Is the Request for Medical Assistance in Dying the Quintessential Example of Shared Decision-Making? Ethical, Medical and Historical Issues in a Heated Debate in France.

Shared decision-making (SDM) is a structured negotiation process, that seeks to strike a balance between the physician and the patient. This deliberative model, in which the expertise, values and preferences of both parties are pre-eminent, is well suited to a vast majority of clinical settings, including palliative care and end-of-life contexts. Could SDM also be used in cases where a request is made for medical assistance in dying (MAiD: physician-assisted suicide or euthanasia) by a person with an advanced illness and intractable suffering? To date, MAiD remains illegal in France and has sparked a heated national debate. The main points of controversy are to what degree the health professional should be involved, and how autonomous the patient actually is when they make the request. Apart from these concerns, it is reasonable to suppose that, were legalization to occur, the request for MAiD would be an ideal field for SDM. This kind of deliberative process would allow the patient's wishes to be listened to, their requests carefully assessed and medical professionals to take part in the entire process. However, many physicians in France continue to deny any obvious role for SDM in the final stages of life, above all in the context of MAiD. This paper examines this French paradox by discussing health laws concerning patients' rights, the specific characteristics of medical practices -particularly regarding ethical principles and SDM-, and the various arguments advanced in the debate over the roles of patients and professionals who are facing a request for MAiD.