Society. End of life: "It is impossible to objectively predict how long a patient has left to live."

The two texts on end of life will be debated starting this Monday in the National Assembly . While the "palliative care" section is a consensus, the same cannot be said for the text on active assistance in dying.

Claire Compagnon, member of the HAS college and president of the recommendations, relevance, pathways and indicators committee (CRPPI), explains to us why the "quality of life left" was favored over the notion of "vital prognosis."

Why did the government ask the High Authority for Health to rule on the notion of "medium-term vital prognosis" and that of "advanced or terminal phase of an illness", ahead of the law on end of life?

The Ministers of Health successively contacted us during 2024 to clarify the concepts of medium-term vital prognosis and advanced-stage illness. The working group's task was to answer the following questions: how should the medium-term vital prognosis for a sick person be assessed, and what definition should be given? How should the uncertainty attached to this concept of medium-term vital prognosis be taken into account? Is it relevant to talk about a medium-term vital prognosis per pathology? And then, what is the definition of an advanced stage? And what are the objective criteria that could clarify this concept of an advanced stage? The stakes are high. If we retain one or other of these temporal criteria, we determine who is eligible for, or not, the right to active assistance in dying.

What are your conclusions?

After reviewing the scientific literature on the subject, hearings with medical experts and social science researchers in France and abroad, and examining foreign legislation, the High Authority for Health considers that it is impossible to objectively predict the time a patient has left to live.

Why is it impossible to predict medium-term life prognosis?

Each sick individual has their own medical singularity and specific reactions to treatments. In addition, their psychological state, their life path and other more subjective elements of their personality are involved in their treatment pathway. Finally, all the statistical, clinical and predictive tools in this area do not allow us to answer this question and present a significant degree of uncertainty. This is why it is not possible to define this notion of temporality in the medium term. Similarly, there is no medical consensus on the notion of advanced phase when considered from an individual perspective: it can be defined as the entry into an irreversible process marked by the worsening of the sick person's state of health and which affects their quality of life.

So the HAS recommends that politicians not include these concepts in the law?

The High Authority says that it is impossible today to have the elements to objectively predict the time a person has left to live. We are providing a scientific opinion. Our role ends there. Whether or not to introduce this concept into the law is not our responsibility. That is the job of parliamentarians.

Should we think differently about certain pathologies, such as Lou Gehrig's disease, which is at the heart of the debate?

Whatever the illness, the answer is always the same. Whether it's for patients with cancer, nervous system diseases, or other pathologies, the challenge is to take into account the time the person has left to live. Moving from a logic of quantity to a logic of quality of the time left to live.