A few weeks before the publication of its report on the end of life, the National Ethics Committee wishes to revise the collegial procedure and involve the family more. A bad idea, according to Jean Leonetti.
The National Consultative Ethics Committee (CCNE) is preparing to publish its report on end of life. In a notice published on its website, in the context of the Vincent Lambert affair, he pleads for a review of the collegial procedure provided for by the Leonetti law, and wishes to involve the family more in the decision to stop the care of a sick person.
The doctor, “judge and party”
The text addresses the “central question of judgment for others” – when a patient can no longer express himself. An essential point, raised by the Vincent Lambert case but also by that of the great premature baby of Poitiers. The authors ask themselves: “Do we have to admit that a third party can know if the life of this person should continue to be lived, and that he can judge the quality of his life? “
For the members of the ethics committee, the collegial procedure places the doctor in a “particularly difficult” situation. The only person empowered to decide whether to stop or continue treatment, he would be both “judge and party”. “The decision, in such a situation of uncertainty, cannot be a matter of medical expertise alone, and, for this reason, should not be taken by the doctor alone,” they write.
Towards a “collective decision”
For the CCNE, the deliberation should not be conceived as “a collegial discussion between experts” and must be “implemented in a much broader way”. From a “collective deliberation” provided for by the Leonetti law, he therefore wishes to move on to a “collective decision”, taken on a case-by-case basis with nursing staff, family and relatives.
But the Vincent Lambert case has shown how difficult it can be to get consensus on the end-of-life decision, including within the family. The authors of the text therefore plead for a process of “mediation” in the event of disagreement, involving a third person “impartial, neutral, without decision-making power” and independent of the hospital administration.
“There will only be losers”
But for Jean Leonetti, author of the law on the end of life, revising the collegial procedure would be a mistake. “From an ethical and deontological point of view, we have to think about: how to apply a collective decision? If there are differing opinions, they should be put to a vote – of family against doctors, or within the disassociated medical team, or, worse, within the same family, with a party that would have “Won” against the other party… I let you imagine how violent and very negative that would be. There would only be losers in this operation. », He believes.
The deputy for Alpes-Maritimes insists that the concept of collective decision “does not correspond to any legal reality”. Even if “the non-medical arguments weigh”, he considers that the decision to stop treatment must be based on exclusively medical reasons, devoid of any passion. The debate is open.
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