Doctor Béatrix Paillot is a hospital practitioner in Ile-De France (French department). Geriatrician for about 15 years, experimented in the accompaniment of dying, old-age people and their families, she is part of the Euthanasia Manual’s expert committee. She goes over the questions raised by the problem of euthanasia and the keys to start coming up with an answer.
FJL: Having recourse to euthanasia seems to be natural for many people: what are the reasons for this?
Doctor Béatrix Paillot: The request for euthanasia by the sick is the result of various fears. The first is to suffer. The second of being abandoned. The third of having a meaningless life because of one’s limits. We could also quote the fear of being a burden for society. These fears are the main reasons for wanting to dye. Thinking there is no other way of solving the problem, our contemporaries have tempted to get rid of the sick, disabled or dying people.
Is there any other way of relieving them from these fears? What can one do, for example, against therapeutic obstinacy?
In therapeutic obstinacy, there is an attempts at saving a sick person through unreasonable means though the chances of success have become minimal.
In order to achieve a utopic recovery, the patient is put through tests or unpleasant treatments which have very little chance of being beneficial to him and end up making him suffer unnecessarily. During this whole time, there is not enough effort put into relieving the patient from his physical or moral sufferings, being by his side, answering his questions, encouraging quality relationships with his loved ones, helping him find a new purpose in life. If reanimation is legitimate in quite a lot of cases, in others it is not so.
Discernment must be made by the healthcare team in order for the care proposed to always be proportioned to the general state of the person, based not only on his life expectancy and physiological state but also on his fundamental needs and what is important to him.
Even proportioned, care doesn’t remove the question of suffering. How do you overcome it and the fear it creates?
Nowadays, medicine has the technical capabilities to take away most physical pains with simple therapeutics. One no longer dies of great physical pain as used to be the case 50 years ago. One of the ways to avoid the fear triggered by pain is to take it away before it even arrives. This is what most of the healthcare teams do. But some of them need to be better trained in this field. In case of difficulties, it is always possible to call a pain centre.
The problem of suffering is wider though: there is the moral suffering of the sick person but also of his loved ones. What can one do?
Moral suffering is soothed by a friendly presence, by the understanding of what the other is going through and by showing him that he can still be a source of well-being for his loved ones: a smile, an attention given, a friendship. The sick person doesn’t just receive care: in his way, he can give out care as well. He thus finds a meaning to his life and manifests his intrinsic human dignity.
We help his loved ones to cope better with what is going on by taking the time to listen to them, explaining the situation, answering their questions and by helping them to build a true relationship, one of quality, with our suffering patient.
It can give one the opportunity to go back to what is essential. I am thinking of an elderly sick person suffering from cancer who used to say about suffering: “It purifies one’s personality. It takes one back to important events of the past, to what is essential. Yes, there is a positive side in suffering, in waiting for death”.
To not « steal » the death of a sick person by hastening it enables to open up, in one’s heart, unexpected paths in life.
However, the solutions we have just considered don’t take away the issue concerning dignity, of the meaning of the life of a dying or sick person.
Of course. And this issue is at the heart of the debate on euthanasia. How, can I still find a meaning to my life when I am sick, disabled and/ or dependent? How can I keep my dignity in such conditions? To tell the truth, these are mostly questions that healthy people, who are afraid of the end of their life, have. But they can also be found in suffering people who are afraid of the future. I am thinking of a disabled woman who used to say: “later on, I will ask for euthanasia”. Trying to enter into her logic for a few second I asked myself:” Why doesn’t she ask for it right away?”
Her disability was so severe she could no longer do anything. However, she still found a sense to her life and didn’t want to dye yet.
Quite often, it is the way healthy people look at sick people that pushes them into asking for death. If we only look at what the person is no longer, we stir in that person the will to die. On the contrary, if we look for what is still there, we sir in that person the desire to live.
Since we started speaking, you have been insisting on the importance of putting the patient in the centre. What about the medical team? Does euthanasia have an impact on them?
They are even, after the sick, the first victims of euthanasia!
Medical teams have a mission: to serve and accompany life. Yet, carrying out an act like euthanasia is the exact opposite, it is provoking death. If a law is voted in that sense, it will probably cause many caregivers to leave because they will no longer recognize themselves in their job. What’s more, the medical staff is left on its own when faced with the act in itself.
Euthanasia is, in my sense, fundamentally a tragedy of loneliness. Loneliness of a dying person faced with suffering, loneliness of a family, loneliness of the medical staff. Medical solutions to soothe pain and administer care proportioned to the state of the person do exist. Palliative centres need only to be developed. That is why I will never insist enough on the necessity of getting accompanied by someone in hard times, and there are many possible solutions.
Let’s no give up when faced with the questions of the end of life but let’s learn to confront them together.