Report by Sicard

The Sicard report is a report drawn up by the Presidential Mission for Reflection on the end of life created by decree of the President of the Republic François Hollande on 17 December 2012.

The mission

This mission is chaired by Didier Sicard , a distinguished physician, who chaired the National Ethics Committee between 1999 and 2008. His other members are Jean-Claude Ameisen , Régis Aubry , Marie-Frédérique Bacqué , Alain Cordier , Chantal Deschamps , Éric Fourneret , Florence Gruat , Valérie Sebag-Depadt ¹ . It organizes eight public debates, from 6 October to 8 December 2012, in various cities in France ² .

Report to Chair

In its report of 18 December 2012, the mission is examining whether or not to open the door to “medical assistance to end his life with dignity”, which was the commitment of François Hollande during the campaign Presidential election in 2012 ³ .

The report denounces insufficient access to palliative care , particularly through testimonies. He regrets the de facto separation between palliative care and other medical specialties. It advocates reviewing all medical training to promote “the integration of palliative care competency into all clinical practice” ⁴ .

According to the report, there is a need to “better accommodate citizens’ expectations and expectations of the end of life” ³ . Arguing that many French people wish to be helped medically to die, the report envisages two practices that could meet this expectation. On the one hand, it advocates the use of deep sedation , in fact already provided for by the law Leonetti, allowing the administration to a terminal patient of morphine or a sedative at a very high dose, even if to kill more Quickly ^{4 , 5} . Furthermore, it considers, without the advocate, a form of assisted suicide , a practice of issuing prescription for lethal products, under certain conditions, and the patient ultimately chooses whether to use ⁶ .

On the other hand, euthanasia is strongly criticized: the authors of the report do not believe in the possibility of a controlled introduction since, according to them, “euthanasic practice develops its own dynamics resisting any effective control and tends to widen”. They also point out the impact of the introduction of euthanasia on the “societal representations” of old age, illness or disability ⁴ .

Finally, the report does not intend to upset the Leonetti law by the introduction of new legislation in emergency. It points to the fact that this law is little, badly or not applied and advocates above all a “massive training effort” ^{4 , 6} . He particularly criticizes the attitude of health professionals, which is often that of a “medicine without soul”, still marked by a culture of all-healing ^{4 , 3} and “deafness in the face of psychic distress and wishes Of patients ” ⁵ . He believes that practices can evolve by applying the Leonetti law not literally but in his mind ³ .

Reactions to the publication of the report

In a statement, the Association for the Right to Die with Dignity is critical of the report, which appears to her not to show any progress since a previous report in 2008. She criticizes her vision of the Leonetti law , Which she considers responsible for “so many end-of-life tragedies”. The president of the association, Jean-Luc Romero , welcomes the mention of assisted suicide, but regrets that it is not accompanied by any concrete perspective and calls for “respect for proposal No. 21 of François Hollande” ⁷ .

For its part, Alliance VITA welcomes the work of the Sicard mission. She particularly appreciated the refusal of the “social death” of sick and elderly people, the demand for the generalization of palliative culture, and the refusal to legalize the lethal injection. On the other hand, it expresses its concern about assisted suicide, an act decided for a few but which would have a strong impact on society as a whole ⁸ .

The introduction of assisted suicide is also rejected by several politicians of right ⁹ . The Minister of Social Affairs and Health, Marisol Touraine , considers that the report is “a very important step, a breach”. In presenting the report, President François Hollande believes that “despite the undeniable contributions of the Leonetti law, the legislation in force does not meet all the legitimate concerns expressed by people with serious and incurable illnesses”. It indicates that a bill will be presented to Parliament in June 2013, after consultation with the National Consultative Ethics Committee ¹⁰ .

Notes and references