Euthanasia | France for a dignified death

A legislative initiative for self-determined end-of-life, launched over a year ago but then put on hold due to the dissolution of parliament, new elections, and a change of government, has been split into two texts by the current government under Prime Minister Francois Bayrou, which, however, belong together in substance. The National Assembly will vote on it next Tuesday, before the Senate, the lower chamber of parliament, takes up the matter, and both chambers will then finally consider the matter.

The law on the nationwide expansion of palliative care enjoys such broad support across all political camps that the text was already unanimously approved a few days ago at the committee meeting preparing the plenary debate. The situation is quite different with the law on euthanasia and assisted suicide, where opinions differ between the various parties and often even within a single political camp.

Prime Minister Bayrou is known to be a staunch Catholic and extremely reserved about assisted suicide. Unlike President Emmanuel Macron, who has taken an ambiguous stance on this controversial issue and is trying to win over both progressive forces and the more conservative French to change the law.

Macron has always made it clear, however, that he rejects the very far-reaching Belgian-Dutch euthanasia model, which was even extended months ago to include minors and mentally ill patients, who can now also claim euthanasia there. The president is closer to the Swiss model of assisted suicide, but without wanting to go as far as that. Furthermore, Macron does not use the word euthanasia or the term assisted suicide. "The name we have chosen for the French model is assisted dying, because that is simple and humane," the president explained in an interview. The law should not create a "right," but rather open up a "possibility."

But then the members of parliament thwarted his plans. At the end of last week, they enshrined the "right" to self-determined death in the law with a clear majority. The next fundamental debate is about the restriction in the law that euthanasia may only be performed if death from illness is expected in the "short or medium term."

This formula is very vague and already limits the effect of the law passed in 2016 and named after the leading members of parliament, Claeys and Leonetti. This law allows for the drug-induced "deep sedation" of terminally ill patients who have fallen into a coma until death, provided the person concerned has previously requested this in their advance directive or has not excluded it.

The hopes of the government then in office under President François Hollande that this would defuse the controversial issue of self-determined end-of-life decisions were not realized. Many people felt that the Claeys-Leonetti Act did not go far enough. There was increasing demand for euthanasia, i.e., active euthanasia by a physician, or at least assisted suicide by providing a lethal drug for the patient to administer themselves.

To ensure the greatest possible consensus in the new attempt, President Macron, elected in 2017 and re-elected in 2022, convened a citizens' convention of nearly 200 people by lot at the beginning of his second term. This convention discussed the issue over several months and ultimately put forward a series of proposals . Some of these proposals went so far that the president, seeking conciliation, pointedly also consulted representatives of the medical profession and various religious communities, who were rather critical of the issue.

The bill, presented at the end of 2023 and now reactivated, is intended to be a compromise. It makes euthanasia dependent on four conditions. First, only adults who have full mental capacity and judgment are eligible—i.e., no children or adolescents or, for example, no Alzheimer's patients. The second condition is that they have an incurable illness that will kill them in the short or medium term and that causes them pain for which there is no effective treatment. The decision is to be made by a panel of physicians.

If the patient's wish for euthanasia is granted, they will receive the medication in the hospital and can take it there or at home, or – if this is not possible due to their physical condition – have it administered by a person of their choice . Critics particularly dislike the draft law for granting the final decision to a panel of doctors, not the patient.

On the other hand, the Catholic Church and other religious communities have already strongly opposed the proposed law, as have politicians from the right-wing opposition Republican Party and the far-right Rassemblement National movement. Many doctors and healthcare workers are also expressing concern and criticism, or rejecting the law outright because they feel obligated to heal or at least alleviate suffering , not to prematurely end lives .

When opponents of the law point to the possibility of pain-relieving support until death through palliative care, this is hypocritical or at least unrealistic. In 21 of the country's 100 departments, there is no structure or staff for this, and in the others, there is insufficient staff.

It's high time for a law dedicated exclusively to this cause. Last year, only half of terminally ill French people who were entitled to palliative care received it. Therefore, it's not surprising that surveys show that 83 percent of French people, and even 70 percent of Catholics, support euthanasia.