Euthanasie en Français (Euthanasia in French): The Dramatic Case of Vincent Lambert & the Case for Advance Directives

The heartbreaking case of Vincent Lambert has produced a consequential plea for urgent action by the United Nations Committee on the Rights of Persons with Disabilities.    This unexpected yet welcome development is the latest chapter in a French version of the Terry Schiavo case that riveted national attention in the United States in 2005. 

Vincent Lambert, 42, was critically injured in a motorcycle accident in 2008.  He sustained severe brain damage and has been diagnosed as being in persistent vegetative state (PVS), a condition that presumes no self-awareness and no conscious response to external stimuli. He requires assisted nutrition and hydration (ANH) in order to survive but he does not require a ventilator. 

Adding to the tragic circumstances is an intra-family dispute that pits his wife and some siblings against his parents and other siblings. The former want ANH withdrawn, asserting that he would not want it. The later insist that euthanasia must be rejected and ANH provided. The conflict is possible because Vincent never prepared what L.I.F.E. provides: an advance medical directive, or an appointment of health care representative. Even our short form directive would eliminate doubt as to the patient’s wishes and provide the necessary foundation to protect life. 

PVS is not a terminal illness. Nor is it a state of permanently unconscious. Patients in PVS experience waking and sleeping cycles, typically do not require a ventilator, and frequently open and close their eyes. Disputes and uncertainty persist as to the precise nature of the condition as well as the accuracy of diagnosis. But what is undisputed is that PVS is not a terminal condition. 

A 2016 French law applicable to terminally ill patients allows physicians to withdraw life sustaining treatment – including ANH – in purportedly hopeless cases while administering powerful sedatives until the patient dies from the lack of food and fluids. 

The European Court of Human Rights and France’s top administrative body had upheld the doctors’ earlier decision to stop Lambert’s life support. His parents filed a petition with the UN Committee on the Rights of Persons with Disabilities and, according to news reports, a French court ordered that his feeding be resumed until the UN body resolves the petition filed in that forum.

In the media storm that surrounds the case there has emerged a strong statement from the Vatican. Consistent with a statement from Pope John Paul II in 2004 and a ruling on the issues from the Congregation for the Doctrine of the Faith in 2007 [link is in the bioethics library], the most recent Vatican statement affirms the essential norm that ANH is ordinary and proportionate care that must be provided to a PVS patient “as long as the person is able to receive nutrition and hydration, provided this does not cause intolerable suffering or prove damaging to the patient.”  It continues by stating that its “suspension … represents … a form of abandonment” and describes ANH in the specific context as “an inescapable duty.”

Loving Life At The End of Life

Embracing life as the earthly vessel fades presents unique challenges. End of life medical decision-making strikes many as an uncomfortable topic. But loving life includes nurturing it and, when the inevitable approaches, assuring that the values and integrity that marked more robust seasons are not sacrificed to pressures, expediency, or despair. 

L.I.F.E. maintains a series of advance medical directives and proxy appointments that are morally sound, fully in accord with Catholic doctrine, and flexible enough to allow individualization. 

We have heard some voices object to the very concept of advance directives as opening a Pandora’s Box best left to compassionate decision making by loved ones. That may be adequate for some people in some circumstances. But the risks are plentiful. What if you are critically injured in an accident in Vermont, New Jersey or Washington where assisted suicide laws hover over end-of-life health care decisions? What if you don’t have next of kin who share your values? What if your spouse or children face the prospect of pressures that may lead them to mistaken judgments? What about your peace of mind that may accompany knowledge that you have spoken your heart and made clear to your medical providers what your decisions are, or would be, based on your underlying values and beliefs?  

L.I.F.E. offers a comprehensive life protective Advance Medical Directive that assures ordinary care will be provided if you become incapacitated, yet recognizes that futility has no place in continued life support in the final stage of terminal illness. It provides for a proxy decision maker who will have full access to your medical team and records and full authority to direct care in accordance with your wishes. It also offers the option to make an anatomical gift (organ donation). 

The typical living will is a generalized and inadequately nuanced binding legal document entered into without adequate reflection or understanding that may predetermine the withholding of life sustaining treatment when it is otherwise warranted. Would you want all antibiotics withheld if suffering from pneumonia just because you previously opted for a Do Not Resuscitate (DNR) order in the event of a cardiac arrest? Can anyone confidently anticipate all the factors to be weighed in making such critical life decisions before the actual circumstances arise?

Visit L.I.F.E.’s easy to understand medical directive page. In addition to the comprehensive directive there is also a Short Form Advance Medical Directive, operative in the event you are unable to make informed decisions for yourself, as well as Short Form Appointment of a Health Care Representative who is authorized to make decisions on your behalf. 

To dive deep into the issues arising in end of life medical-moral decision making and the development of legal instruments to assert various levels of control and clarity about whocontrols such decisions, as well as the forces are work in society and law driving developments, don’t miss this extended study of the topic by LIFE’s Tom Davis.