Last week, in a case which has divided France as Terri Schiavo’s did in the US, a Frenchman who has been in a vegetative state for more than 10 years had a last-minute reprieve from dying after doctors turned off his life support. It was turned back on pending further deliberations in the courts.
Vincent Lambert, now 42, became a quadriplegic and was badly brain damaged in a car accident in 2008. His wife, who is his legal guardian, and some of his siblings asked doctors remove life support in 2014. His parents wanted to keep him alive and have been fighting in the courts ever since. Euthanasia is illegal in France, but there is a provision for removing hydration and nutrition and allowing a heavily-sedated patient to die of thirst and starvation.
So Vincent Lambert unwittingly became the flashpoint for a bitter debate over the “right to die” in France as his relatives slugged it out in the courts.
Lambert can breathe on his own and opens and moves his eyes; his parents insist that he is not terminally ill and that he may be able to communicate.
The experts disagree – but more over the ethics than clinical issues.
The French Society for Palliative Care said last week that Lambert was in “a situation of artificial prolongation of life, as a result of medical action,” and that taking him off life support was justified.
But dozens of French medical specialists in care for the disabled countered in an eloquent op-ed in Le Monde that Lambert should not be allowed to die, despite his terrible handicaps.
Vincent Lambert is not at the end of his life. He is severely disabled and has no external support for vital organ function (lungs, heart, kidneys). He is not able to bring food to his mouth and swallow it, but he assimilates it normally. He is not dying, but in a state of chronic altered consciousness.
They contend that it is impossible to be certain about his state of consciousness.
Consciousness is difficult to analyze. It fluctuates. Even experienced teams are wrong in 30% to 40% of diagnoses. It is a very active research subject and a large field of knowledge progression exists in this field. A person diagnosed in a vegetative or minimally conscious state may be conscious.
Furthermore, people can be relatively content with their lot, however difficult this may be for us to understand.
It may be thought that for a patient with a slowly progressive, neurological or cancerous condition, continuation of care no longer makes sense. To a certain extent, these patients may want to continue living, with tolerable treatments. But some people ask to terminate their treatments. But to make a decision on behalf of people who cannot express themselves, to judge that their life is not dignified or “makes no sense”, is neither ethical nor scientifically justifiable.
A survey of the quality of life of motor-impaired people with locked-in syndrome, who can only move their eyes, as in Julian Schnabel's The Diving Bell and the Butterfly (2007), showed that if they manage to communicate … they may even have a quality of life similar to that of the average in the general population.
How Vincent Lambert is treated, they say, is a test for French democracy:
What kind of society do we want? The signatories of this letter are doctors specializing in the care of people with disabilities and we say that the honour of our society is at stake; we much continue to care for the most vulnerable amongst us, even if they are in a state of altered consciousness.
French President Emmanuel Macron rejected calls by the parents to intervene, saying “the decision to stop treatment was taken after a constant dialogue between his doctors and his wife, who is his legal representative”. Pope Francis also chimed in: “Let us always safeguard life, God's gift, from its beginning until its natural end. Let us not give in to a throwaway culture.”
According to the New York Times, there are about 1,500 to 1,700 people in France with serious brain damage similar to Lambert’s, but that requests to cease artificial hydration and nutrition are rare, and that normally families and doctors agreed about end-of-life decisions.
Michael Cook is editor of MercatorNet