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• W2425715035 abstract "En France, dans le contexte de révision des lois de bioéthique, le débat public fait surgir la question de la possibilité de demander une aide médicale à mourir. Ce travail se propose : de faire un état des lieux du cadre réglementaire et des pratiques, dans cinq pays ayant légiféré, la Suisse, les Pays-Bas, la Belgique, le Luxembourg et l’état de l’Oregon (USA) ; de réaliser une analyse critique du rôle du psychiatre et de l’intérêt d’entretiens psychiatriques lors d’une demande d’aide à mourir (DAM).Trois mots clefs apparaissent fréquemment avec une forte ambiguïté sémantique dans la question du droit à mourir : euthanasie ; assistance au suicide ; suicide assisté. À partir de ces derniers, nous avons interrogé les bases de données Pubmed et Cairn, ainsi que divers sites officiels des pays concernés, entre janvier 1997, date d’entrée en vigueur de la première législation dans l’état d’Oregon, et janvier 2020. Au total, 127 références ont été obtenues et ont toutes été analysées. Soixante contributions originales en ont été extraites et résument, à elles seules, l’ensemble des questions d’intérêt.La législation de la DAM et les conditions concrètes de sa mise en pratique diffèrent largement entre les pays. C’est essentiellement la validité des critères formels qui est considérée ; par ailleurs, la qualification des médecins, habilités à valider la demande, varie grandement et un réel entretien psychiatrique, explorant les motivations profondes de la personne, est très rarement mis en œuvre.Dans l’intérêt du patient, nous insistons sur la nécessité d’entretiens psychiatriques avec toute personne formulant une demande d’aide médicale à mourir. Cette demande doit s’appréhender, au-delà d’un savoir technique et scientifique, sur le terrain du colloque singulier, afin de permettre une contextualisation de la demande dans la dialectique du patient.In the context of the present re-examination of the French bioethical laws by the National Advisory Ethics Committee (“Comité consultatif national d’éthique”: CCNE), a recent survey indicated a request of the public opinion to obtain a medical aid in end of life and a so-called “assisted suicide”. This led psychiatrists to re-consider their role and deontological position which usually led them to consider a request for an assistance in suicide as – a priori – a pathological demand, occurring within a suicidal crisis. The present article intends to: 1) describe the laws and practices of countries which allow medically assisted end of life help procedures; 2) clarify the definitions of “assisted suicide”, “assistance to suicide” and “euthanasia”; 3) consider available epidemiological data and the roles given to doctors and, more specifically psychiatrists, in these procedures; 4) analyse the rationale behind these demands. These considerations should enable French psychiatrists to clarify their position when facing requests for a medical aid in dying.Four European countries (Switzerland, the Netherlands, Belgium, Luxemburg) and Oregon (the first US state to introduce legislation) were considered, since they accumulated and published a large amount of experiences and data about “assisted suicide” and medical help in dying. In total, 127 articles were selected, mainly from PubMed and Cairn databases, published between 1997 and 2020. These articles deal with legal considerations, epidemiological data, ethical and sociological considerations.Laws and practices differ notably according to the state/country. In Belgium, the Netherlands and Luxemburg, as in Oregon, the medical help in dying has been de-criminalized, as long as certain legal criteria are met. In Switzerland, where no specific law exists in the penal code, non-governmental associations have benefited from the legal vacuum and organized the practice of “assisted suicide” for “altruistic motives”. In the scientific and legal literature, the terms used to describe and define the medical help in dying upon request differ greatly. In France, the National Advisory Ethics Committee defines euthanasia (“euthanasie”), assisted suicide (“suicide assisté”) and suicide assistance (“assistance au suicide”). Available epidemiological data, whatever the country considered, indicate that requests for a medical aid in dying are expressed mainly by patients aged over 60 years and suffering from cancer. Psychiatric diseases account for only 1% to 3%. Most often, systematic assessment by a psychiatrist is neither requested nor made, when the demand does not occur during a primary psychiatric illness. In the case of an existing primary psychiatric pathology, a psychiatrist assesses the case against formal legal predefined criteria. This latter practice was only recently introduced, after some feedback and after legal actions had been brought to Court. When the underlying motivations of the request are considered, it appears that, even in the absence of an evolving psychiatric condition, several psychological or psychopathological reasons prevail such as spirituality, attachment style, social isolation, despair, depression… which should greatly benefit psychiatric exploration, investigation and expertise.In some countries, the request for medically assisted help in dying has become a legal and social reality. In France, where the public debate is still open, it should be emphasized that a psychiatric assessment and interview should be systematically provided to any person requesting medical assistance to die or commit suicide. It is the commitment of psychiatrists to understand the implicit demands and unexpressed motives underlying this request which have strong links with the unique life-events and emotional experiences of the person. The psychiatrist has a unique role in the contextualization of such a request." @default.
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• W2425715035 date "2012-02-01" @default.
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• W2425715035 doi "https://doi.org/10.1016/j.medpal.2011.03.010" @default.
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