LThe debate about active euthanasia is shaking up our understanding of medicine. The National Academy of Medicine was able to express reservations regarding this assistance, which would violate the doctor’s calling and the Hippocratic oath. While discipline has so far been in the service of life in general and the survival of the patient in particular, the question of a medical act that aims to end the life of a sick person arises for the first time.

In any case, the health regulations today define active euthanasia as follows: “the prescription of a lethal product to a person by a doctor at the person’s express request and the assistance in the administration of that product by a doctor” (Article 1, L. 1110-5-4). From now on, the application hypothesis must take into account that this act must result from the patient’s desire to choose the conditions of his death.

How then can we think about the conditions of a “death worth living” rather than allowing the continuation of a life deemed “unworth living”? The seriousness of this question makes us think that we need to build a new relationship between the patient and the caregiver because, as the sociologist Frédéric Blondel in the New journal for psychosociology, “The end of life is a problem of social bonding that involves a process of social consensus construction.”.

The relationship between patient and doctor is today characterized by the need for so-called “free and informed” consent, defined as by Professor Grégoire Moutel – quoted in the same journal “the approval of a course of action with full knowledge of the facts” within a “Explicit association of the patient and the doctor against the disease”. But who agrees to what? All too often, consent is limited to the signing of a document proving the patient’s consent to a therapeutic treatment proposed by the doctor, making the patient a passive person receiving or undergoing treatment rather than an actor in his illness and his care process.

A “paternalistic” legacy

The original project of what we call “therapeutic training”. lies in the ability of health professionals to make the patient an autonomous agent of his illness, able to give and follow his own rules. The risk then is that therapeutic training is reduced to the efforts of the medical profession to guide the patient to the treatment recommended by the development of the disease, without really taking into account his own wishes.

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