Demande d’aide active à mourir et désintrication pulsionnelle : face à la mort, le plus faible n’est peut-être pas celui qu’on croit !

Abstract

IssuesPatients who request active assistance in dying receive little support from palliative care teams. They are often thought of as strong, exceptional people, above palliative considerations. MethodsA psychoanalytical analysis based on the notion of the death drive shows that the initial line of reasoning can be reversed and that, when faced with death, the weakest person may not be the one we believe! My thesis advances the theory that a disintegration of the death drive occurs in psychic life. The balance between the instinct of life and the instinct of death is upended, and the death drive takes precedence: the request for active assistance in dying is thus the only voice/pathway that allows this subject to continue to hold onto life. ResultsA patient who requests help in dying is first and foremost a subject who has lost their grip on a desire dynamic that is future-oriented. They are no longer able to manage the complexity of the experience they are going through and are, therefore, more on the side of weakness than strength. DiscussionThis reflection invites us to recommend palliative care, not for the purpose of countering the usual reasoning of care (life must continue to desire life as a first intention), but to allow for some leeway, especially at the time of psychic decline which heralds the end. Is it possible to think about a subject's terminal collapse, identify it, take it into account, adjust to it? The moral considerations that welcome and accompany the workings of the death drive are principles that render this manner of reasoning possible. ConclusionBecause they are paradoxically more fragile, weaker, and more alone in the face of their psychic impasse than those who are able to face death, and than those who manage to remain connected to others, the patients who seek help in dying should be accompanied as a priority.