The French National Assembly has approved a law which creates a right to terminal sedation until death, but not to euthanasia or assisted suicide. The law has been debated for years and the present text is a consensus which tries to maintain a middle ground between voluntary euthanasia and therapeutic obstinacy.
Patients have a right to request “deep, continuous sedation altering consciousness until death” but only if they are at the end of life. Doctors may stop life-sustaining treatments, including artificial hydration and nutrition. Sedation and painkillers will be allowed “even if they may shorten the person’s life”.
Socialist Alain Claeys, co-author of the bill, said: “Our text has one purpose: fighting a bad dying that still happens too often in France.” The conservative co-author Jean Leonetti, explained: “At end of your life, if the suffering is unbearable, you’ll be allowed to get to sleep, soothed and serene.”
The law also directs doctors to honour advance directives when patients are no longer able to communicate.
The new law contains ambiguities which will soon be put to the test. Pro-euthanasia sociologistPhilippe Bataille told L'Humanité that the law enshrined a fundamental contradiction: it “makes euthanasia both possible and prohibited at the same time. That is to say, it prevents the doctor from intentionally causing death” but it also “allows a simple ‘letting die’ (not a ‘kill’), that is to say only the suspension of hydration and nutrition, accompanied by palliative care until death ensues”.
The anti-euthanasia group Soulager mais pas tuer (Care not killing) said that “The introduction of a ‘right of continuous deep sedation until death’ indeed opens the door to euthanasia. Its promoters have issued reassuring statements, but they have always refused to include black and white provisions in the law that the intention of this type of sedation must not be to cause death. In endorsing this deliberate blurring, this text weakens the relationship between carers and patients, since the new law does not clearly close the door to hidden euthanasia.”
The US Department of Health and Human Services has ruled that that transgender people are entitled to sex-change surgery provided under Medicare Advantage insurers. An Air Force veteran, Charlene Lauderdale, sought coverage for her transitioning surgery in November 2014 but it was denied because it was not the proper treatment for her, as she had been hospitalised four times for psychiatric problems.
The background to this decision is instructive. For many years, Medicare refused to cover transgender surgery. But in May 2014 a HHS Appeals Board ruled that this exclusion was based on outdated, incomplete, and biased science and medicine.
It turns out that the board reached its decision in a rather unusual way. In 1981 Medicare described sex reassignment surgery as “controversial” and “experimental” and said that it should not be covered. When this was appealed in 2013, the Centers for Medicare & Medicaid Services (CMS) declined to defend the old determination. The only evidence presented to the appeals board was submitted by advocacy groups supporting the “aggrieved party”. The CMS presented not one sentence of evidence.
Our legal system is adversarial and its integrity depends on an honest clash between opposing points of view. Why did the CMS throw in the towel? Did it really believe that there is no scientific evidence whatsoever which might question the benefits of transgender surgery? It certainly exists.
In fact, a 2014 review about research into suicide and transgender population found “an unparalleled level of suicidal behavior among transgender adults”. This was compiled by the Williams Institute, at the UCLA School of Law, an LGBT think tank, and the American Foundation for Suicide Prevention.
Their conclusions are also quite sobering: “The prevalence of suicide attempts among respondents to the National Transgender Discrimination Survey (NTDS), conducted by the National Gay and Lesbian Task Force and National Center for Transgender Equality, is 41 percent, which vastly exceeds the 4.6 percent of the overall U.S. population who report a lifetime suicide attempt, and is also higher than the 10-20 percent of lesbian, gay and bisexual adults who report ever attempting suicide.”
Bioethics must always be based on evidence. Ignoring contrary evidence, as the HHS seems to have done, not only corrupts the legal process, it could do immense harm to vulnerable people.Michael Cook
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