France

• September 2022: End-of-life

The issue of the end of life has been regularly addressed in France for the past two decades: with Law No. 99-477 of 9 June 1999 aimed at guaranteeing the right to access to palliative care, and then Law No. 2016-87 of 2 February 2016 creating new rights for patients and people at the end of life (known as the Claeys-Leonetti Law).
It has gained importance in France over the last few years, first with the Falorni Report on the end-of-life and the proposed law giving the right to a free and chosen end of life, in April 2021.
Recently, the publication of a book denouncing the poor living conditions of elderly residents in private clinics and Ehpads (accommodation establishments for dependent elderly people) managed by the Orpea group has re-launched the debate (Victor Castanet, Les fossoyeurs, Fayard, 2022).
The National Consultative Ethics Committee for Life Sciences and Health, founded in 1983, recently published an opinion on Ethical issues relating to end-of-life situations.
Among other things, the committee said that "active assistance in dying" could be applied in France, but "under certain strict conditions". President Emmanuel Macron has announced a consultation with a view to a possible law by the end of 2023.
Several European countries have already legislated on end-of-life issues.

Further information:
– Press release of the Comité consultatif national d’éthique pour les sciences de la vie et la santé
– Comité consultatif national d’éthique pour les sciences de la vie et la santé, Avis 139 sur les questions éthiques relatives aux situations de fin de vie: autonomie et solidarité
– Olivier Falorni, Rapport fait au nom de la Commission des affaires sociales sur la proposition de loi donnant le droit à une fin de vie libre et choisie, April 2021
– Réforme, "Fin de vie en France, 20 ans de débat et de lois", September 2022

Anne-Laure Zwilling

• May 2019: The Vincent Lambert case and the end of life

The case of Vincent Lambert has just undergone a new twist. Vincent Lambert, who is now a quadriplegic following a traffic accident in 2008, is totally dependent, artificially fed and hydrated and in a state of minimal consciousness since 2011. His case has become emblematic of the end-of-life debate.
In France, the end of life is regulated by Act No. 2016-87 of 2 February 2016creating new rights for patients and persons at the end of life. This act, known as the Claeys-Leonetti Act, introduced a right to "deep and continuous sedation until death" for terminally ill patients and provides that care should be stopped if there is "unreasonable obstinacy", "when care appears unnecessary, disproportionate or has no other effect than the artificial maintenance of life", in order to avoid therapeutic persecution. In addition, an opinion of the Conseil économique, social et environnemental (Economic, Social and Environmental Council) recommended on 10 April 2018 that persons suffering from an incurable disease in "advanced or terminal phase", and whose physical or psychological suffering is "impossible to soothe", should have a right to benefit from "explicitly lethal deep sedation", a provision qualified as "conditional depenalization of assistance to die" (see Le Monde, 10 April 2018).

However, the question of the end of life is still being discussed. This debate goes far beyond the religious issue. In the case of Vincent Lambert, however, it is coloured by the religious convictions of one of the parties: this case mainly opposes Vincent Lambert’s wife to his parents, in particular his mother, close to the brotherhood of Saint Pius X, a traditionalist Catholic movement at odds with the Vatican. On behalf of their convictions, parents oppose decisions to stop treatment. Thus, twice, in 2013 and again in 2014, the nursing staff decided to stop treatment in agreement with V. Lambert’s wife, but the parents referred to an administrative court which annulled this decision both times.
In January 2014, V. Lambert’s wife appealed to the Conseil d’Etat, which, after an expert opinion, ruled that the decision to stop treatment in June 2014 was legal. The parents then referred the matter to the European Court of Human Rights (ECHR), which asked "the French government to suspend the execution of the judgment delivered by the Council of State" until it can rule (see the current debate of 24 June 2014).
The ECHR delivered a judgment on 5 June 2015, considering that the procedure adopted to stop keeping Vincent Lambert alive was in accordance with Article 2 of the European Convention on Human Rights (right to life). This decision was condemned by the French bishops who consider it to be an assisted suicide rather than a medical stop. (La Croix, 11 June 2016.)
In 2018, Vincent Lambert’s medical team again decided to stop treatment: a report by experts appointed by the Châlons-en-Champagne (Marne) administrative court confirmed Vincent Lambert’s "chronic vegetative state", described as "irreversible". (Le Monde, 22 November 2018.)
The Church considered this decision to stop the treatment unacceptable, by a public declaration of the bioethics group of the French Bishops’ Conference. The Archbishop of Reims and his auxiliary bishop declared that they prayed "so that our French society does not commit itself to the path of euthanasia". (See their declaration.)
The parents again file appeals with the Council of State and the ECHR, which are rejected: the Council of State ruled that the collegial decision taken by the Reims University Hospital to stop care was legal, in a decision handed down on Wednesday 24 April 2019. And on 20 May 2019, the European Court of Human Rights decided to refuse the request for interim measures submitted to it (Lambert and Others v. France, Application No. 21675/19).
On 15 May 2019, the Paris Administrative Court rejected an appeal by Vincent Lambert’s parents, who requested the suspension of the procedure for stopping care pending the examination of their complaint lodged with the UN International Committee on the Rights of Persons with Disabilities (CIDPH). The court explained its rejection on the grounds that this committee, which is "not a national body", "does not constitute a court", and that the French government "had no obligation to respect" the committee’s request to ensure that Vincent Lambert’s food and hydration are not suspended during the committee’s examination of his case.
Vincent Lambert’s attending physician began stopping his nutrition and hydration in the morning of May 20, 2019.
However, on the evening of 20 May 2019, the Paris Court of Appeal ordered the French State to take all measures to ensure compliance with the provisional measures requested by the CIDPH for the resumption of the medical treatment, considering that "regardless of the mandatory or binding nature of the suspension measure requested by the Committee, the French State has undertaken to respect this international pact". This is only a measure to give the SOPF time to decide on the merits. However, this decision was received as a victory by Vincent Lambert’s parents (see Le Monde and Le Parisien, May 20, 2019).

For further information : Anne-Sophie Faivre Le Cadre, « Affaire Vincent Lambert : tout comprendre en 8 dates », Le Monde, 22 November 2018.

Anne-Laure Zwilling

• 24 June 2014: the ECHR suspends the Conseil d’Etat ruling whereby the medical decision to end Mr Vincent Lambert’s treatment is considered legal

Since a road accident in 2008 left Mr Vincent Lambert paralysed, he has been fed and hydrated artificially and is entirely dependent.
Following the consultation procedure provided for by the Leonetti Act of 22 April 2005 regarding patient rights and the end of life, the physician responsible for Mr Vincent Lambert took a decision on 11 January 2014 to stop feeding and hydrating the patient. Members of the family then brought the matter before the administrative court in Châlons-en-Champagne which, in its judgement of 16 January 2014, suspended the enforcement of the physician’s decision.
On 31 January 2014, Vincent Lambert’s wife and one of his nephews filed an appeal against this decision to the Council of State, which requested a medical assessment by a panel of three physicians. On 24 June 2014, the Conseil d’État disputes assembly ruled that the decision taken by the physician responsible for Mr Vincent Lambert to stop artificially feeding and hydrating him was legal, notably in view of the medical assessment that found that Mr Lambert’s state of consciousness had deteriorated and in light of the fact that Mr Lambert had expressed a desire prior to the accident not to be artificially kept alive if he was in a state of considerable dependence.
On 23 June 2014, the initial applicants referred the matter to the European Court of Human Rights for an interim measure. On 24 June 2014, the chamber to which the case was assigned decided to suspend enforcement of the ruling issued by the Conseil d’État for the duration of proceedings before the ECHR, which is now responsible for examining the admissibility and merits of the application.

Sources: press release by the Conseil d’Etat, 24 June 2014 and press release by the European Court of Human Rights, 25 June 2014.
Read also the article by Lucie Guichon « Fin de vie, soins palliatifs et euthanasie : les réactions des organisations religieuses à l’affaire Vincent Lambert » (pdf).