France's National Assembly passes right to assisted dying under strict conditions

Eligibility extends to adults suffering from a serious and incurable illness causing unbearable suffering. „Die Möglichkeit der Sterbehilfe können nur dauerhaft in Frankreich lebende französische Staatsbürger ab 18 Jahren nutzen", it states. A purely mental illness alone is not sufficient to establish eligibility for assisted dying.

Strict requirements and procedures

In addition, those concerned must be capable of judgement and must express their wish freely and repeatedly. The patient must „den Wunsch nach Sterbehilfe frei und klar an einen Arzt oder eine Ärztin richten können und sich der Tragweite bewusst sein" and be able to make their decision freely and consciously. The law provides that the patient self-administers the lethal substance unless they are physically unable to do so.

The law provides for a multi-stage review procedure, among other things. „Zuvor müssen mehrere Ärztinnen bzw. Ärzte den Antrag prüfen"; accordingly, „ein interdisziplinäres Gremium unter ärztlicher Beteiligung den Wunsch nach Sterbehilfe prüft und der Arzt dem Erkrankten binnen zwei Wochen das Ergebnis mitteilt". After a positive decision, an additional reflection period applies. „Dieser muss seinen Wunsch nach Sterbehilfe nach zwei Tagen Bedenkzeit bekräftigen". In addition, a reflection period of at least two days applies.

„Und nur wenn die betroffene Person die tödliche Substanz nicht selbst einnehmen kann, darf ein Arzt oder eine Pflegefachperson die Verabreichung übernehmen." In this case, the act is carried out by a doctor or a nurse. „Das Mittel kann von den Betroffenen selbst oder – falls sie körperlich dazu nicht in der Lage sind – von medizinischem Personal verabreicht werden." Assisted suicide and active euthanasia differ in that, in assisted suicide, the patient self-administers the substance, whereas in active euthanasia – also known as „Tötung auf Verlangen" – another person, such as a doctor, administers the lethal substance.

Palliative medicine and freedom of conscience

The law expressly provides for a right to information about palliative care: those concerned must be informed about the options of palliative medicine and must be able to receive it on request. A separate law to expand palliative care was also passed. It is intended to prevent people from resorting to assisted dying because of a lack of palliative support.

Doctors and nursing staff may refrain from participating in assisted dying if they cannot reconcile this with their conscience. „Diese können aus Gewissensgründen eine Beteiligung an der Sterbehilfe ablehnen und an Berufskollegen verweisen." This also applies if the patient discontinues or refuses a treatment – even then, the path to assisted dying remains, in principle, open.

Review by the Constitutional Council

Before the law takes effect, it must be reviewed by the Constitutional Council. Prime Minister Sébastien Lecornu has announced that he will refer the matter to the Constitutional Council. It is to examine whether individual provisions are compatible with the principles of human dignity and individual liberty. „Obwohl der Entscheid nun gefällt wurde, wird das Gesetz noch nicht sofort in Kraft treten." The law could now still be reviewed by the French Constitutional Council and possibly amended.

The conservative-dominated Senate had voted against the bill; since then, the draft has been adopted several times in the National Assembly but rejected just as often by the conservative-dominated Senate. After the failure of a conciliation procedure, the government ultimately decided to give the National Assembly the final word – a constitutionally provided step, since the lower house has the final word in the legislative process.

Political path and Macron's reform record

The bill is considered one of the most important social reforms of President Emmanuel Macron. Although Macron had already shown himself open to an assisted dying law in 2017, during his first term he shelved the issue. But Macron hesitated again: although he was fundamentally open to a further development of the legislation, he feared possible social tensions and conflicts with religious communities. In his second term, the French president then convened a citizens' convention on end-of-life issues.

The citizens' convention spoke out by a majority in early 2023 in favour of introducing active euthanasia. An initial government draft was presented in 2024, but the surprise dissolution of the National Assembly in June of that year stopped the project just short of the goal. The current law is the result of a relaunch of the procedure after the subsequent election. While polls show that a large majority of the population supports the new rules, they met with resistance from parts of the medical profession, conservative politicians, and the Catholic Church.

Resistance from medicine and the Church

The reform is controversial in France not only among politicians but also among health professionals. Some believe that assisted dying is ethically indefensible and must not be a task of medical staff. Supporters argue, by contrast, that the law gives terminally ill patients more autonomy at the end of life. Former Interior Minister Bruno Retailleau declared: „Eine Gesellschaft müsse die Schwächsten schützen und pflegen und dürfe sie niemals aufgeben".

The Catholic Church also traditionally rejects any liberalisation of assisted dying. The French Bishops' Conference warned that the possibility of assisted suicide could open the door to abuse, for instance if terminally ill people felt themselves to be a burden. President Macron's second term ends the following spring; the law is nevertheless regarded as one of the defining socio-political projects of his presidency.

France in European comparison

With the new rules, France joins a growing group of European states that permit active euthanasia, including the Netherlands, Belgium, and Spain. Assisted suicide is also permitted under certain conditions in Austria, Germany, and Switzerland. In Germany, active euthanasia – that is, killing on request, for example by injection – is punishable. Assisted suicide is also not punishable – it may consist in procuring or providing a lethal means that the patient self-administers.

In Germany, there has been a debate for years over legal regulation of assisted dying. The discussion has repeatedly attracted public attention, for example through the publicly announced assisted suicide of Austrian publicist Niki Glattauer in the autumn of the previous year.

The backstory of the French law is closely tied to individual fates. Vincent Lambert, who fell into a permanent vegetative state in 2009 following a traffic accident, died in 2019 at the age of 42 after a long legal battle over the withdrawal of life-sustaining treatment. His wife had advocated for the withdrawal, while his parents fought it all the way to the highest court.

Individual fates behind the debate

The case of Alain Cocq from Dijon also shaped the debate in France. He suffered for 30 years from an incurable and extremely painful arterial disease, made a public appeal to President Macron in 2020 to allow active euthanasia, and went on hunger strike twice after being refused by the Élysée Palace. Cocq took his case to the European Court of Justice and ultimately opted for assisted suicide in Switzerland, where he died in 2021 at the age of 58.

In France, doctors had already been permitted since 2005 to withhold or withdraw life-sustaining treatment at the patient's request or where therapy was futile. Since 2016, seriously ill people in France have also had the right to strong pain treatment that may hasten death. Over the past two decades, French end-of-life rules have been loosened several times, until parliament has now taken the next major step.