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Published in: Medicine, Health Care and Philosophy 2/2013

01-05-2013 | Scientific Contribution

Euthanasia and end-of-life practices in France and Germany. A comparative study

Author: Ruth Horn

Published in: Medicine, Health Care and Philosophy | Issue 2/2013

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Abstract

The objective of this paper is to understand from a sociological perspective how the moral question of euthanasia, framed as the “right to die”, emerges and is dealt with in society. It takes France and Germany as case studies, two countries in which euthanasia is prohibited and which have similar legislation on the issue. I presuppose that, and explore how, each society has its own specificities in terms of practical, social and political norms that affect the ways in which they deal with these issues. The paper thus seeks to understand how requests for the “right to die” emerge in each society, through both the debate (analysis of daily newspapers, medical and philosophical literature, legal texts) and the practices (ethnographic work in three French and two German hospitals) that elucidate the phenomenon. It does so, however, without attempting to solve the moral question of euthanasia. In spite of the differences observed between these two countries, the central issue at stake in their respective debates is the question of the individual’s autonomy to choose the conditions in which he or she wishes to die; these conditions depend, amongst others, on the doctor-patient relationship, the organisation of end-of-life care in hospital settings, and more generally, on the way autonomy is defined and handled in the public debate.
Footnotes
1
If the number of documented cases does not permit statistical comparisons, one can however suggest some particularities. Proportionally more palliative care patients died in France (21/31) than in Germany (24/52). This may relate to the fact that I spent a longer period with French teams, but also that French doctors refer patients later to palliative care teams than do German doctors. And if I reported more German than French cases, although I spent more time in France, this may be related to two reasons. First, in Germany I observed that professionals working both in palliative care units and as advisors for other units within the same hospital Secondly, in Germany patients stay for a shorter time in palliative care units than in France. German patients are often referred back to their original unit, to hospices or they return home. This suggests that German palliative care teams intervene at an earlier stage, before the patient is in an acute situation, and that they collaborate more intensively with other specialists. As we will see, in France, on the contrary, the intervention of a palliative care team is often accepted only at the “last stage”.
 
2
I conducted the interviews in the first language and translated them later. There is no formal requirement in Germany or in France to have a project like this reviewed by an ethics committee. However, access was negotiated with the head of the palliative care team and appropriate standards for observation and interviews set out and observed, including guarantees of the anonymity of participants.
 
3
What counts in French criminal law is the intention of the act and not the motive (article 221-6 Code Pénal). However, the jurisprundence shows that there are rarely convictions for homicide in cases where the death of a patient has been intentionally hastened. Most often, the actor is acquitted or is given a suspected sentence (see the cases of Marie Humbert and Dr Frédéric Chaussoy in the „affaire Vincent Humbert“ or the case of Chantal Chanel and Dr Laurence Tramois in the „affaire du Périgueux". TF1, 2008).
 
4
This is the literal translation of the French expression “acharnement thérapeutique”. In the French end-of-life debate, this expression is currently employed when criticising a professional’s behaviour. The fact that there is no equal expression either in German or in English suggests a particularity of the French situation.
 
5
In an article published January 6, 1984, in Le Monde, Patrick Verspieren, Jesuit Father and “founder” of the French palliative care movement, criticises the attitudes of “most” doctors concerning their respect of terminally ill patients. He denounces the fact that in French hospitals „euthanasia has become currently and systematically […] the usual medication at the last stage of life.
 
6
If in UK as well, there are palliative care consultation teams rather than palliative care units within the hospitals, the situation cannot be compared to France. The development of the English hospice movement and the important number of hospices and their intense collaboration with hospital doctors has suggested for a long time that there is no need for development of palliative care within hospital settings. However, this does not mean that this development has not created certain problems.
 
7
A study of Courtas (1991) shows that most of the members of the French association for the right-to-die (ADMD) leading the euthanasia debate did see their loved ones die under “difficult and awful conditions”.
 
8
According to a Swiss report in 2006, 253 German patients have benefited of assisted suicide between 1998 and 2005 (Eidgenössisches Justiz- und Polizeidepartment, 2006, p. 33).
 
9
This point is confirmed amongst others by the data from Oregon where physician assisted suicide is authorised since 1994. The principal argument for their request is losing autonomy. Furthermore, only one third of the persons who get prescriptions for lethal medications ultimately take this. These results suggest that some persons only need to be assured that there is the possibility of a quick and self-determined death (State of Oregon 2011).
 
Literature
go back to reference Assemblée Nationale. 2004. Rapport no 1708. Mission d’information sur l’accompagnement de la fin de vie (1): 141–142. Assemblée Nationale. 2004. Rapport no 1708. Mission d’information sur l’accompagnement de la fin de vie (1): 141–142.
go back to reference Bundesgerichtshof. XII ZB 2/03. 17.03.2003. Bundesgerichtshof. XII ZB 2/03. 17.03.2003.
go back to reference Bundesärztekammer. 2011. Grundsätze der zur ärztlichen Sterbebegleitung. Deutsches Ärzteblatt 108(7): A346–A348. Bundesärztekammer. 2011. Grundsätze der zur ärztlichen Sterbebegleitung. Deutsches Ärzteblatt 108(7): A346–A348.
go back to reference Burkhardt, S., R. La Harpe, T.W. Harding, and J. Sobel. 2006. Euthanasia and assisted suicide: comparison of legal aspects in Switzerland and other countries. Medicine, Science and the Law 46(4): 287–294. Burkhardt, S., R. La Harpe, T.W. Harding, and J. Sobel. 2006. Euthanasia and assisted suicide: comparison of legal aspects in Switzerland and other countries. Medicine, Science and the Law 46(4): 287–294.
go back to reference Cabé, M.-H., O. Blandin, and G. Poutout. 2008. Etat des lieux du dispositif de soins palliatifs au niveau national. Synthèse. Rouen: ATEMIS. Cabé, M.-H., O. Blandin, and G. Poutout. 2008. Etat des lieux du dispositif de soins palliatifs au niveau national. Synthèse. Rouen: ATEMIS.
go back to reference Comité Consultatif National d’Ethique. 2000. Avis no 63. Fin de vie, arrêt de vie, euthanasie. Comité Consultatif National d’Ethique. 2000. Avis no 63. Fin de vie, arrêt de vie, euthanasie.
go back to reference Courtas, R. 1991. L’intervention de l’individu dans la fin de sa vie. In Biomédecine et devenir de la personne, ed. S. Novaes. Paris: Seuil. Courtas, R. 1991. L’intervention de l’individu dans la fin de sa vie. In Biomédecine et devenir de la personne, ed. S. Novaes. Paris: Seuil.
go back to reference Crane, D. 2009. Sanctity of social life: Physician’s treatment of critically ill patients. New Brunswick: Transaction Publishers. Crane, D. 2009. Sanctity of social life: Physician’s treatment of critically ill patients. New Brunswick: Transaction Publishers.
go back to reference Deliens, L., J.L. Bernheim, and G. van der Wal. 2003. A comparative study of the euthanasia laws of Belgium and the Netherlands. Revue Médicale de Liège 58(7–8): 485–492.PubMed Deliens, L., J.L. Bernheim, and G. van der Wal. 2003. A comparative study of the euthanasia laws of Belgium and the Netherlands. Revue Médicale de Liège 58(7–8): 485–492.PubMed
go back to reference Dickenson, D., R. Huxtable, and R. Parker. 2010. The Cambridge medical ethics workbook, 2nd ed. Cambridge: Cambridge University Press.CrossRef Dickenson, D., R. Huxtable, and R. Parker. 2010. The Cambridge medical ethics workbook, 2nd ed. Cambridge: Cambridge University Press.CrossRef
go back to reference Dossier de Presse. 1975–2005. Euthanasie, droit à la mort, soins palliatifs en France. Fondation Nationale des Sciences Politiques. Paris. Dossier de Presse. 1975–2005. Euthanasie, droit à la mort, soins palliatifs en France. Fondation Nationale des Sciences Politiques. Paris.
go back to reference Dossier de Presse. 1983–2007. Euthanasie. Comité Consultatif National d’Éthique, Paris. Dossier de Presse. 1983–2007. Euthanasie. Comité Consultatif National d’Éthique, Paris.
go back to reference Drittes Gesetz zur Änderung des Betreuungsrechts vom 29.07.2009. BGBI. I: 2286. Drittes Gesetz zur Änderung des Betreuungsrechts vom 29.07.2009. BGBI. I: 2286.
go back to reference Drum, C.E., G. White, G. Taitano, and W. Horner-Johnson. 2010. The Oregon Death with Dignity Act: results of a literature review and naturalistic inquiry. Disability and Health Journal 3(1): 3–15.PubMedCrossRef Drum, C.E., G. White, G. Taitano, and W. Horner-Johnson. 2010. The Oregon Death with Dignity Act: results of a literature review and naturalistic inquiry. Disability and Health Journal 3(1): 3–15.PubMedCrossRef
go back to reference Eidgenössisches Justiz- und Polizeidepartment. 2006. Sterbehilfe und Palliativemedizin – Handlungsbedarf für den Bund? Bern. Eidgenössisches Justiz- und Polizeidepartment. 2006. Sterbehilfe und PalliativemedizinHandlungsbedarf für den Bund? Bern.
go back to reference Fox, R.C. 2008. The bioethics that I would like to see. Clinical Ethics 3: 25.CrossRef Fox, R.C. 2008. The bioethics that I would like to see. Clinical Ethics 3: 25.CrossRef
go back to reference Fox, R.C., and J.P. Swazey. 2008. Observing bioethics. New York: Oxford University Press.CrossRef Fox, R.C., and J.P. Swazey. 2008. Observing bioethics. New York: Oxford University Press.CrossRef
go back to reference Generaljustizdirektion der Militärregierung des französischen Besatzungsgebietes in Deutschland. 1947. Der Konstanzer Juristentag (2.-5. Juni 1947). Tübingen: Mohr. Generaljustizdirektion der Militärregierung des französischen Besatzungsgebietes in Deutschland. 1947. Der Konstanzer Juristentag (2.-5. Juni 1947). Tübingen: Mohr.
go back to reference Hervieu-Léger, D. 2003. Catholicisme, la fin d’un monde. Paris: Bayard. Hervieu-Léger, D. 2003. Catholicisme, la fin d’un monde. Paris: Bayard.
go back to reference Horn, R. 2006. Die Französische Antwort: Ein Überblick über den Verlauf der Sterbehilfe-Debatte in Frankreich. In collaboration with I. Saake, T. Roser, Zeitschrift für medizinische Ethik 3: 281–295. Horn, R. 2006. Die Französische Antwort: Ein Überblick über den Verlauf der Sterbehilfe-Debatte in Frankreich. In collaboration with I. Saake, T. Roser, Zeitschrift für medizinische Ethik 3: 281–295.
go back to reference Horn, R. 2009. Le debat sur l’euthanasie et les pratiques en fin de vie en France et en Allemagne. Une étude comparative. Unpublished doctoral dissertation. Paris: Ecole des Hautes Etudes en Sciences Sociales. Horn, R. 2009. Le debat sur l’euthanasie et les pratiques en fin de vie en France et en Allemagne. Une étude comparative. Unpublished doctoral dissertation. Paris: Ecole des Hautes Etudes en Sciences Sociales.
go back to reference Hufen, F. 2005. In dubio pro dignitate. In Aktive und Passive Sterbehilfe Medizinische, rechtswissenschaftliche und philosophische Aspekte, ed. F. Thiele, 84–85. München: Wilhelm Fink Verlag. Hufen, F. 2005. In dubio pro dignitate. In Aktive und Passive Sterbehilfe Medizinische, rechtswissenschaftliche und philosophische Aspekte, ed. F. Thiele, 84–85. München: Wilhelm Fink Verlag.
go back to reference Isambert, F.-A. 1982. Une sociologie de l’avortement est-elle possible? Revue Française de Sociologie 13: 359–381.CrossRef Isambert, F.-A. 1982. Une sociologie de l’avortement est-elle possible? Revue Française de Sociologie 13: 359–381.CrossRef
go back to reference Loi no 91-748 du 31 juillet 1991 portant réforme hospitalière. 1991. Journal Officiel 179: 10226. Loi no 91-748 du 31 juillet 1991 portant réforme hospitalière. 1991. Journal Officiel 179: 10226.
go back to reference Loi no 99-477 du 9 juin 1999 visant à garantir le droit à l’accès aux soins palliatifs. 1999. Journal Officiel 132: 8487. Loi no 99-477 du 9 juin 1999 visant à garantir le droit à l’accès aux soins palliatifs. 1999. Journal Officiel 132: 8487.
go back to reference Kant, E. 1998. Grundlegung zur Metaphysik der Sitten. Ditzingen: Reclam. Kant, E. 1998. Grundlegung zur Metaphysik der Sitten. Ditzingen: Reclam.
go back to reference Lalande, F., Veber, O. 2009. La mort à l’hôpital. Inspection générale des affaires sociales. Lalande, F., Veber, O. 2009. La mort à l’hôpital. Inspection générale des affaires sociales.
go back to reference Lipp, V., Simon, A. 2011. Beihilfe zum Suizid: Keine ärztliche Aufgabe. Deutsches Ärzteblatt 108(5): A212–A216. Lipp, V., Simon, A. 2011. Beihilfe zum Suizid: Keine ärztliche Aufgabe. Deutsches Ärzteblatt 108(5): A212–A216.
go back to reference Loi no 2002-303 du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé. 2002. Journal Officiel 54: 4118. Loi no 2002-303 du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé. 2002. Journal Officiel 54: 4118.
go back to reference Loi no 2005-370 du 22 avril 2005 relative aux droits des malades et à la fin de vie. 2005. Journal Officiel 59: 7089. Loi no 2005-370 du 22 avril 2005 relative aux droits des malades et à la fin de vie. 2005. Journal Officiel 59: 7089.
go back to reference Maehle, A.-H. 2009. Doctors, honour and the law. Medical ethics in imperial Germany. Houndmills, Basingstoke, Hampshire: Palgrave Macmillan.CrossRef Maehle, A.-H. 2009. Doctors, honour and the law. Medical ethics in imperial Germany. Houndmills, Basingstoke, Hampshire: Palgrave Macmillan.CrossRef
go back to reference Mill, J.S. 2005. On liberty. New York: Cosimo classics. Mill, J.S. 2005. On liberty. New York: Cosimo classics.
go back to reference Mino, J.C., and F. Lert. 2003. Le travail invisible des équipes de soutien et conseil en soins palliatifs à domicile. Sciences Sociales et Santé 2(1): 35–54.CrossRef Mino, J.C., and F. Lert. 2003. Le travail invisible des équipes de soutien et conseil en soins palliatifs à domicile. Sciences Sociales et Santé 2(1): 35–54.CrossRef
go back to reference Nationaler Ethikrat. 2006. Selbstbestimmung und Fürsorge am Lebensende. Nationaler Ethikrat. 2006. Selbstbestimmung und Fürsorge am Lebensende.
go back to reference Oberlandesgericht Frankfurt a.M. 20 W 224/98. 5.8.1998. Oberlandesgericht Frankfurt a.M. 20 W 224/98. 5.8.1998.
go back to reference Pasman, H.R.W., M.L. Rurup, D.L. Willems, and B.D. Onwuteaka-Philipsen. 2009. Concept of unbearable suffering in context of ungranted requests for euthanasia: qualitative interviews with patients and physicians. British Medical Journal 339: b4362.PubMedCrossRef Pasman, H.R.W., M.L. Rurup, D.L. Willems, and B.D. Onwuteaka-Philipsen. 2009. Concept of unbearable suffering in context of ungranted requests for euthanasia: qualitative interviews with patients and physicians. British Medical Journal 339: b4362.PubMedCrossRef
go back to reference Schindler T. 2005. Sterbeorte in Deutschland. Deutsche Gesellschaft für Palliativmedizin. Schindler T. 2005. Sterbeorte in Deutschland. Deutsche Gesellschaft für Palliativmedizin.
go back to reference Seale, C., and J. Addington-Hall. 1994. Euthanasia: The role of good care. Social Science and Medicine 40(5): 581–587. Seale, C., and J. Addington-Hall. 1994. Euthanasia: The role of good care. Social Science and Medicine 40(5): 581–587.
go back to reference Seitz, D., and O. Seitz. 2004. Die moderne Hospizbewegung in Deutschland auf dem Weg ins öffentliche Bewusstsein—Ursprünge, kontroverse Diskussionen, Perspektiven. Herbholzheim: Centaurus. Seitz, D., and O. Seitz. 2004. Die moderne Hospizbewegung in Deutschland auf dem Weg ins öffentliche Bewusstsein—Ursprünge, kontroverse Diskussionen, Perspektiven. Herbholzheim: Centaurus.
go back to reference Smets, T., J. Bilsen, J. Cohen, M.L. Rurup, E. De Keyser, and L. Deliens. 2009. The medical practice of euthanasia in Belgium and The Netherlands: Legal notification, control and evaluation procedures. Health Policy 90(2–3): 181–187.PubMedCrossRef Smets, T., J. Bilsen, J. Cohen, M.L. Rurup, E. De Keyser, and L. Deliens. 2009. The medical practice of euthanasia in Belgium and The Netherlands: Legal notification, control and evaluation procedures. Health Policy 90(2–3): 181–187.PubMedCrossRef
go back to reference Thorns, A., and N. Sykes. 2000. Opioid use in last week of life and implications for end-of-life decision-making. Lancet 356(9227): 398–399.PubMedCrossRef Thorns, A., and N. Sykes. 2000. Opioid use in last week of life and implications for end-of-life decision-making. Lancet 356(9227): 398–399.PubMedCrossRef
go back to reference Thorns, A., and N. Sykes. 2003. The use of opioids and sedatives at the end of life. Lancet Oncology 4(5): 312–318.PubMedCrossRef Thorns, A., and N. Sykes. 2003. The use of opioids and sedatives at the end of life. Lancet Oncology 4(5): 312–318.PubMedCrossRef
go back to reference Thouvenin, D. 2008. Audition 15 juillet 2008. In Assemblée Nationale. 2005. Rapport d’information fait au nom de la Mission d’évaluation de la loi no 2005-370 du 22 avril 2005 relative aux droits des malades et à la fin de vie (2): 404–405. Thouvenin, D. 2008. Audition 15 juillet 2008. In Assemblée Nationale. 2005. Rapport d’information fait au nom de la Mission d’évaluation de la loi no 2005-370 du 22 avril 2005 relative aux droits des malades et à la fin de vie (2): 404–405.
Metadata
Title
Euthanasia and end-of-life practices in France and Germany. A comparative study
Author
Ruth Horn
Publication date
01-05-2013
Publisher
Springer Netherlands
Published in
Medicine, Health Care and Philosophy / Issue 2/2013
Print ISSN: 1386-7423
Electronic ISSN: 1572-8633
DOI
https://doi.org/10.1007/s11019-011-9357-5

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