Question asked by Fred on 04/03/2020
Hello,
Several of you asked us about the publication, on March 29, of a decree allowing city doctors to prescribe, without a marketing authorization (MA) and as part of the Covid-19 epidemic, a drug called Rivotril. This exemption is in effect until April 15.
Since the weekend, the government is accused of having in this way “Legalized euthanasia” in the Ehpad. An accusation taken up in particular by Senator LR de Côte-d´Or Alain Houpert and Gilbert Collard.
With this decree and the trivialization of Rivotril, is there not a risk of going from patient selection to massive euthanasia that does not say its name? # COVID2019france https://t.co/Q1PbwdQNRK
– Alain Houpert (@alainhoupert) April 2, 2020
# COVID19 : a decree of March 28, 2020 authorizes the#euthanasia to get rid of the old people who would clog up the hospital, listen to this interview on #RadioShalom ! She says it all! And to say that we claim to be the country of human rights …#Rivotril #Coronavirus # Covid_19fr pic.twitter.com/1woRlaxYV2
– Gilbert Collard (@GilbertCollard) April 2, 2020
What is Rivotril? It is a sedative that is used when patients suffer from lung damage such that there is a risk of suffocation. We use it “So as not to let them die of suffocation”, explains to CheckNews Benoît Veber, head of surgical resuscitation at the Rouen University Hospital.
Used in case of shortage of another sedative
Doctors usually use midazolam, another drug for which hospitals fear a shortage risk. In fact, it is both used “To put patients in intensive care to sleep, but also in palliative care to soften their end of life”, indicates the practitioner.
However, there is currently a very high consumption of these drugs in intensive care, and a tension on the stocks, as explained CheckNews in a previous article on morphine. “In case of shortage, the proposal is therefore to use Rivotril to ensure the comfort of palliative care patients”, underlines Benoît Veber.
Since February, midazolam can be prescribed by city doctors, to facilitate the end of life at home, but this was (so far) not the case with Rivotril, only available at the hospital. Since the first is in short supply, the second can therefore be prescribed by city doctors until April 15, and be used to support patients at the end of their life at home, or in nursing homes.
On his site, the Federation of dispensing pharmacists specifies that the prescription of Rivotril has “The objective is the palliative care of patients facing an asphyxial state who cannot be admitted to intensive care or for whom a decision to limit active treatments has been taken”.
Deep sedation is not euthanasia
The decree thus provides that “The doctor complies with exceptional and transient protocols relating, on the one hand, to the management of dyspnea [une gêne respiratoire, ndlr] and, on the other hand, to the palliative care of respiratory distress, established by the French society of support and palliative care and put online on its site “.
In a press release published on Saturday April 4, the president of the French Society of Geriatrics and Gerontology (SFGG), Olivier Guérin, reacts: “It is obviously out of the question to sedate patients who would require hospitalization, or outside a rigorous clinical evaluation with a decision as much as possible shared.”
Near 20 minutes, the Directorate General for Health (DGS) explains that this is “To improve support for palliative care, including outside hospitals, in nursing homes, for example, where doctors did not have access to Rivotril” and that his prescription is scheduled for “To improve [la] end of life” of “Patients for whom a decision to limit active treatments has been taken”.
Prescribing Rivotril, like midazolam, has nothing to do with euthanasia. It involves accompanying a patient at the end of life at home, and allowing deep sedation. In his care path guide, the French National Authority for Health (HAS) explains how to distinguish the two, insisting that euthanasia is illegal.
“It is not a relaxation of the terms of use but only, of its terms of dispensation”, specifies the DGS to LCI. So, as recalled Release in February, the HAS recommends that a framework be respected: collegiality in decision-making, systematic link between the doctor and a palliative care unit, and the possibility of withdrawing the person to a hospital if the situation becomes complicated. The French support and palliative care company, in a tip sheet on the Covid-19 also specifies that the therapeutic decision for dyspnea must be collegial.
“Administering Rivotril to a patient does not mean stopping treatment. On the contrary, it is when the situation deteriorates and in certain circumstances an accompaniment to relieve his suffering by placing him in a sedation when the respiratory distress becomes unbearable, but it is certainly not, once again of a drug intended to perform euthanasia. Asphyxiation at the end of life is unacceptable “, repeats the president of the SFGG.
Statement to verify
Decree supposed to facilitate euthanasia in nursing homes
Conclusion
False. Euthanasia remains illegal.
Pauline Moullot
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