The French Lady - A tragic hard case

Chantal Sebire was a 52-year old former teacher and mother of three, who had hoped to set a legal precedent in France for patients seeking 'medical help' to end their own lives. She was suffering from esthesioneuroblastoma, a rare malignancy of the nasal cavity, which had left her face horribly disfigured and partially blind. A court in Dijon, Burgundy, had ruled against allowing a doctor to help her take a lethal dose of barbiturates. She was then found dead at home this morning, presumably having taken her own life, although this has not been confirmed.

The case not surprisingly has generated a huge amount of media interest and raised the question of legalising euthanasia yet again.

Both euthanasia and assisted suicide are legal in the Netherlands, euthanasia alone is legal in Begium and assisted suicide is legal is Switzerland and about to be in Luxembourg, So there is a growing pressure in European countries to change the law. The House of Lords overwhelmingly rejected Lord Joffe's attempt to legalise assisted suicide in Britain by 148-100 in May 2006, and in a nine month period from September 2005 to June 2006 the RCGP, RCP and BMA all moved from a neutral position on euthanasia to being opposed.

Sebire's was a tragic case full of contradictions. Why did she want to change the law to allow euthanasia or assisted suicide when she was obviously capable of killing herself?

Why did she allow her face to be beamed all over the world when she was ashamed to be see in public and said that children ran from her in the street?

This was about much more than Sebire; she was clearly on a crusade to change the law, but in the process has become another willing pawn for the right to die movement. I hope that they don't continue to exploit her after her death but I suspect we have not heard the last of this – past experience does not bode well. In Britain the Voluntary Euthanasia Society (now euphemistically rebranded as 'Dignity in Dying' to disguise their real agenda) has a track record of building their campaigns around 'celebrity' hard cases and their families, who are used as pegs for press comment on every anniversary of their deaths. The Joffe campaign was built around hard cases – the VES renamed itself Dignity in Dying as Bath GP Ann Turner went on her one way trip to the Dignitas 'Clinic' in Switzerland. The second reading debate in the Lords was planned to occur the day after the fourth anniversary of Diane Pretty's death.

Sebire's is a classic case of 'hard cases make bad law' and will generate huge sympathy from a public who will never have witnessed such deformity and will be understandably horrified. 'If I was that I would wish to die' will be a common reaction.

The danger is that the details of the case can distract us from the real issue – which is whether or not the law should be changed to allow doctors to prescribe lethal drugs to people who want them. The problem is that once we cross the line to allow doctors actively to end life in any circumstance – the question will be raised for every circumstance. If we allow euthanasia for 'unbearable suffering' then why restrict it to the terminally ill? Isn't it discrimination not to allow it for all who find their suffering 'unbearable'? And if we allow it for reasons of personal choice, then why not to all who so choose whether or not they are actually dying? Any law allowing assisted dying would have within it the seeds of its own extension.

Two arguments convinced the House of Lords and they apply here too.

1. Persistent requests for euthanasia are very rare when people's physical, psychological and spiritual symptoms are properly managed – therefore our priority should be to make the very best palliative care more readily accessible. You don't have to kill the patient to kill the pain.

2. A change in the law to allow assisted dying would place pressure on vulnerable people – the elderly, depressed, disabled and sick - to request early death for fear of becoming an emotional or financial burden. The 'right to die' (or more accurately 'to be killed') can so easily become the duty to die. We should not therefore change the law for a very small number of hard cases because it would place a much larger number of vulnerable people at risk. In a free society there are limits to freedom. We are not free to exercise freedoms which jeopardize the reasonable freedoms of others.

I have managed a number of patients with facial disfigurement as severe as this lady. Most were similarly terminal but not one ever asked for euthanasia – this should tell us that euthanasia is as much about the person as about the illness.

Our attitude to the suicidal terminally ill should be the same as to anyone suicidal. We need to ask why they feel that way and seek to correct the cause, whether physical, psychological or spiritual. The Hippocratic Oath forbids the giving of deadly medicine even on request, for good reasons. We don't need to prolong the dying process and should not embark on treatments that are worse than the disease or when the burden of the treatment outweighs any benefit. But killing the patient is never good medicine. It is a lazy substitute to competent compassionate care. Care, not killing, is the way, even in the hardest cases.