European Network of Health Care Chaplaincy
Conseil National des Aumôneries des Hôpitaux – France
The French law of April 22, 2005 (Leonetti's law) brings new rights to patients and clarifies medical practices regarding end of life care.
This new law prohibits unreasonable obstinacy in investigations or therapeutics and authorizes the withholding or withdrawal of treatments when they appear "useless, disproportionate or having no other effect than solely the artificial preservation of life".
Relief from pain and access to palliative care become a fundamental right of patients.
With regard to pain control, the law also allows doctors to dispense to patients "in an advanced or final phase of a serious and incurable affliction" anti-pain treatments as needed, even if these treatments, as a side effect, hasten their death.
The drafting of advance directives regarding end of life constitutes a new right of patients. The decision to withdraw or withhold a treatment from patients unable to express their will has to take into account the wishes they might have expressed through advance directives, and/or the wishes of a trusted person or, lastly, of the family. Before making any decision, physicians should respect a collegial medical procedure. Euthanasia defined as the act of terminating one's life on a patient's explicit request remains illegal. Assisted suicide remains illegal as well.
The Catholic Church in France considers this law as well balanced since it promotes pain relief and palliative cares and rejects euthanasia and assisted suicide. This law by prohibiting useless, disproportionate treatments and unreasonable obstinacy basically respects the acceptation of our human condition when confronted to death.
In his letter : Accepter la mort, maintenir les soins auprès du malade, (septembre 2004) Monseigneur Jean-Pierre Ricard Président de la Conférence des évêques de France, states :
It may happen, for a patient, to refuse all treatments related to his terminally sick body with the exception of “comfort care”. The medical body will have to respect his decision after having exhausted all dialogue resources. In the other cases, current treatments might be maintained, and it will be particularly important to seek the most appropriate feeding means or at least the means to deliver nutritive elements to him. Acting differently would display evidence of loss of interest for the patient or worse his complete abandonment.
There is no real tension in the chaplains’ practice as a direct result of Léonetti’s law. This law is generally considered as very appropriate and an excellent support of discussion/decision in difficult cases. The only difficulty remains the incomplete understanding of the law within the general public or in some medical instances, and its deliberate misinterpretation by pro-euthanasia partisans. Sometimes, too, it’s difficult for chaplains to be recognized as real partners in the patients’ global care. It seems to be often more connection between this problem and secularity than beween this problem and professional competences.
November 21 2009
Commission de l'Aumônerie des Etablissements Sanitaires et Médico-sociaux
The Law Leonetti
The law Leonetti, voted on April 22 2005 in France, came up during strong public debate on the legalisation of euthanasia. This debate took place over a period of four years (2000-2004) after the wilful death of a young man who had been hospitalised following serious injuries and had been left severely handicapped, Vincent Humbert. This law was proposed in answer to many questions brought up at that time even though it does not advocate or legalise euthanasia.
The main foundations of this law concern
1. Pain relief and promotion of palliative care
2. The respect of the patient’s choice to not continue or to stop medical treatment even if such a choice will entail death.
The law very clearly states that this respect is unconditional and concerns all patients, end-of-life patients as well as others. However, this refusal is not applied immediately upon request. The doctor must make sure, according to specific procedures, that the patient’s decision is final. In the case of a final decision, palliative care must always be proposed to the patient as an option. There is only one exception according to the law : an unconscious patient who needs emergency treatment will always receive it.
3. The possibility to stop treatment which prolongs life and/or which does not improve the quality of life.
In the case of a patient who is no longer conscious, the medical team is now allowed to stop such treatment according to this law. In France, such a decision must be collegial, made by the medical team. The family and the person designated as the person of confidence or other persons close to the patient shall be consulted but have no decisional power. This law explicates all details of this procedure. This law also provides a new possibility for French citizens. They can express ahead of time, in writing, their wishes end desires concerning end- of-life treatment.. These declarations have a three-year validity.