While I was a general practitioner in France, I discovered palliative care in 1988 on the occasion of the painful end of life of a loved one. Having first had the opportunity to work in this sector in Paris, I then moved to Belgium: I joined the palliative care team at home in my province of residence then in this sector but at the hospital .
Like my French colleagues, until 2002 I worked more for the development of palliative care in Belgium than for the decriminalization of euthanasia: requests being rare, this seemed to me to be the right path to follow.
A Belgian model
Twenty years ago, 3 laws came to change the relationship between patients and caregivers: the law on the rights of the patient with in particular the need for consent to care, the law on palliative care which is a right, and the law which authorizes euthanasia under very strict conditions. These 3 laws are evaluated by commissions which propose the essential changes, which makes it possible both to speak of the “Belgian model” for euthanasia and to place this country as one of the best in the world for its level of palliative care. .
In daily care, these laws have enabled people to have an open dialogue about death; to contribute to this, the palliative care teams have created tools to support reflection on the end of life. Isn’t one of the objectives of palliative care, from the beginning, to reintroduce death into life?
Listen to patients
As a Catholic doctor, it seemed impossible to me to put forward my faith in order not to listen to patients requesting euthanasia. Working in a palliative care team often makes it possible to support patients and loved ones until the end without euthanasia, but studies have shown that approximately 5% of people continue to be in physical or psychological suffering following their illness. Now that the law also allows them to be helped according to their wishes, that is to say by shortening their life, I have chosen not to interrupt the care relationship (and all other relationships) by imposing the recommended sedation on them. by the Church authorities, unless accepted by the patient.
Accompaniment is an essential pivot of palliative care, but it becomes impossible to continue it with sleep. Experiences of intermittent sedation have shown a state of discomfort in the person upon awakening and this induced sleep makes it difficult to continue the psychospiritual path undertaken. Since the possibility of euthanasia, patients are rarely in favor of this sedation, they have the feeling of a life then without interest or meaning since all communication is cut off. If caregivers agree to follow the patient without imposing a marked path, they can still open new doors, explore paths other than medical to help navigate the end of life without too much discomfort.
Supporting patients requesting euthanasia
This is how I campaign so that people requesting euthanasia can be supported in the context of palliative care. The doctors in palliative care in Belgium, in particular those of the mobile teams of the hospitals and those of the teams at home, intervene in the second line, that is to say in support of the general practitioner, specialist in the hospital or general practitioner at the home.
It is often the attending physician who receives the request for euthanasia and begins the procedure which may lead to the act. Palliative care physicians may be called upon to provide the advice required by law. In this way, we can not only verify the conditions of the law but above all offer support from the team for everyone – patients and relatives, but also the carers involved, including the attending physician.
Faced with a refusal of sedation to relieve suffering, I agree to continue to walk with these patients who see death approaching with fear, as it seems essential to me to listen to the suffering that makes it desired: how abandon, in the name of a loving God, someone who lives in such distress? The Belgian bishops have understood this since they recommend pastoral accompaniment including in these situations of request for euthanasia.
Build the end of life
In the context of Belgian palliative care, I can invite other people, in particular psychologists and palliative care volunteers, to the bedside of the patient and to listen to relatives and caregivers. Often remaining an essential player in euthanasia (an important difference with assisted suicide), I can also set conditions for participating in the act: meeting relatives so that they understand the process, giving myself time for everyone to feel respected before setting a date, help loved ones manage the time before death by fulfilling the wishes of the dying, bring together those who will be present the same day to prepare for this moment…
I have the impression of helping the person and their loved ones to build the end of life, while respecting what is fundamental for everyone. After twenty years of practice, I know that the essential thing for me is respect for others: respect first of all for the patient with his limits and respect for everyone around him, including caregivers. Thus death can be given in a peaceful climate. It’s probably not the ideal of palliative care, but it’s a path that seems compatible with my faith.
“As a Catholic doctor, it seemed impossible to me not to listen to patients asking for euthanasia”