Dr Kevin Fitzpatrick OBE, is the director of EPC International and lives near Avignon, France.
France is in danger of buying a deadly illusion: that terminal sedation is neither assisted suicide nor euthanasia. In the Netherlands it can be both, and the numbers of people being terminally sedated there are growing at an alarming rate. From the minute the Assemblée Nationale should pass any such legislation, terminal sedation will become the lie to hide the practice of euthanasia throughout France too.
On Tuesday March 17, 2015 the French parliament overwhelmingly voted to give people the right to demand terminal sedation – that is, for them to be made unconscious in their last hours and days. We have been warning about the steep rise in the use of terminal sedation in the Netherlands, as a form of ‘back-door’ euthanasia.
In the Netherlands, only informed adults who meet all the criteria of the Dutch law are counted as euthanasia deaths. None of those who are unable to give informed consent, a key element of the Dutch law, are counted. So no neonates killed because of their disabilities, no older people with dementia, or those in persistent coma, no-one who finds some doctor willing to ‘grant’ them a euthanasia death because they fail to meet Dutch legal criteria. Those who die through terminal sedation are not generally counted either, but the rise in their numbers is frightening.
Even in those cases where deep sedation is a serious consideration, for those few individual people whose refractory symptoms cannot be managed by modern palliative medicine, profound questions remain to be answered. But in the 1990s this group was estimated at below 5% of all cases. Today palliative care specialists, and advances in their field, mean that fewer than 2% of patients are faced with terminal sedation as their only option. Of course every individual deserves our best response, but if their numbers are falling why then should terminal sedation be on the rise at all? In the Netherlands or anywhere else?