End of life and cancer: Understanding the ethical issues of voluntary assisted dying

In its advice No. 139 entitled “Ethical issues related to end-of-life situations: autonomy and solidarity”, the National Ethics Committee opens for the first time in France the way to a possible active assistance in dying (assisted suicide or euthanasia). Such an ethical, legal and medical evolution would have major consequences in the palliative approach proposed to cancer patients. This clarification aims to enlighten the reflection, in a very complex societal debate. About thirty issues of the supporters and opponents of the legalization of active assistance in dying are first detailed. The values of autonomy and freedom are confronted with those of medical care and solidarity; the individual approach clashes with the collective interest; the interest of the patient and the place of the physician are considered from different angles. Finally, we propose a reflective path, in order to examine step by step the stakes, by examining successively the diagnosis of end of life conditions in France, then the questions asked and the proposals about: suicide; the principle of active assistance in dying; the procedures for reviewing a request for active assistance in dying; the modalities of implementation (assisted suicide or euthanasia); the place of the physician as agent of this decision. Only an analytical approach will make it possible to avoid amalgams and cognitive biases in a debate that closely mixes rationality and emotions.