Case of Vincent Lambert

The case of Vincent Lambert is a legal case related to the debate on euthanasia in France in the years 2010 . Following a traffic accident in 2008, Vincent Lambert , (40) , is immersed in a state of minimal consciousness , known as “pauci-relational” , or even more “minimal consciousness” . On 10 April 2013 , after several years of unsuccessful attempts to improve the condition, the medical team in charge of his case decided – after consulting his wife but without the advice of his parents or siblings – to stop Feed and moisturize.

The absence of consultation with the rest of the family resulted in a cancellation of the decision of the CHU de Reims by the administrative court of Châlons-en-Champagne . In September 2013, the CHU initiated a new procedure on the end of life of Vincent Lambert, calling this time the whole family by registered letter. This new procedure also results in a decision to stop feeding and hydrating it,. A long legal battle then began between two parties respectively favorable and opposed to stopping the diet and hydration of Vincent Lambert: the medical team, the wife of Vincent Lambert, his nephew and six of his eight Brothers and sisters on the one hand; His parents and two of his brothers and sisters on the other hand.

The European Court of Human Rights (ECHR) 1 renders a decision on 5 June 2015. This judgment, the first on this subject to be taken as a “grand chamber” 2 , is therefore of exceptional importance. The Court stated that it was limited to finding that the procedure adopted by France to stop maintaining Vincent Lambert alive was in conformity with Article 2 of the European Convention on Human Rights . This opinion of the Court is important in that it validates (and potentially exemplifies) the French regulatory framework on how to approach patients at the end of life.

On October 9, 2015, the administrative court, seized by the nephew of Vincent Lambert, rejected the request to stop treatment considering that only his attending physician is able to decide on this type of decision 3 .

Chronology

Vincent Lambert

  • 2008 : On September 29 , 4 , a road accident causes a head trauma that plunges Vincent Lambert (born on5 ), just 32 years old , in a vegetative coma , from which he will nevertheless come out 6 to reach a minimal state of consciousness 7 (“pauci-relational”).
  • 2009 : After a stay at the center of awakening of Berck-sur-Mer , Vincent Lambert is transferred to the CHU of Reims 8 .
  • 2011 : First medical expertise of Vincent Lambert at the COMA Science Group of Liège. Expertise notes “a perception of pain and emotions preserved; voluntary control test of the breathing highlights a response to the command ” 9 .
  • Since 2011 : Vincent Lambert is immobilized in a state of minimal consciousness, it is not connected to any machine, but can not swallow properly, it is nourished artificially.
  • 2012 : After his return to the Reims University Hospital Center, eighty-seven sessions of speech therapy were performed for ~ five months, from April 6 to September 3, 2012, in an attempt to establish a communication code; These sessions were not able to set up a communication code due to the non-replicability of the answers. For the medical team, Vincent does not pretend 9 .
  • 2012 : Despite the failure of speech therapy sessions, caregivers are seeing behavioral manifestations, which they believe could be interpreted as an opposition to toilet treatment, reflecting a denial of life. As a result of these observations and based on his analysis of the absence of favorable neurological evolution of the patient, his doctor initiated the collegiate procedure provided for in article R. 4127-37 of the French Health Code The public 9 .
  • 2013 : On April 10, her doctor concluded that an “unreasonable obstinacy” within the meaning of Article L. 1110-5, and decides to stop artificial feeding and hydration decrease of Vincent Lambert 9 .
  • 2014 : The expert report requested by the Council of State, tabled on May 26, concludes that the clinical condition of Vincent Lambert corresponds to a vegetative state “, with” disorders of swallowing, severe motor impairment of the four Limbs, some signs of brain stem dysfunction “and” preserved respiratory autonomy “. The clinical evolution is marked by the disappearance of the fluctuations in the state of consciousness that were observed during the review carried out in July 2011 at the Coma Science Group of the university hospital of Liège, as well as by the failure of the active therapeutic attempts advocated Which suggests “a deterioration in the state of consciousness since that date” 9 , 10 . The severity of cerebral atrophy and observed lesions, with the five-and-a-half-year period since the initial accident, lead to the estimation of irreversible cerebral lesions. Vincent Lambert may respond to care and stimulation, but experts suggest that the characteristics of these reactions suggest that these are unconscious responses and did not consider it possible to interpret these behavioral responses as indicating a “conscious experience of suffering” or manifesting an intention or a wish to terminate or continue treatment that keeps alive 9 .

Case Vincent Lambert

  •  : The Leonetti bill is tabled in the National Assembly 11 .
  •  : The responsible medical team of Vincent Lambert decides collegially that the maintenance of the hydrating and nourishing care constitutes in this context an unreasonable obstination, and decides to cease gradually to feed and hydrate it 7 , 12 , 13 .
  •  : Having learned “by chance” seventeen days later 6 the initiation of the procedure, Pierre (born in 1929 5 , 14 ) and Viviane Lambert (born in 1945 5 , 14), Vincent’s parents, and two of his Eight brothers and sisters, seize the administrative tribunal of Chalons-en-Champagne .
  •  : The Administrative Court urgently ordered restoration of food and artificial hydration 17 days after its launch. The court justified its decision by the lack of consultation with the family members of Vincent Lambert who brought proceedings before the courts on 10 April 7 , 12 , 13 .
  • September 2013 : The family of Vincent Lambert full is convened by registered letter with acknowledgment of receipt by the medical team to re-engage the process 15 .
  •  : The “collegial process end of life” , under the Leonetti law, is engaged, against the opinion of those members of the Vincent Lambert family who are opposed to this procedure 16 .
  •  : The Administrative Court of Châlons-en-Champagne, again seized, asked not to apply the new decision, considering that “the continuation of the treatment was neither unnecessary nor disproportionate and was not aimed solely at the artificial maintenance of life ” , and that Dr. Eric Kariger, head of the medical team responsible for Vincent Lambert, ” has wrongly assessed the will of Vincent Lambert considering that it would refuse to give any treatment now in life 4 ” .
  •  : Five brothers and sisters of Vincent who had not taken part in the legal proceedings (as well as a nephew already involved) publicly appeal to Marisol Touraine , Minister of Health , for the CHU to assume its responsibilities and to appeal decision of the administrative court before the State Council , the highest French administrative court 17 .
  •  Rachel Vincent Lambert’s wife announces its intention to enter the Council of State 18 .
  •  : The judge of the Conseil d’Etat, who was seized of the fate of Vincent Lambert by his wife, the CHU de Reims and a nephew, referred the decision to a collegiate formation, 18 in view of the complexity of the question raised.
  • March / April 2014 : Three recognized experts in neuroscience perform a new medical expertise of Vincent Lambert and indicate no hope of improvement 10 .
  •  : The Conseil d’État approved the decision of the CHU and reformed the judgment of the Administrative Court of Châlons-en-Champagne rendered on January 16, 2014 on the irreversibility of its brain lesions and on the deterioration of its state (Vincent Lambert is now In a chronic vegetative state [ref. Needed] ). A few hours later, the European Court of Human Rights , on the eve of the decision by the members of Vincent Lambert’s family who opposed it, ordered his interim suspension as a precaution. The court also banned any movement of the patient in order to stop his feeding and hydration (the word euthanasia is nowhere mentioned in the requests of the Court made in France) 19 .
  •  : The European Court of Human Rights (ECHR) announces that it will expedite the examination of the complaint concerning Vincent Lambert 2 , 14 .
  •  : The room shall decline jurisdiction in favor of the Grand Chamber 5 .
  •  : The ECHR holds a Grand Chamber hearing on the “Lambert and others against France” case 20 .
  •  : Viviane Lambert publishes her testimony in the book For the life of my son 21 .
  •  : The ECHR makes its decision on the cessation of the care of Vincent Lambert. By twelve votes to five, it considers that “there would be no violation of Article 2 (of the European Convention on Human Rights, governing the right to life) in the event of the Decision of the Council of State authorizing the cessation of care ” 1 .
  •  : Vincent Lambert’s parents file an application for review of this decision before the ECHR, citing “new and decisive elements” 22 .
  •  : The ECHR rejects the application for review, considering that the new elements “do not constitute new facts likely to have a decisive influence on the outcome of the case” 23 .
  •  : The family is summoned to the CHU of Reims 24 . Following this meeting, the medical team engages the shutdown procedure of treatment using the terms of unreasonable obstinacy 25 . The parents, refusing this decision, file a complaint for “attempted murder and forcible confinement against the CHU and the doctors who took care of or take care of Vincent Lambert” 26 . On July 21, the bishops of Rhône-Alpes , Vincent Lambert’s parents’ residence region protested against a medical decision which “Risk deliberately cause his death” 27 . A second family council is scheduled for July 23, 2015 to announce the decision of the medical team 26 .
  •  : The medical team decides to suspend the collegial procedure of stopping the care because according to it “the conditions of serenity and security necessary for the continuation of this procedure, as much for Vincent Lambert as for the healthcare team, are not met ” 28 . Vincent Lambert’s physician requests that he be placed under judicial protection of his patient who would be the subject of a removal project, the protection of his service, which would be the subject of threats, and the appointment by the public prosecutor. Republic of a legal representative for Vincent Lambert 29 .
  •  : Administrative justice rejects the request for cessation of treatment, considering that only his attending physician is in a position to rule on this type of decision 3 .
  •  Rachel Lambert was appointed guardian of her husband by the guardianship judge of Reims 30 .
  •  : The lawyer of Lambert relatives grabbed the Court of Appeal against the decision of the guardianship court and wishes to resume the legal procedure of transfer of Vincent Lambert to a specialized establishment 31 .
  •  : Believing that “Rachel Lambert has not failed and has fulfilled his duties as a wife,” the Court of Appeal of Reims ( Marne ) confirms that it is the main guardian of her husband 32 .
  •  : Return of the case to the Council of State 33 .
  •  : The Vincent Lambert parents complain against the Reims University Hospital for “neglect person unable to protect themselves,” 3435 .
  •  : French President François Hollande responds publicly to a written request sent to him by François Lambert (Vincent Lambert’s nephew). He refused to comment or take any action against the CHU, saying that “this can not be the president who decides: is the medical team, it is with the family” 36 .

The pauci-relational state

Main article: Minimum state of consciousness .

According to the report made in 2011 by the University Hospital Center in Liège , “Vincent Lambert is in a pauci-relational state involving the persistence of an emotional perception and the existence of possible reactions to his environment and that, artificial nutrition and hydration had not intended to keep alive artificially ” jug 1 .

Examination of the case by the Council of State

The meeting of the litigation of the Council of State to rule on the case by decision 37 of 24 June 2014. The judgment held firstly that Vincent Lambert state was not a ” pauci-relational state ” , According to the expertise of 2011, but a ” vegetative state “. It also maintains that feeding can be considered as part of the treatments which can be stopped:

  • “If artificial feeding and hydration are among the possible treatments that could be stopped when their prosecution would be unreasonable obstinacy, the only circumstance that a person is in an irreversible state of unconsciousness or, a fortiori, Of loss of autonomy making it dependent on such a mode of nutrition and hydration can not in itself characterize a situation in which the continuation of treatment would appear to be unjustified in the name of the refusal of unreasonable obstinacy. » Jug 2
  • “It is clear from the experts’ conclusions that” Mr. Lambert’s current clinical condition corresponds to a vegetative state “… if the experts have noted that Mr. Lambert can react to the care provided to him and to certain stimuli , They indicated that the characteristics of these reactions suggest that these are unconscious responses and did not consider it possible to interpret these behavioral responses as evidence of a “conscious experience of suffering” or expressing an intention or a wish to terminate or continue treatment that keeps alive ” jug 3
  • The doctor in charge of Vincent Lambert, indicating in the grounds of the contested decision his certainty that he did not wish to live under such conditions before his accident can not be regarded as having misinterpreted the wishes Manifested by the patient before his accident 9 .
  • ‘It follows from all the foregoing considerations that the various conditions laid down by law for the decision of the doctor responsible for the patient to be taken by a decision terminating a treatment having no other effect than the artificial maintenance of Life and whose pursuit would thus translate an unreasonable obstinacy can be regarded, in the case of Mr. Vincent Lambert and in view of the contradictory instructions conducted by the Council of State, as united. “

There was no subsequent review of the state of Vincent Lambert, to determine if Vincent Lambert is immersed in a pauci-relational state , a degree of consciousness allowing interactions with his environment, 38 or A vegetative state which does not exhibit such interactions. Nor has there been any legal clarification on the legitimacy of stopping the diet and hydration of a patient who is not himself “at the end of life” when they are the only “treatment”, leading in practice to starve and thirst patient whose “pause processing” jug 4 .

Opinion of the European Court of Human Rights

Arguments of the Defendants

The parents of Vincent Lambert, with one of his sisters and a half brother, contest the decision of the Council of State in favor of the stoppage of his artificial feeding and hydration, considering that it would violate his right to life and amount to torture 38 . They dispute that Vincent Lambert is in a vegetative state , stressing that “Vincent has begun to swallow again, this opens the possibility of eating” 39 . For Dr. Bernard Jeanblanc, head of a specialized department that welcomes people with altered consciousness: “For having seen him recently, Vincent is not in a vegetative state, but in a state of pauci-relational state” 38 .

An application accordingly to the ECHR is based on the following arguments jug 5 :

  • If the applicants recognize that the cessation of feeding and hydration can be legitimate in cases of unreasonable obstinacy and if they say admit the legitimate distinction between, on one hand, the euthanasia and assisted suicide and On the other hand, the therapeutic abstention which consists in stopping or not undertaking treatment which has become unreasonable, they repeatedly submit in their observations that, since those conditions are not satisfied, kind of intentional killing and refer to the notion of “euthanasia” jug 6 .
  • The applicants first consider that the law of 22 April 2005 does not apply to Vincent Lambert, who according to them is neither ill nor at the end of his life but seriously handicapped.They denounce the “vagueness” of the law on the following points:
    • The notion of unreasonable obstinacy (and in particular the criterion of treatment “having no other effect than the artificial maintenance of life”, which they consider totally imprecise)
    • And the qualification of hydration and artificial feeding as “treatments” and not as “care”.

They believe that receiving enteral feeding Vincent Lambert is not “treatment” likely to be arrested and that his medical situation is not under the “unreasonable obstinacy” jug 7 .

  • The UNAFTC No 1 echoes the concerns of families and institutions that unites and makes the following points of view: patients in a chronic vegetative state and pauci-relational state are not the end of life, and Are not “artificially kept alive”; when the prognosis is not engaged, the food and hydration artificial should not be considered as a treatment may be stopped jug 8 .

Referral and Exclusion of Defendants

The Court was seized of a possible violation of Article 2 (right of every person to life), Article 3 (prohibition of inhuman or degrading treatment) and Article 8 (respect for family life) European Convention on Human Rights .

In response, the Court declined to consider a possible violation of Articles 3 and 8 of the Convention because “the Court found that the applicants had no standing to invoke, on behalf of and on behalf of Vincent Lambert , violation of Articles 2, 3 and 8 of the Convention ” jug 9 .

As a result of this irregularity noted by the court, and according to the view of this court justified by this irregularity, all the questions relating to the possible “inhuman or degrading” treatment of the treatment proposed for Vincent Lambert Life of Vincent Lambert “in fact, by starving him to death” , 5 by removing all assistance in this area) and questions relating to the opposition of a part of his family (the one defending the maintenance Food and care on the basis of “respect for family life”) were excluded from the deliberations on the grounds of form: the persons posing these questions were not entitled – according to the ECHR – Face the European Court of Human Rights.

The parents of Vincent Lambert and their lawyers were shocked by this rejection, protesting that “today in Europe, every family is unfounded to defend a defenseless relative” 40 . For their lawyer, “As of today, an unconscious person is no longer protected by the European Convention on Human Rights”, which “applies now only to persons in good health, conscious in ability to capture themselves the Court ” 41 , 39 , noting that the court will in the matter against its own jurisprudence 39 . The five judges of the ECHR who expressed a dissenting opinion also consider that Vincent Lambert’s parents were well qualified to act on behalf of and on behalf of Vincent Lambert: “As close relatives , they even have even more justification To act on behalf of the court before the Court. ” 40

The court, however, examines “all substantive issues raised by this case under Article 2 of the Convention” , including when these issues were cited by the applicants tried without standing jug 5 . These questions, which are therefore limited to the examination of the conformity of the French legal framework with the requirements of the European Convention on Human Rights and the observance of this framework by the procedure followed for Vincent Lambert, after.

Findings of the Court

The judgment of the European Court of Human Rights was delivered on 5 June 2015 by the Grand Chamber of Seventeen Judges, composed of Dean Spielmann (Luxembourg), President, Guido Raimondi (Italy), Mark Villiger (Liechtenstein) , Isabelle Berro of Monaco, Khanlar Hajiyev of Azerbaijan, Ján Šikuta of Slovakia, George Nicolaou of Cyprus, Nona Tsotsoria of Georgia, Vincent A. de Gaetano of Malta, Angelika Nußberger of Germany, Linos Alexandre Sicilianos, (Greece); Erik Møse (Norway); André Potocki (France); Helena Jäderblom (Sweden); Aleš Pejchal (Czech Republic); Valeriu Griţco (Republic of Moldova); Egidijus Kūris (Lithuania); and Erik Fribergh .

The court thus specifies the context of its judgment:

  • The Court emphasizes that it is not entered in this case the issue of euthanasia, but that of stopping treatment that artificially sustain life jug 10 , No. 2 .
  • The Court considers that, in this area which affects the end of life, as in that which affects the beginning of life, States should be given a margin of discretion as to the not stopping a treatment now artificially life and its terms of implementation jug 12 .
  • The Court refers to the legislative framework laid down by the Public Health Code . It also recalls that interpretation is inherent in the exercise of the judicial function. In this case, the State Council has had to clarify the scope of the law, and to define the terms “treatment” and “unreasonable obstinacy” jug 13 .
  • The Conseil d’État considered that the legislature intended to include in the treatments which could be adopted or limited all the acts which tend to artificially ensure the maintenance of the vital functions of the patient and that the diet and artificial hydration are part of these acts jug 14 .
  • According to Article L. 1110-5 of the Code, treatment constitutes unreasonable obstinacy when it has “no other effect than the mere maintenance of life artificially”. This last criterion was applied in this case and that the applicants submitted inaccurate jug 15 .
  • At the end of this analysis, the Court can not follow the applicants’ arguments. It considers that the provisions of the Act of 22 April 2005 , as interpreted by the Council of State, constitute a sufficiently clear legislative framework for the purposes of Article 2 of the Convention in order to provide a precise framework for the decision of the Doctor in a situation such as that of the present case. The Court therefore concludes that the State has established a regulatory framework to protect the lives of patients jug 16 .
  • The Court is fully aware of the importance of the problems raised by this case, which involves medical, legal and ethical issues of the greatest complexity. In the circumstances, the Court reiterates that it is primarily for the domestic authorities that he belonged to verify the compliance of the decision to stop treatment with domestic law and the Convention and to establish the patient’s wishes in accordance with national law jug 17 .
    • The role of the Court was to examine the State’s compliance with its positive obligations under Article 2 of the Convention . According to this approach, the Court considered that the legislative framework provided for by national law , as interpreted by the Council of State, and the decision-making process , conducted in this case in a meticulous manner .
    • In addition, as to the judicial remedies enjoyed by the applicants, the Court came to the conclusion that the present case had been the subject of a thorough examination in which all points of view had been able to express themselves and all aspects had been been carefully considered , given as a detailed medical report that of general observations of the highest medical and ethical bodies .
    • The Court therefore concludes that the domestic authorities have complied with their positive obligations under Article 2 of the Convention in view of the margin of discretion they enjoyed in the present case.
  • It follows that there is no violation of Article 2 of the Convention in case of implementation of the decision of the State Council of 24 June 2014 jug 18 .

Importance of the Judgment

“Natural death” is an endangered notion: by 2015, almost half of the deaths in France could be delayed by medical means, and this proportion increases steadily. This necessarily raises the question of how to get out of acute care, to get into the issue of palliative care .

The release of ” therapeutic fury ” or unreasonable obstinacy was found to be in the best interests of the individual. Every year, 20,000 people in France, in a legal situation of “unreasonable obstinacy”, are stopped by these treatments in the context of a procedure between doctors and a calm and respectful dialogue with the family And relatives .

The judgment of the ECHR shows above all that French law is indeed in line with the European declaration of human rights. As Jean Leonetti, the author of the Law on Patients’ Rights and End of Life , points out, “An inverse decision might have prompted many doctors to consider the rule now as unreasonable stubbornness. ” 42 The European Court insists that these issues each state has flexibility 43 .

The judgment also locks in its considerations respecting the patient’s will 43 : “The court recognizes, of course, no right to euthanasia, she told us that from the time the doctors feel they are Unreasonable stubbornness of care, or relentlessness of therapy, if the patient has expressed a desire not to prolong the care, then the physician must follow the patient’s opinion, even if the patient is no longer in a state of consent. ” 43

Dissenting Opinion

Judges Hajiyev, Šikuta, Tsotsoria, de Gaetano and Griţco express their partially dissenting opinion by referring to the substantive issues which were not addressed in the final operative paragraph, as to what should be the cause of death for the ” At the end of life ” 40 :

“Vincent Lambert is alive and we take care of him. It is also fed – and water and food are two essential elements for the maintenance of life and intimately linked to human dignity. This intimate relationship has been repeatedly affirmed in many international documents 44 . We ask the question: What can justify a State authorizing a physician … in this case not to “disconnect” Vincent Lambert (he is not connected to a Machine that would keep it artificially alive) but rather to stop or refrain from nourishing and hydrating it, in fact, starving it to death? » Jud 19

They recalled the inhuman nature of the treatment and its incompatibility with the European Convention on Human Rights, which the court was responsible for defending:

“A person with a severe disability who is unable to communicate … may be deprived of two life-sustaining components, namely food and water, and, furthermore, the Convention is Ineffective in the face of this reality. We believe not only that this conclusion is frightening, but also – and we regret to say so – that it amounts to a step backwards in the degree of protection that the Convention and the Court have hitherto offered to persons Vulnerable. » Jud 20 , 40

They criticize the partial presentation that was given of the criteria of the Leonetti law to circumvent French law, which prohibits euthanasia:

“This case is a matter of euthanasia that does not mean its name. […] Obviously, the criteria of the Leonetti law, as interpreted by the highest administrative jurisdiction, in cases where they are applied to an unconscious person and subjected to a “treatment” that is not really therapeutic But simply a matter of care, actually results in a precipitate death that would not otherwise have occurred in the foreseeable future. » Jud 21 , 40

They conclude:

“In 2010, the Court accepted the title of Awareness of Europe … this consciousness must not only be well informed but must also be based on high moral or ethical values. These values ​​should always be the flagship that guides us, regardless of thelegal tares ” that can be produced during the process of analyzing a case. It is not enough to acknowledge that a case ” touches on medical, legal and ethical issues of the greatest complexity “; It is of the essence of a conscience, based on the recta ratio , to allow ethical questions to shape and guide legal reasoning to its final conclusion. It is precisely this, to have a consciousness. We regret that the Court, with this judgment, has lost the right to bear the title above. ” 22 .

Polemics

In May 2013, the wife of Vincent Lambert accuses certain movements Catholic fundamentalists have exploited the case 45 . It is indeed on radical sites close to the fundamentalist movement (Catholic Riposte, Le Salon beige ), or on the anti-abortion blog of Jeanne Smits, journalist at Present , that the first information about Vincent Lambert is published. And that is M e Jerome Triomphe – also advocate the fundamentalist movement Civitas , which defends the interests of Vincent Lambert parents 4 . The latter are also advised by a press officer close to Opus Dei 46 . In June 2015, the bishops of the Rhône-Alpes region have ruled against the judgment of care 47 .

After the judgment of the European Court of Human Rights of June 5, 2015, a video of the patient is broadcast on June 9 following by the committee of support for its survival which wants to show that Vincent Lambert “interacts” with his The environment 48 . For Professor Eric Kariger, the former head of the palliative care department who followed Vincent Lambert for many years, is a media manipulation. “It is disrespectful for the sick person, his wife and daughter, who can not mourn, through this fierceness that comes from their own family” 49 .

Professor Éric Kariger is the author of a book on the Vincent Lambert case 50 where he reveals that in 2013 he was the subject of a complaint for an assassination attempt with aggravating circumstances on the part of Vincent’s parents, His brother David and his sister Anne 51 . According to him, the persecution of the latter would come from a guilt not to have succeeded in protecting Vincent from a pedophile in the Priestly Society of Saint Pius X 52 , 53 : “I wonder if they do not experience a Certain guilt not to have protected Vincent as they would have liked to. Perhaps they are in a process of reparation that brings them today to protect their lives “at all costs” .