Bill on Assisted Death in France: A Crucial Debate on End-of-Life Patient Rights
- Mireille Vincent
- 28 giu 2024
- Tempo di lettura: 5 min
The European legal framework for euthanasia varies significantly, encompassing active euthanasia, passive euthanasia, and assisted suicide.
Active euthanasia involves intentionally ending a person's life to alleviate suffering, typically through a lethal substance administered by a doctor or a third party. Passive euthanasia entails withholding or withdrawing life-prolonging treatments, such as disconnecting a ventilator. Assisted suicide involves providing the means for a person to end their own life, with the individual carrying out the act themselves.
Several European countries have legalized active euthanasia, each with specific regulations. The Netherlands pioneered this in 2001, requiring a written request and proof of unbearable suffering, extending in 2023 to children under 12 with incurable diseases. Belgium followed in 2002, extending to minors in 2014, provided they have discernment capacity. Luxembourg, Spain, and Portugal also have frameworks allowing euthanasia under strict conditions. Passive euthanasia is permitted in many countries, including France, where laws allow the refusal of unreasonable treatment and deep sedation until death. However, euthanasia and assisted suicide remain illegal in several Eastern European countries. (1)
Against this backdrop, the French government submitted a draft of law to the Conseil d'État on March 18, aiming to affirm free choice on the end of life and ensure universal access to palliative care. This proposal marks a significant step in the debate on the rights of terminally ill patients, responding to citizens' calls for dignity and personal choice. The current French legal framework, governed by laws such as the 2016 Leonetti-Claeys law, has notable advancements but also limitations. According to the Senate's Social Affairs Committee, expanding available options is necessary to ensure all patients can die with dignity. (2)
Access to palliative care remains uneven across France, with only 20% of patients who need it receiving it. The new bill proposes "assisted dying", a compromise between euthanasia and assisted suicide, under strict conditions. (3) Presented by the Minister of Labor, Health, and Solidarity, Catherine Vautrin, the bill that the French deputies will debate is, according to the executive, “an ethical response to the needs of supporting the sick and to unbearable suffering. A project of solidarity with the idea of creating a space that is not a new right or freedom, but a space that is a balance between respect and the autonomy of the individual.” (4) It extends the scope of current legislation to medium-term vital prognoses of "six to twelve months", with the lethal product having a faster effect, according to Minister Catherine Vautrin.
The bill guarantees the right to choose end-of-life conditions, including euthanasia or assisted suicide, under strictly regulated conditions and after validation by healthcare professionals. Decisions must be thoughtful, free, and informed, certified by two doctors and a psychologist.
Measures to ensure universal and equitable access to palliative care include strengthening resources, training medical personnel, and raising public awareness. An additional budget would create new palliative care units and specialized training.
To prevent abuse, an ethics committee would oversee requests and ensure compliance. Each case would be examined to meet all legal and ethical conditions.
Article 1 of the bill introduces active assistance in dying, with strict conditions: the person must be an adult, with full capacity, and in an advanced or terminal stage of a serious, incurable condition causing unbearable suffering or dependence. This framework emphasizes informed consent and patient autonomy. Article 2 outlines the medical procedure to follow: confirmation by two doctors, information on alternatives, written confirmation of the request, and a two-day reflection period. This rigidity of procedure can also be found in Article 3 with detailed documentation and control by a regional commission to ensure transparency and prevent abuse. It is important to underline that doctors can refuse to participate, provided they refer the patient to another practitioner within two days, balancing doctors' and patients' rights. The bill also develops palliative care and patients' rights, creating "accompanying care" and "accompanying houses" for pain management. Patients must schedule their death in advance, choose the location, and be surrounded by loved ones, with a caregiver retrieving and preparing the lethal substance.
Supporters of the law argue that it respects individual freedom by allowing each person to choose their end of life according to their beliefs. The law offers an alternative to those suffering unbearably and irreversibly, allowing them to die with dignity. Opponents highlight the ethical and moral issues of legalizing euthanasia and assisted suicide, fearing potential abuses. Some healthcare professionals express reservations about their role in administering death, emphasizing the oath to not harm. The president of the Association for the Right to Die with Dignity, Jonathan Denis, and the head of the MGEN mutual insurance, Matthias Savignac, request the removal of the "vital prognosis engaged" condition for assisted suicide to uphold the republican promise of equality. (5) Religious leaders, particularly the French Church, have strongly criticized the bill, condemning it as a drift towards death as a solution. Éric de Moulins-Beaufort, president of the “Conférence des évêques de France”, expressed concerns about the lack of a specific conscience clause. The rector of the Great Mosque of Paris, Chems-eddine Hafiz, expressed concern, speaking of "provoked death" and highlighting ambiguities about assisted suicide and euthanasia. Chief Rabbi Haïm Korsia noted that red lines were respected as "no new rights or freedoms are being opened," emphasizing the end of suffering rather than assisted suicide. Christian Krieger, president of the Protestant Federation of France (FPF), acknowledged the implementation difficulties but noted that the law does not seem to encourage pure assisted suicide. Several caregiver associations, including the French Society for Accompaniment and Palliative Care (SFAP), have expressed dismay and anger. They believe the proposal goes against the values of care and non-abandonment that underpin the French end-of-life care model. François-Xavier Bellamy of LR and Laurent Jacobelli of RN criticized the proposal, accusing President of the Republic Emmanuel Macron of diverting attention from the main concerns of the French people, such as purchasing power, security, and immigration. (6)
The path to adopting a law remains long, likely not before 2025, due to the numerous ethical, moral, and social debates raised by the bill on assisted dying. However, this project marks an important step towards recognizing individual freedoms and the dignity of terminally ill patients in France. The debate on the French bill regarding assisted death highlights the complexities surrounding end-of-life patient rights within the European legal framework. While some countries have established regulations for active euthanasia and assisted suicide, France's current laws primarily focus on passive euthanasia. The proposed legislation aims to provide terminally ill patients with more autonomy by legalizing "assisted dying" under strict conditions, ensuring informed consent, and expanding palliative care. Despite support for individual choice and dignity, the bill faces significant ethical, moral, and practical opposition, indicating a lengthy path to potential adoption. This initiative represents a pivotal moment in addressing the balance between patient rights and ethical considerations in end-of-life care.
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The contents of the article represent solely the ideas and opinions of the author and in no way the opinions of Bocconi University or the IUS@B association.
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