‘Ma vérité sur l'affaire Vincent Lambert' by Éric Kariger

This text presents physician Éric Kariger’s version of the highly mediatised ‘Vincent Lambert affair’, a legal and media storm that followed the decision of Lambert’s palliative care team to withdraw the intravenous nutrition and hydration that was artificially sustaining his life. Vincent was a psychiatric nurse who was left in a paraplegic state following a road traffic collision in 2008. Despite several years of interventions by various medical teams, it was deemed that there was no reasonable hope of Vincent’s condition improving. This sparked a series of multidisciplinary meetings to establish whether the continuation of life sustaining interventions constituted ‘unreasonable obstinacy’, and, as per the provisions of the 2005 Loi Leonetti, should therefore be withdrawn. Kariger spends significant time explaining the process that led to the team’s decision to withdraw support measures, with a clear desire to demonstrate that due process had been followed. The media frenzy began when Vincent’s parents discovered not only the medical team’s decision, but that life-sustaining interventions had been withdrawn without their knowledge. Kariger accepts that this was a failing, though not a legal one, as Vincent’s wife, Rachel (his next of kin), had been informed about the meetings’ outcome and that the life-sustaining interventions would be withdrawn. The decision to withdraw nutrition and hydration was completely antithetical to the ‘fundamentalist’ Catholic beliefs – as Kariger describes them – of Vincent’s parents, who brought charges against him for attempted murder and reported him to the national governing body for physicians in France. The criminal proceedings were eventually dropped; however, an injunction forced Kariger to reconnect life-sustaining measures 31 days after their withdrawal. Subsequent multidisciplinary meetings reached the same conclusion, that life-sustaining treatment should be withdrawn; however, further legal proceedings by Vincent’s parents blocked attempts to do so, and Kariger eventually resigned as head of the unit in which Vincent was hospitalised. The text presents clearly and logically Kariger’s version of this story, beginning with the circumstances that led to Vincent’s hospitalization, through the various stages of the ‘affair,’ and their impact on Kariger and his colleagues. The text also seeks to help the public ‘get to know’ Kariger: a chapter focuses entirely on his life story, drawing out the various experiences that have made him the man he is and forged his professional identity, including the role of faith in his life and work.

The text’s preface, by journalist Philippe Demenet, provides a re-cap of the ‘Vincent Lambert affair’, points to the importance of Kariger’s faith – contrasted with the ‘fundamentalist’ views of Vincent’s parents from the outset – and emphasises Kariger’s strict adherence to the Loi Leonetti. This preface establishes the primary aims of the text: in an echo of Frédéric Chaussoy’s text on the ‘Vincent Humbert affair’ (see related entries below), this text clearly seeks to clear Kariger’s name in the courts of public opinion by presenting his version of the story and humanising him, not least by highlighting the extreme abuse (including death threats) he received. The main body of the text is structured into four chapters, three of which focus on the ‘Vincent Lambert affair’ and one – the third, interestingly – recounts aspects of Kariger’s life, focusing on events that shaped his personal and professional values. The decision to structure the text like this – with a condensed version of Kariger’s life story interrupting the narrative two-thirds of the way through – has an important aesthetic impact, deepening the reader’s empathy for the physician. Indeed, the chapter in which Kariger presents his case offers something vaguely reminiscent of the character statements used in court. The main body of the text is structured in question-and-answer style, with questions posed by Philippe Demenet; however, there is a noticeable shift in Chapter 4, where the questioning takes on more of a legal tone, almost as if Kariger were on the stand, presenting evidence to justify his actions. While hints of this justificatory tone appear earlier, as Demenet probes potentially controversial statements made by Kariger, this tone becomes more sustained in this final chapter, which concludes with a recapitulation of the facts of the ‘case’, leaving no doubt about the legality of the decisions taken by Kariger and his team. Kariger’s voice is likewise key: this is very much his version of the Vincent Lambert story, and the text is as personally reflective as it is factual. There is also a clear desire to present Kariger as a reasonable man, with a well thought-through, logical and compassionate approach to issues; the tone of his answers plays an important role in this. So too does his discussion of his personal faith, which is not only present thematically, but also informs his language – when he describes Vincent as a ‘martyr’, for example. The final section, which opens with a chronological overview from 29 September 2008 until 7 January 2015, when the case was discussed at the European Court of Human Rights (judgement of the court provided in legal citations below), adds a further aesthetic dimension. The section continues with a summary of end-of-life laws in France, including discussion of what would eventually become the Loi Claeys-Leonetti (2016), regarding palliative sedation, and of patients’ rights at the end of life. Following this discussion of the legal context and associated rights, there are a few pages on the role and significance of advance directives, and their potential limitations. Interestingly, Kariger provides a template for writing one’s own advance directive, which shifts the text even further into the realm of the legal. Next comes a reproduction of Article 37 of the French Code of Medical Ethics, emphasising the responsibilities of physicians in end-of-life situations. As with the legal-style argumentation of the final pages of the text’s main body, this weight of evidence – the laying out of chronology, laws, rights, professional guidance – points the reader once again to the legal background to the text and to the pending decision from the European Court of Human Rights, actively under consideration at the time of the text’s publication. Although the court ruled in favour of Kariger’s team and the hospital, this text offers something of Kariger’s own verdict on the events: this is his truth, regardless of what the eventual legal outcome would be. The text concludes with copies of original correspondence, including anonymous letters that address Kariger as ‘the executioner’ and accuse him of being a Nazi, alongside letters of support from the Sisters of Charity, the Movement for Christian Retirees, and his own team. The decision to reproduce handwritten correspondence offers a helpful reminder of the highly personal nature of the backlash Kariger faced. The two examples of abuse mail that appear here are referenced elsewhere in the text, but their reproduction in the handwriting of their authors, has a significantly more visceral impact on the reader.

The Vincent Lambert story, alongside that of Vincent Humbert, is one of the most significant end-of-life stories in France. Indeed, where Vincent Humbert’s story led to the passing of the 2005 Loi Leonetti, Vincent Lambert’s story can likewise be seen to have played an important role in debates surrounding the introduction of the Loi Claeys-Leonetti in 2016 (French Deputy Olivier Falorni says as much in the introduction to his Rapport fait au nom de la Commission des affaires sociales sur la proposition de loi donnant le droit à une fin de vie libre et choisie, no. 4042, 2021), and subsequently, in discussions regarding advance directives. Kariger’s text also presents an interesting and important point in the context of this Archive: the withdrawal of life-sustaining interventions is not the same as assisted dying. Indeed, despite Lambert’s case being widely cited in debates regarding the legalisation of assisted dying in France (high double figures in both the Assemblée nationale and Sénat), and the significant criticism Kariger faced from Catholic groups (see Interest group citations below), he did not participate in ‘active euthanasia’ (i.e. deliberate intervention by a healthcare professional to end an individual’s life). Kariger, for his part, remains resolutely against the legalisation of assisted dying and argues that the ‘unreasonable obstinacy’ evident in Vincent’s case justifies – even if inadvertently – the autonomy-based case for the legalisation of the practice. Throughout the text, Kariger is clear that he wants to achieve a balance between the right to life and the right to a dignified life without ‘unreasonable obstinacy’; for him, this is found in adherence to the principles of the Loi Leonetti (2005). In narrating various legal decisions, and engaging with the ideas contained in the legal text of what would become the Loi Claeys-Leonetti (2016), the text offers valuable insights into the interaction between judicial decisions and the practice of medicine. The text further offers an intriguing discussion of the important distinction Kariger sees between palliative sedation and assisted dying, one still held by the majority of palliative care physicians: intent. In such an approach, Kariger advocates moving beyond what he describes as a pro-life, pro-euthanasia binary, in search of end-of-life practice that prioritises the best interests of the patient (all the while maintaining his clear stance against the legalisation of assisted dying). Nonetheless, the fact that Kariger has been called to give evidence in the context of the palliative care and assisted dying bills currently making their way through the French parliament attests to the significant role he played in Vincent Lambert’s case, and to his broader expertise in the area.