French seek a more civilised way of death

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FRANCE, the country renowned for its savoir vivre, is engrossed in an agonising moral debate on its "savoir mourir".

The health minister, Bernard Kouchner, last week called on his country to help guide the world through the moral maze of euthanasia by "inventing a new ritual for the end of life".

Was he calling for euthanasia to be made legal in France? Not quite. Was he justifying, even supporting, the actions of French health professionals who hasten the deaths of patients in extreme and untreatable pain? Certainly. The euth- anasia debate, which rages in most countries, has been crystallised in France - and some say impossibly confused - by the fact that Mr Kouchner, 58, is himself a doctor.

Recently he has taken the side of health professionals accused of bringing their patients' lives to a peaceful close. He said he faced similarly excruciating decisions when he was in practice, strongly implying that he made the same choices. In other words, he has admitted breaking the law and supported others accused of doing the same.

Last week, for the first time, a panel of French doctors decided to take no action against Dr Jean-Paul Duffaut from Aveyron, in south-western France, who brought forward (by a few hours) the death of a 92-year-old patient in great pain. The regional ethics panel saluted Dr Duffaut's "charity and ethics", though he may still face legal charges. "I am delighted with this decision,"said Mr Kouchner. "It reveals a great deal of humanity."

But right-wing politicians and commentators and the Catholic Church have been horrified - some suggesting even that it is robbing people of the redemptive qualities of pain. Monsignor Oliver de Berranger, bishop of Saint-Denis, pointed to Saint Therese of Lisieux, who refused medicine for her consumption to "better accompany Jesus" in his suffering on the cross. "All suffering has a redemptive value... by conscious association with Christ, who gave His life to save humanity," said the bishop.

On a more banal level, the letters column of Le Figaro - a noted forum for right-wing paranoia - has been choked with correspondence from people who believe that euthanasia is a plot by the Socialist-led government to reduce health costs by culling old people.

In Europe, only the Netherlands permits euthanasia. It remains formally illegal but, since 1993, doctors have been permitted to end the life of those terminally ill and suffering pain - with or without the patient's knowledge. Each case must be submitted to an ethics panel for subsequent approval. Each year, 25,000 Dutch people die in this way. Colombia, the state of Oregon in the US and the Northern Territory of Australia allow euthanasia in limited circumstances, at the patient's request. In Britain, it is illegal.

French public opinion is changing fast. In one poll last week, 79 per cent of those questioned - 64 per cent of practising Catholics - said they would like to be offered a chance of an early death if suffering an incurable and painful disease. In the last poll, 10 years ago, only 57 per cent favoured euthanasia.

The same day, Mr Kouchner announced a pounds 10m package of measures to improve the care of the dying in France, including the doubling of the number of palliative, or terminal, care units. Forty of the 96 French departements have no hospice of this kind. He said the more that was done to ease the suffering of the dying; the less the question of euthanasia - "detestable word" - would arise.

"I want us to invent in our country a special environment for the passage to death, a new ritual for the end of life. Without dogmatism. without certitudes, with humility and love, let us allow our loved ones to die with less pain and less brutality."

The health minister has called for a parliamentary debate on the subject but opposes legislation. In effect, he believes the answer is to permit a new, moral flexibility, based on the wishes of patients and the conscience of individual doctors.

Many welcome the minister's attempts to address the subject more openly. But some senior doctors accuse Mr Kouchner of generating confusion; of unhelpfully erasing the moral and legal boundaries.

As Michele Salamagne, head of the terminal care unit at the Paul-Brousse de Villejuif hospital in Paris, said: "Who do we obey? Who decides what? Should everyone do as they please? That's not what caring for people means to me."