Fin de vie et souffrance psychique intolérable. Contiguïté éthique ou option législative : quel paradigme retenir ?

Abstract

End-of-life patients in many countries have legal access to euthanasia, support for suicide, or assisted suicide. Intolerable psychological suffering, whether or not associated with incurable and/or debilitating pathologies, beyond the therapeutic possibilities, is at the very core of their request. It is, however, difficult for third parties to evaluate such suffering since all suffering is inherently subjective. Moreover, it is particularly challenging for caregivers and medical staff when the patient is not close to a natural death. It is difficult to ascertain the incurability of a psychiatric illness and intolerable suffering, which is a subjective criterion to be accepted as such by the nursing staff. The capacity for discernment and decision-making of a patient overwhelmed by his/her moral pain is impaired, and an elderly person may present cognitive disorders, which must be assessed in his/her request for active assistance in dying. In this article, we analyze the complexity of the approach to intolerable mental suffering. Such suffering is related to societal issues, the consequences of often incapacitating psychiatric problems and psychological difficulties, particularly existential ones. We insist on the necessity of evaluating the cognitive capacity of elderly persons to make such a decision and on the importance of the accompaniment of those awaiting active assistance in dying. Decision-making and care for seniors with multiple chronic conditions must focus on the seniors’ priorities and on their quality of life. These priorities are not exclusively medical. The general approach to unbearable suffering at the end of life or in other circumstances is necessarily global, holistic, and bio-psycho-social.