Bonnemaison - right or wrong?

The Affaire Bonnemaison came to the public eye in France in 2011 when Dr Nicolas Bonnemaison, a doctor working in a Bayonne hospital was accused of causing the deaths of seven elderly patients. His pleaded innocent citing the age of the patients and their 'terminal' state of health.

After extensive lobbying by fellow professionals and over 60000 names in a petition to clear his name the doctor was acquitted of the seven murders or 'assisted deaths' in the hearing last july. This opened the debate on Euthanasia in France especially the role of medical practitioners and the 'assistance' given to terminally ill patients at the end of their life.

None of the seven familes appealed against the original decision but two families of the deceased took out civil actions last december. The hearing last week saw one of the charges upheld and in the other case Dr Bonnemaison was found guilty. He received a two-year suspended sentence and was ordered to pay damages of 30000€.

This weekend, Dr Bonnemaison was found in his car in a quiet lane in the Landes. He is now in critical condition in a Bordeaux hospital following a suicide attempt. He apparently took a cocktail of drugs then tried to end his life by carbon monoxide poisoning. A suicide note has since been found saying he couldn't carry on after four years of fighting. It is said he has debts due to the court cases which must have contributed to his decision to end his life.

Should the doctor have been found guilty of prematurely ending the life of an elderly patient ? The original decision to free Dr Bonnemaison set a precedent in the medical profession probably but was the original decision reckless and does it send out the wrong message to fellow healthcare professionals ? Do we want to be 'liberated' like this in the event of terminal illness ?

Can there be an answer? Certainly one size won't fit all.

IF we could list all the potential circumstances and there are many already in this thread, how would you frame a law to be fair to all those people involved. The owner of the life, the medics, the close family, close friends, the not so close family, those who would gain, those who would lose, how could a clear straightforward law be fair to all.

I think the answer is that "there is no answer"- very sad!

In the ethical debate on this topic, not just among medics but also into philosophy and other areas where they think they might find solutions, the 'nature nurture' topic arises. Do we let nature take its course or do we nurture, in other words keep people going until all functions cease. They use arguments that include examples of people in comas for up to 30 years who have woken up and soon been lucid to argue for nurture, but seem to avoid people who are in a more thoroughly vegetative or physically intolerable state for which there is no 'cure' or real relief. However, in nature it is quite impossible that a person who goes into a coma will survive 30 years so I am never happy with that type of point, as for the people who are physically totally destroyed, have gone past any lucidity with a dementia disease or have the likes of Huntingdons I question the ethics of abandoning nature and persisting with nurture from which the sufferer gets nothing and the carers and loved ones more or less forced to suffer for them. There are many cases when dependants should let go for them or are they simply living with some kind of false hope of a miracle rather than the relief of the inevitable?

I'm sure most of us fear Alzheimers or similar and with a young family in tow the worry must be accentuated. My late father in law died from the effects of Huntingdons Disease which is a horrible neuro muscular hereditary disease. It took him fifteen years to die following many years of hell for all of us. No human should have been subjected to the humiliation and pain of such a condition. He was not lucid enough to make decisions during at least the last seven or eight years of his life so unable to make the 'final' decision. Does this mean he should have been subjected to this hell or wouldn't it have been 'kinder' for his dependants to have had the option, along with medical opinion to end his life humanely ?

I have looked at this very seriously. Like other people probably the prospect of Alzheimer Syndrome disturbs, mainly because I have a young family who could be subjected to years of suffering my years of increasing absence to the worst end of it that I have seen several times. I also have a couple of things that can probably be maintained for a couple of decades. However, if I started to drift away, then I would cease to take medication in the hope I could help myself go. The problem for any of us making decisions like this is whether that is selfish or genuinely for the benefit of others. That is not just for the individual who wants to go, be let go or helped go but for their loved ones. If they don't want to let somebody go then where does the affected person stand? That is where I always end up. The question is always open. So my answer to the question is that it must be an all round consent matter, the 'patient', a majority of those who are close enough to be part of that and the medical people. Yes, the patient ultimately decides but only when it is clear that there is understanding established. In the case of someone like your wife Peter my opinion is that it becomes selfish if the family say they would prefer to keep her going. Extreme pain, terrible infirmity and no longer being lucid in the near future should be easy, but they are not. Some people cannot let go, but keep on hoping after all hope is gone. That is on both sides. So, it is never easy.

Then there are some very clear cultural traits with their roots in belief they have had to examine in the studies they have done in the UK. The University of Glasgow Law and Ethics people have done a superb piece of research, however there are many others. Practising Roman Catholics particularly, but also those who have stayed out of it for years but still hang on to belief, live with a doctrine that says that it should not be. On the other side of the Christian divide, only the most conservative Protestant groups deny their adherents the right to choose. Most British Jews are split down the middle and Moslems similarly but depending on which part of Islam. Hindus, Buddhists and other religions are far more pragmatic about death so appear to be more pro than contra. But no, since assisted suicide and euthanasia constitute deliberate killing of another person it contradicts the fundamental Buddhist principle of not killing any living being. According to them suicide is an act without compassion because it causes grief to others.They also believe that death will not relieve the killed person of suffering, only postpone the suffering to the next life. Hindus are similar. So, death is seen pragmatically but being helped to die is very wrong. These are not just religious but cultural beliefs. Even in the secular world the traditions carried over from religious culture are difficult to remove. That is usually translated in the most secular surroundings as 'ethics'. I tend to see that as mob rule over the wishes of individuals and those who decide with them.

Vincent Humbert said much about such things in his book Je vous demande le droit de mourir that he wrote with his thumb. His mother was acquitted of helping him die and new legislation kind of began to fall into place. Two years ago Hollande said there should be a national debate. Where is it then? Hollande also promised a law on it by the end of 2013, France's medical ethics advisory council voted against the legalisation of ‘active’ euthanasia, as found in Swiss clinics such as Dignitas, saying that euthanasia should only be allowed in exceptional cases and then when the patients are able to make 'persistent and lucid requests.' So, Bonnemaison did what he did four years ago, it has been allowed to come to this and look what it has done to him.

As somebody deeply entrenched in the human rights world, and believe it when I say we are not just considering elderly adults given war injured children I have seen who spend every waking hour screaming for help, even several years after being almost blown apart or burned unrecognisable as a human being - they too want to die, end the suffering, but ethics. My understanding of our rights is that they give us self-determination. I don't think we should expect every medical person to be able to concur with that but those who understand and can do it should be allowed to choose. I know from how it works with Dignitas that they also try to offer dissuasive arguments in order to make sure the decision to go is thorough and that when it is done in such circumstances then it should be respected and people allowed to keep that right rather than being denied it by people who uphold their version of ethics without any personal experience of the pain and suffering.

So, for myself I wanted to be informed and clear before the event ever possibly arises. That is what we should all be entitled to which of course respects the views of those who cannot or will not let go until nature takes its course irrespective of what it brings with it. At the heart of it the word respect is probably what I find most important of all. I find the Affaire Bonnemaison and how he was treated entirely lacks it when what he did was difficult enough without subjecting him to legal process and public scrutiny that led to him wishing to end his life.

Feelings in France about looking after your parents vary quite a lot. My experience is that in the south, most people feel strongly about looking after their parents, letting them move in with them, visiting daily and moving them into specialised accommodation only when strictly necessary. This is also the case in places where there is work, so people stay put, rather then moving to other regions and also happens in regions where people tend to have large houses, with dependencies.

Still, this is far from being as widespread as it was! We, for example , live comfortably, but would be hard pressed to take my mother in, (not to mention that she isn't the easiest person to live with) and my uncle would go crazy if he had to live not only in a flat, but in a large town. Feelings have changed over the years, and strangely enough, I think people are more concerned about their parents, not less. One change is certainly due to the fact that families are smaller, another is probably connected with parents being closer to their children emotionally than they were. I also believe that as having parents in assisted living is far less stigmatising than it was 30 or 40 years ago, people don't feel pressured into looking after their parents and this helps them do it out of deeper feelings than those inspired by duty, or the fear of what others could say about them.

As you mentioned above, the "patient" should be able to decide, my great aunt entered a retirement home in her late eighties and lived there quite happily (although she complained about the lack of good card players….), her main reason was that she didn't want to be a burden. I can relate to this and also understand and admire your wife's decision, however, I am not sure that all of us will retain sufficient lucidity to make the best decision when the time comes. I have a friend whose mother lives alone and is convinced most of the time that she's Little Red Riding Hood….. another who wants to stay in a large house with 3 dogs that the neighbours are constantly coming in to feed because she forgets to! If you are surrounded with people who care, then some kind of solution will be found, but what happens when nobody really cares? Or too many people care and squabble about the right decision? Or those who do care are far away and nobody takes the time to consult with them?

I find it quite frightening that euthanising these people, with their consent, could become an acceptable way out, rather than making them as comfortable as we could.

Peter - how incredibly brave - both of you. The love is almost tangible in your recounting of your personal circumstances.

In answer to your question - the patient decides

That's interesting Marie-Claude. What do you feel the general feeling is in France regarding looking after our parents ? Is it a case of doing ones best to look after them within the family framework to the end or simply to put them away in a home somewhere ? Have feelings changed here over the years ?

I was offered the possibility of my wife staying at home with a hospital bed being installed at the house in order for her to spend the reaming weeks of her life at home with medical supervision daily to give injections etc. My wife refused this because she couldn't face the idea of her being a burden to me..

Yes, quite agree but where are the lines drawn ?

Who decides when the time is 'ok' for the patient to consider asking for 'help' for example ?

As far as my wife was concerned it was she who asked the doctor to start with the morphine etc on a certain day when she found the pain of cancer too much to take. Until then she was in some pain but lucid and able to make decisions. When she had made sure all had been arranged within the family ie. wills, signatures, wishes etc and when she was satisfied she could leave us the doctor basically ended her life, something which I will be eternally gratefiul for because she passed away very peacefully five days later pain free..

She was only 56 proving there are no age limits when assisted death is carried out..

I'm sure that Bonnemaison was convinced he was doing the right thing and he must have felt terribly let down, and probably guilty in a way as well, when two families who originally agreed to (initiated?) euthanasia decided to press charges.

Like almost everybody I know, I say that I would rather go before things got too ugly/uncomfortable/distressing/painful, however, I am concerned that termination of life will insidiously become a substitute to old age, especially as I think there will be an abundance of oldies quite soon! Additionally, something tells me that we baby boomers will be difficult to deal with and may have more health issues than our parents' generation have and will end up costing a fortune to maintain. Tempting for the younger generation? Probably not.

I was talking to my uncle today (he is 88 and lives on his own in the Jura) he is still very fit physically and mentally, but may not be able to maintain the level of fierce independence he is accustomed to for ever. Then what? He won't go into any kind of home, can't live with his (quite horrible) children….

For the time being, I think the best solution is being nice to my daughter and hope for the best!

For me Peter - it's all about who makes the decision - the patient or the Doctor.....