framework of the "conscience clause" allowing any doctor to refuse to perform assisted dying, based on the existing rules for abortion. This decision will remain individual, despite attempts by the right to authorize a collective clause at the level of an establishment or service, with Patrick Hetzel citing "palliative care services hostile" to assisted dying and his colleague Philippe Juvin, the case of retirement homes "run by religious congregations."

"Amendments devoid of humanity" denounced by the socialist Sandrine Runel, with the aim of "rendering the law inoperative" according to the centrist Philippe Vigier (Modem), and even a risk of "republican rupture" for Frédéric Valletoux (Horizons).

However, there is no conscience clause for pharmacists who supply the lethal product, requested by opponents of the text but rejected by the Assembly earlier in the day.

Creation of a register of caregivers

The parliamentarians also approved the details of the procedure governing the administration of the substance and its aftermath. An amendment by Stéphane Delautrette was notably adopted, specifying that while the presence of a healthcare professional is not mandatory, they must be "sufficiently close and in direct view of the person."

In addition to the various criteria and steps prior to this final act, the deputies also approved the creation of a "monitoring and evaluation commission", primarily responsible for maintaining the register of caregivers providing assisted dying, and reporting to health authorities or the courts any facts falling within their jurisdiction - breaches of ethics on the one hand, and crimes and offenses on the other.