PARIS — Just hours after doctors stopped artificially feeding and hydrating a 42-year-old Frenchman who has spent more than a decade in a vegetative state, a French court ruled late Monday night that he must be put back on life support.
It was a stunning twist in the case of the man, Vincent Lambert, a nurse who was left in a vegetative state after a motor vehicle crash in 2008 and whose situation has bitterly divided his family and put him at the center of a right-to-die debate in France.
Earlier Monday, doctors at a hospital in the northeastern city of Reims had stopped artificially feeding and hydrating him and began administering strong doses of sedation.
The decision to remove Lambert from life support was announced this month after a series of rulings, despite staunch opposition from his parents. Lambert’s wife, Rachel Lambert, has maintained that her husband had verbally expressed that he did not want to be kept alive in a vegetative state.
While euthanasia is illegal in France, the law allows for what has been called “passive euthanasia,” in which terminally ill or injured patients with no chances of recovery are taken off life support and put into heavy sedation until their death, after extensive consultation with their families and medical staff.
To decide in the place of people who cannot express themselves, to judge that their life is not dignified or ‘has no meaning,’ is neither ethical nor scientifically justifiable
Lawyers for Lambert’s parents had announced a flurry of legal challenges to reverse the decision to take him off life support, but few expected that they would succeed. One of the challenges, filed with the European Court of Human Rights, was quickly rejected, citing the absence of “new evidence.”
But late Monday night, surprising many, another challenge filed with the Paris appeals court succeeded.
The court ruled that France had to delay the decision to halt Lambert’s life support, pending review of his situation by a United Nations-affiliated body, the Committee on the Rights of Persons with Disabilities, where Lambert’s parents had referred his case.
Jean Paillot, a lawyer for Lambert’s parents, told reporters in Paris that it was an “extraordinary victory” and that Lambert’s artificial feeding and hydration had to resume “without delay.”
The dispute has attracted intense attention from the media and from politicians, some of whom had asked President Emmanuel Macron to stop the life support from being removed. Lambert’s parents had also asked that he intervene.
But Macron said in a Facebook message on Monday that while he had been “deeply moved” by Lambert’s situation, and that there were no “simple or unequivocal” answers to end-of-life questions, it was not his role “to suspend a decision that is up to the assessment of doctors and that is in conformity with our laws.”
A vegetative state can be defined as a condition that occurs when the part of the brain that controls thought and behavior no longer works, but vital functions such as the sleep cycle, body temperature control and breathing persist. People in a vegetative state can sometimes open their eyes and have basic reflexes, but they do not have a meaningful response to stimulation or display any sign of experiencing emotions.
Because Lambert did not leave written instructions about his end-of-life wishes, disagreements over his current state and what he would have wanted are at the heart of his family’s divisions.
Lambert’s parents and their supporters argue that because he is not terminally ill, he is a disabled person who does not fall under the purview of France’s legislation regarding end-of-life situations.
“It’s a crime, that’s all,” Viviane Lambert, Lambert’s mother, told reporters outside the hospital in Reims on Monday, after her son’s life support was halted. “I’m ashamed for France.”
On several occasions, including on Monday, Lambert’s parents have released videos of him in attempts to show that he still reacts to stimulation.
But Lambert’s wife, who was made his legal guardian in 2016, says that he had clearly stated that he did not want to live that way. Rachel Lambert and her supporters point to multiple medical assessments that found her husband to be in an irreversible vegetative state, and to court rulings that said that artificially feeding and hydrating him to keep him alive constituted “unreasonable obstinacy” as defined by French law.
“To see him leave is to see him as a free man,” Rachel Lambert told RTL radio on Monday.
French doctors are also divided about the case. The French Society for Palliative Care said in a statement on Monday that Vincent Lambert was in “a situation of artificial prolongation of life, as a result of medical action,” and that taking him off life support was justified.
Others disagreed. In a joint opinion column published on Monday in the newspaper Le Monde, dozens of French medical professionals said that Lambert’s condition had been stable for years and that gauging his state of consciousness was too complex to reach an undoubtable conclusion.
“To decide in the place of people who cannot express themselves, to judge that their life is not dignified or ‘has no meaning,’ is neither ethical nor scientifically justifiable,” they wrote.
Dr. Régis Aubry, the head of palliative care at the Besançon hospital and a member of a governmental advisory body on bioethics issues, said there were about 1,500 to 1,700 people in France in a state similar to Vincent Lambert’s, but that requests to cease artificial hydration and nutrition were rare, and that in a majority of cases families and doctors came to an agreement on end-of-life decisions.
What made Lambert’s case stand out, he said, was the level of disagreement between family members, and the intense media scrutiny that followed.
“Modesty should be paramount when handling these questions,” he said, noting that much is still unknown about the consciousness of vegetative patients, and that legislation could never cover each and every individual case. “Only a discussion between respectful people can lead to the answer that is less bad.”
Doctors, in consultation with Lambert’s wife, first decided to take him off life support in 2013, after years of physical therapy and care failed to improve his condition. But Lambert’s parents, both devout Roman Catholics, opposed the decision and obtained a court ruling that reversed it.
Years of legal battles followed. The Council of State, the highest administrative court in France, and the European Court of Human Rights, both ruled last month that Lambert could be taken off life support.
Lambert’s case has also become increasingly politicized in recent weeks. Some politicians, like former Socialist presidential candidate Benoît Hamon, called for the legalization of assisted suicide.
Others, particularly those on the right, criticized the decision to halt Lambert’s life support. The National Gathering, the far-right party of Marine Le Pen that was formerly known as the National Front, said in a statement that the decision “opened the way for the most dangerous and most worrying abuses.”
Lambert’s case is reminiscent of other high profile disputes over a person’s right to live or die. The family of Terri Schiavo, a Florida woman who spent 15 years in a persistent vegetative state before her feeding tube was removed in 2005, were similarly divided. Her case went on to stoke debate in the United States and beyond.