Assisted dying: what the new French law would and would not allow

After a long and difficult journey, the text on active assistance in dying was voted on by the National Assembly. May 27. This reform project deeply divides Parliament, the government, and society, where opinions diverge on the advisability of allowing assisted suicide or euthanasia for people with terminal illnesses.

What the reform provides

The end-of-life bill was presented in spring 2024 by the Attal government, but its parliamentary review was interrupted by the dissolution of the National Assembly. Its return to the Chamber in spring 2025 took a different form: at the request of Prime Minister François Bayrou, the bill was split into two separate private members' bills : the first on palliative care, and the second, which is receiving the most attention, on the right to "assisted dying."

This second text was adopted on May 12 by the deputies of the Social Affairs Committee, then amended by the deputies before being approved on May 27 in plenary session. Before entering into force, the law will still have to pass through the Senate in the fall and return to the Assembly for a second reading. As it stands, it provides that assisted dying can only be granted to people who simultaneously meet these five conditions:

• be at least 18 years old;
• be of French nationality or reside in France;
• be able to express one's will "in a free and informed manner" ;
• have declared a serious and incurable illness that is life-threatening, in an “advanced” or terminal phase ;
• present “refractory or unbearable” physical or psychological suffering.

The patient must submit their request to a doctor who, after convening a panel composed of at least one of their caregivers and a specialist, must render their decision within fifteen days. They must self-administer the lethal substance, or be assisted by a doctor or nurse if they are unable to do so.

The text also provides that professionals can exercise their conscience clause to refuse to perform this act, while guaranteeing patients access to assisted dying. A two-year prison sentence and a €30,000 fine are also provided for as punishment for obstructing assisted dying, regardless of the means used, including through online disinformation.

Two ambiguities that raise questions

An important question is raised by the current wording of the reform: how to define the “advanced phase” of a vital prognosis?

The deputies chose to introduce into the law the definition formulated by the High Authority for Health (HAS) in its opinion of April 30 : in the "context of an incurable disease" , this phase "can be defined as the entry into an irreversible process marked by the worsening of the state of health of the sick person which affects their quality of life" .

In its opinion, the HAS concluded that it was impossible to scientifically assess the remaining life expectancy of a patient suffering from an incurable disease and insisted on the "uniqueness of each situation" . It highlighted the different subjectivity of health professionals and the patient, adding that "the sick person [is] the only one legitimate to say what is unbearable for them".

Criticisms about the ambiguity of the terms used in spring 2024 thus remain relevant. Mélanie Heard, head of the health division of the Terra Nova think tank, and Martine Lombard, professor emeritus of law, expressed concern in an article in Le Monde that the ambiguity of the wording would empty "the future law on the end of life of a large part of its practical scope" , leaving the responsibility of interpretation to doctors, who will probably be very cautious. The HAS also emphasizes the importance of a process of support and collective deliberation, involving "the sick person and with their agreement, health professionals, and/or any person having a relationship of trust and proximity with them, as well as the trusted person, if applicable".

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The other unresolved issue at the moment is that of advance directives. The Leonetti Law of 2005 allows every adult to express their wishes regarding "their end of life with regard to the conditions for the continuation, limitation, cessation or refusal of treatment or medical procedures." However, According to the current version of the reform, any person who finds themselves unable to formulate their request directly to a doctor will not be able to request assistance in dying, even if they have done so in an advance directive which may have been reaffirmed and supplemented as their illness progresses.

France's neighbors offer examples that allow us to reflect on the consequences of the reform. Assisted suicide is authorized or decriminalized in several European states, such as Austria (2022), Germany (2020), Italy (since 2019), and Switzerland (since 1942); euthanasia is legal in Spain (2021), Luxembourg (2009), Belgium (2002), and the Netherlands (2001).

It is among the latter two that the practice of euthanasia is most widespread, with 3,423 and 9,068 cases recorded in 2023 respectively. Based on the statistics of the pathologies of the patients concerned in these two countries, we attempted to determine whether they would be affected by the future French law. This is a theoretical reflection, at a stage where the text is still far from being voted on.

• Advanced stage cancers

Cancerous tumors are the leading cause of conditions leading to euthanasia. In Belgium, they represent more than half (56%) of terminations of life ( 1,899 cases in 2023 ), as in the Netherlands ( 5,105 cases out of 9,068 in 2023 ).

In Belgium, malignant tumours of the digestive organs (pancreas, colon, esophagus and stomach), respiratory organs (mainly lung) and breast were responsible for 60% of cases of termination of life linked to a cancerous tumour.

With the reform voted by the Assembly , it would be possible to request assistance in dying in France for these incurable cancerous conditions at advanced stages: they would meet the conditions of the law, because they affect the vital prognosis of patients in the advanced or terminal stages, and are associated with unbearable physical or psychological suffering.

The accumulation of chronic pathologies, including geriatric ones, can also be the cause of unbearable suffering with no prospect of improvement since some of them are degenerative, age-related. The combination of disorders induced by the different conditions is a source of physical but also psychological suffering: loss of autonomy, impaired quality of life, sensory deficiency, depression, etc. They lead to 18% of euthanasias in the Netherlands (1,599 cases) and 23% in Belgium (793 cases).

With the reform voted by the Assembly , the management of these multiple pathologies by French assisted dying would depend on the doctor's assessment of the stage of the patient's illness. In Belgium, 421 of the 793 people who presented with combinations of several refractory chronic conditions in 2023 were diagnosed with a so-called "short" expected death date (in the coming days, weeks, or months). Conversely, the 372 people diagnosed with a "non-short" expected death date would not, a priori, fall within the scope of future French assisted dying.

• Diseases of the nervous system

Nervous system diseases – Parkinson's disease, Lou Gehrig's disease, multiple sclerosis, for example – are the third major type of illness for which patients most often resort to euthanasia: 10% in Belgium and 7% in the Netherlands.

These neurodegenerative diseases cause motor and cognitive impairments for which there is no cure. Treatments can slow the progression of these diseases, reduce symptoms, and improve quality of life, but in the long term, the disorders can progress and develop into irreversible disabilities.

With the reform voted by the Assembly , the verification of the commitment of the vital prognosis "in the advanced phase" would probably be subject to the interpretation of the doctor. The HAS opinion seems to open access to assisted dying to these patients.

• Diseases of the circulatory system

Circulatory system diseases are primarily related to the after-effects of a stroke, which can cause sudden and severe loss of autonomy and complete dependence. The main after-effects are mild to severe hemiplegia, speech disorders, sensory disturbances, and pain. These pathologies account for 3% of euthanasias performed in Belgium and 4% of those performed in the Netherlands.

With the reform voted by the Assembly , patients suffering from these pathologies would for the most part be excluded from assisted dying, particularly if their vital prognosis is not directly engaged.

• Respiratory system diseases

Pulmonary fibrosis is one of the main chronic respiratory diseases of euthanized people. It is incurable and progressive, and treatments only slow its development. This type of pathology affects 3% of euthanized patients in Belgium and 4% in the Netherlands.

With the reform voted by the Assembly , recourse to assisted dying could be considered in the “advanced phase” of the illness.

• Neurodegenerative diseases

These pathologies, such as Alzheimer's disease, are characterized by a growing deterioration of memory and cognitive functions, as well as behavioral disorders. Since the process is irreversible, in the absence of curative treatment, the disease leads to a progressive loss of autonomy. Dementia cases account for 1% of euthanasia cases in Belgium and 4% in the Netherlands.

With the reform voted by the Assembly , these conditions could not be included in the framework of assisted dying. The person requesting assisted dying would have to be able to express their request in an "informed manner" , and even in this case, their vital prognosis would probably not yet be engaged in the advanced phase of the illness. Even if the person had left advance directives, to request to die when dementia would cause them unbearable suffering, these could not be taken into account under the future law.

Belgian and Dutch legislation incorporates these requests, based on advance directives and the wishes expressed by patients during their moments of lucidity. When they are no longer able to express themselves, the medical team makes the decision with a very regulated procedure (which is very rare, with eight cases out of 336 in the Netherlands).

• Psychiatric illnesses

Psychiatric disorders are rare among requests for assisted dying: 1.5% of cases in the Netherlands and 1.4% in Belgium.

With the reform voted by the Assembly , these illnesses would be excluded from assisted dying, because they do not threaten the vital prognosis of the patients.

In addition to these most common pathologies covered by the legislation of our European neighbors, other emblematic cases have fueled the public debate around euthanasia in France. Thus, young Vincent Humbert, quadriplegic, blind and mute after a road accident, who had asked President Chirac for the right to die in 2002 , would not find an answer in the future legislation on the end of life.