Décision contentieuse

Interruption of treatment for Mr Vincent Lambert

The Conseil d’État has deemed it legal for Mr Vincent’s life support to be stopped.

> The decision in French

The main points

- After a medical consensus, on January 11, 2014, the doctor in charge of Mr Lambert decided to put an end to his patient’s intravenous food and water. The physician’s declaration deemed legal at the time, had not however been applied as the physician who had made the decision was no longer in charge of the patient’s care once legal recourse was enacted.

- Following a new medical consensus Mr Vincent’s new assigned doctor prescribed, on April 9, 2018, to discontinue the patient’s treatment, which was challenged by certain members of the family.

- The summary proceedings judge of the Conseil d’État, presiding over three judges considers, in the light of the collegial procedure and the medical and non-medical issues discussed before him, that this decision cannot be held unlawful.

The facts and the procedure

1. On January 11, 2014, Mr. Vincent Lambert’s appointed physician at the Centre Hospitalier Universitaire (CHU) in Reims had made the decision to end the patient’s intravenous food and water. After a decision on, June 5, 2015, the European Court of Human Rights then ruled that there would be no violation of the European Convention for the Protection of Human Rights and Fundamental Freedoms in the event of the implementation of the decision of the Conseil d’État. However, this ruling could not be implemented as the patient’s doctor had changed during this time.

2. On September 22, 2017, Mr. Lambert’s new physician informed the family of his decision to initiate a new medical consensus. Following this procedure, on April 9, 2018, the doctor made the decision to stop Mr Vincent Lambert’s intravenous food and water, along with the end to the treatment of deep and continuous sedation. Several members of the family appealed to the summary proceedings judge of the Châlons-en-Champagne court, asking for the suspension of this ruling. After having sought additional expertise, the judge, by an order of January 31, 2019, dismissed the motion. This order was challenged on appeal before the Conseil d’État.

The Council of State’s decision

Based on today’s ruling, the Conseil d’État has not accepted the appeal.

 

1. By his order, the summary proceedings judge of France’s Conseil d’État begins by stating that he must hold a special proceeding in the case of a decision to stop medical care.

In principle, the summary proceedings judge, who declared in a brief statement, can stop an infringement of a fundamental freedom only when it is evidently illegal. However, as regards to the decision to discontinue or not to initiate treatment on the grounds that it would reflect unreasonable obstinacy, the execution of which irreversibly affects life, the summary proceedings judge orders the protective measures since it considers that this ruling does not fall within the assumptions provided for by law.

2. The summary proceedings judge of France’s Conseil d’État then considers whether the terms mandated by law for halting the medical treatment of a person unable to express one’s wishes were fulfilled with Mr. Lambert’s case. This aligns with its jurisprudence, which declares that the leading physician must implement a consensus among medical colleagues and be based on a set of medical and non-medical issues. The respective bearings of which depends on each patient’s particular circumstances.

In the present case, it initially ruled that the medical consensus prior to the enacting of the contested decision is not vitiated by any irregularity.

It then reviews the factors which justified the contested decision.

On the one hand, with regard to medical evidence, the summary proceedings judge referred to the 2014 ruling based on expert testimony given by a panel of professionals. France’s Conseil d’État ruled that the clinical condition of Mr. Lambert was vegetative, and the serious, extensive brain damage that was found to be irreversible was indicative of a negative clinical prognosis. It notes that other reviews carried out in 2015 and 2017 by two neurologists led to the confirmation that Mr. Lambert was in a chronic and deep vegetative state since 2014. He also states that within the current directives, a new analysis was conducted, which confirmed that the patient’s vegetative state was clinically comparable to the one observed in 2014, with the exception of "minimal elements worsening".

On the other hand, in the case of non-medical issues, the summary proceedings judge recalled that, in the same decision handed down in 2014, France’s Conseil d’État ruled that, in considering that Mr Lambert would not have wanted to live under such conditions. The doctor heading medical consensus did not incorrectly define the wishes expressed by the patient before his accident. In the absence of any new notions which would contradict this point, the Conseil d’État summary proceedings judge considers that the physician could, in light of the applicable legal framework, deem important the motive thus manifested by Mr. Lambert before his accident.

The Conseil d’État summary proceedings judge reasoned that the various terms required by the law were met for the decision to stop the artificial feeding and hydration of Mr. Lambert, accompanied by the withdrawal of life support, could be led by the patient’s palliative care doctor. Accordingly, he considers that this decision cannot be held to be illegal.