Euthanasia: “Must we conclude that the epicenter of the debate is above all spiritual? »

On September 13, the National Consultative Ethics Committee published its opinion 139, on “Ethical questions relating to end of life situations : autonomy and solidarity”, opening for the first time the way of active medical assistance in dying (assisted suicide or euthanasia). The debate opened in 1978 with the Caillavet bill is revived more than ever.

The argument of advocates of active assistance in dying focuses on the individual request of the sick person and immediate compassion; that of the opponents, on a collective and united solicitude, and on the place of the doctor in the care. Obviously, intimate representations and convictions play a role as great as strict rationality. But is this tension ethical or spiritual?

Distinguish between ethics and spirituality

These two notions, often confused or associated, are distinguished here. Ethics corresponds to the relationship with others and to conduct in society. Spirituality summons, reminds the philosopher Luc Ferry, the question of the good life for mortals, and wonders about happiness, love, the relationship to death. She is religious or secular.

The central question here is that of death, of the anguish of its occurrence or of the conditions of agony: it is therefore that of spirituality. The first stage of reflection is that of suicide, “only really serious philosophical problem” to use the words of Albert Camus. It is the question of our place in the world and the meaning of life in the midst of physical or moral suffering, in the face of dependence and the indignity felt for oneself.

The maximum point of tension lies in accepting or not that a life may no longer be worth living. Palliative care professionals, braced against any acceptance of medical assistance in dying, not only refuse the idea of ​​performing a lethal gesture, but they also reject the renouncement of the sick person’s life. It is telling that the advocacy of these practitioners, and of the philosophers who support their resistance, is centered on the centrality of accompanying life, not preparing for death.

religious influence

Because “Dying patients do not perceive themselves as dying, as soon to be dead, but as still alive (…), writes Paul Ricœur. What occupies the thought capacity still preserved, (it is) the mobilization of the deepest resources of life to affirm itself again”. There is therefore a priesthood of non-abandonment and protection of life up to its most extreme limit, life always precious and preferable to its voluntary shortening.

It is not surprising that the religious influence is more marked on this side of the divide, where we find several Christian philosophers. The terms of vocation or priesthood are not there by chance. Of course, the Christian faith (like other monotheisms) is far from being a constant among opponents of active assistance in dying. But whether secular or religious, it is spirituality that is first questioned. In other words, it is the issue seen above of the good life for mortals.

The four principles of bioethics

The other questions are more of an ethical order, and relate to our relationship with others. According to the four simplistic but convenient principles of bioethics, are questioned here: the reality of decision-making autonomy, and with it that of individual freedom; the principles of maleficence and non-maleficence are embodied in the medical act itself (act of care and fraternity? Or inadmissible action of killing?), but also in the repercussions at the heart of the community of men (message sent on perceived uselessness, psychological consequences for survivors, shaken confidence in a medical profession that has become authorized to kill).

The two opposing planes do not face each other directly: two different questions are asked, inducing two types of answers. Difficult to talk to each other under these conditions… The defenders of active assistance in dying place themselves first at the level of the person who requests this assistance, and therefore of the validation of their autonomy and their freedom to die when they wishes. The other aspects are also taken into account, but to a lesser degree: autonomy and freedom take precedence over the “sacredness of life”, the ethical dimension prevails over the spiritual question.

Conversely, opponents of active assistance in dying simultaneously activate two arguments: on the one hand, the preservation of life and the possibility of finding meaning in it even in agony, while relieving suffering as best as possible. ; on the other hand, the impossibility for a doctor to cause death, an act both outside the scope of his vocation and with incalculable consequences on the social vision of the vulnerable man, the trust between patient and doctor. The first dimension is above all spiritual, the second concerns ethical questioning.

Spirituality is on the side of opponents of assisted suicide

Should we conclude that the epicenter of the debate is above all spiritual, and the replies that follow of a more moral nature? In any case, it will be observed that spirituality and ethics are not divided equally between the two camps: whereas the supporters of active assistance in dying insist on above all ethical, pragmatic and legal, even political dimensions (on the basis, despite everything , immediate compassion for those forgotten by palliative medicine), its opponents insist on the values ​​of collective concern, but also strong ethical principles. By magnifying the line, one could say that spirituality is above all on the side of the opponents of assisted suicide, ethical questioning on both sides.

In reality, none of the usual classifications accurately reflects the split around active medical assistance in dying. Proof if it were needed that only a flattening of each dimension of the dilemma makes it possible to reflect as an honest man. Any amalgam conversely leads to a confusion of ideas and irreducible contradictions.

Euthanasia: “Must we conclude that the epicenter of the debate is above all spiritual? »