Débat sur la fin de vie : quelle place pour les personnes souffrant de pathologies mentales ?

In the present end-of-life debate, the question whether physician-assisted suicide should be legalized is becoming increasingly mentioned. If such a legislative change was decided, this would completely disrupt the scope of medical practice, especially in psychiatry. Although the legislation of countries that have legalized or decriminalized euthanasia and physician-assisted suicide still leave no room for the possibility of voluntary death for patients with mental illness, recent changes in practices show that some of these patients were able to resort to it. Such a societal evolution could also be interpreted as a non discriminative practice and an extension of human rights to patients with mental illness. In this paper, we hypothesize that the exclusion of people with mental disorders from the current debate about the end-of-life could be explained by the way how our society views and copes with vulnerability. For clinicians, meeting a patient with severe mental illness is always a unique experience that confronts the clinician to the patient's own frailty and to the clinician's helplessness and powerlessness to cope with the complexity and the severity of the disease. We can assume that it is only at the price of this shared experience of vulnerability and helplessness that the caregiver could leave the expertise position in which he may be confined, given that such a position could only lead the expert to try to answer the question whether the intentionality to die should be viewed as either rational or irrational. Such an experience then forces clinicians to take on the challenge of caring the patient and to maintain a relationship that ensures continuity of care and respect for the patient's dignity.