“Assistance in Dying” Bill Analysis: Between Aggravation and Cosmetic Attenuation
Whereas the bill on palliative care was adopted unanimously, the bill which aims to legalise euthanasia and assisted suicide concealed behind the deceitful expression “assistance in dying” was adopted by a divided parliament : 199 votes against, 305 for and 57 abstentions.
The public session debate at the National Assembly between 17thand 24th May 2025 resulted in a text far removed from the impossible equilibrium claimed by the reporter Olivier Falorni and the Health Minister Catherine Vautrin. How can one possibly talk of equilibrium when the law aims to lift the prohibition against killing?
As underlined by Alliance VITA in a warning statement following the vote: “The unanimous adoption of the bill concerning palliative care, as essential as it is, does not, in any way, compensate for the deleterious effects of the legalisation of assisted suicide and euthanasia: firstly, because the ten-year strategy for palliative care will be spread across ten years whereas the so-called “assistance in dying”, if it comes into effect, will be immediately available. Also, because the palliative culture for accompaniment and relief is the complete opposite of euthanasia practices, which are invariably brutal and, in many cases, expeditious.“
A legislative step but not a final result
Although this vote marks an unfortunate step, it is not the end of the legislative process. Discussions are to continue with the Senate in the autumn, who may reject or modify the text prior to a second reading at the National Assembly in 2026. This controversial text, which lifts the prohibition against killing for a category of vulnerable patients, could be blocked by the joint mixed commission and be subjected to a new reading if the senators and MPs fail to agree on a common text. At a time when access to care – in particular palliative care and pain relief – is difficult, delayed or even impossible in many regions, the risk is immense – if the process reaches its end – that patients will be suicided or euthanised through a lack of appropriate care.
Principal measures
A “right” to “assistance in dying” as opposed to a last resort
Presented by its authors and the government as a last resort, administered death has drifted towards the notion of a “right”, presented as an option for dying if the criteria are satisfied, for which it will not be possible to suggest alternatives.
Assisted suicide as the first instance
In the Committee on Social Affairs, MPs voted for equality of choice between the practice of assisted suicide and euthanasia according to the wishes of the applicant. An amendment by the government was adopted to re-establish the practice of assisted suicide in the first instance and euthanasia as an exception, if the applicant is unable to self-administer the lethal product. It remains however that both practices involve lifting the prohibition against killing and constitute a threat against the more vulnerable.
Vague and unverifiable criteria
Five criteria must all be satisfied in order to be eligible.
1/ The applicant must be adult including if under legal protection
2/ The applicant must be a French national or be living stably and legally in France.
3/ The applicant must be suffering from “a serious and incurable disease, for whatever reason, which threatens their life expectancy, in an advanced or terminal phase”.
The notion of advanced phase, already used in previous laws such as the 2016 Claeys Leonetti law was considered too difficult objectively by HAS (High Authority for Health) as it is intended to cause the death of a patient, which was not the case with the previous laws.
The government introduced an amendment intended to enlighten the doctor who will be in charge of checking this criterion by specifying that the advanced phase is characterised by “The initiation of an irreversible process marked by the deterioration of the state of health of the patient and affecting his/her quality of life“. Such notions remain imprecise and their evaluation is at the free will of the medical authority. This measure is both unjust, inegalitarian and liberticidal whereas palliative care is not accessible everywhere and by all.
The end-of-life situation has been discarded which leads potentially to making hundreds of thousands of people eligible.
4/ Exhibiting “constant physical or psychological suffering“ which is either “refractory to treatments, or unbearable according to the person” when he/she “chooses not to receive or to terminate a treatment.
An amendment provides some clarification of the notion of “psychological suffering” which on its own “cannot under any circumstances provide eligibility for assistance in dying”. This detail could in principle eliminate psychic or psychiatric diseases. However, the absence of any obligation by the doctor who receives the patient’s request to refer to a psychologist or psychiatrist in the event of psychological suffering risks preventing the recognition of states of depression or even multiple pressures which patients may be subjected to.
According to studies, the fear of being a burden on their entourage is a major reason for requesting euthanasia or assisted suicide both abroad and in France.
These provisions are contrary to the national policy for suicide prevention.
The appeal by 600 psys against euthanasia underlines this paradox: “How can one convince a person in despair to hang on to life if society itself admits that, in certain cases, death is a legitimate solution?
According to specialists in mental health, which has been declared a national cause for 2025, this law constitutes both a negative signal for suicide prevention policies and a threat for all those working on a daily basis with people made fragile by psychiatric disease and despair.
5/ Being “apt to express their free and enlightened will”. The following wording was added to the text: “A person whose discernment is “seriously affected” cannot be eligible“. How can one possibly judge seriously affected discernment, a notion which is neither defined in legal terms, nor medically which once again represents a new margin of appreciation for the doctor. Also, those under legal protection would be eligible subject to information in line with their “discernment faculties” whereas they are considered as degraded in terms of their decision-making abilities. Several MPs alerted about the risk of abuse of weakness. In vain…
In the context of the difficulty of access to care, when half of those who need palliative care are unable to obtain access, that pain relief waiting lists take several months, how can one evaluate a free and enlightened will?
Note that the request for euthanasia and assisted suicide cannot be included in advance directives which the government and the reporter present as a safeguard intended to guarantee the “equilibrium of the text”.
A procedure under the control of a single doctor
- The final decision is dependent on a single doctor
The doctor who receives the request for death can only do so face to face and not by remote video-consultation. He/she will be responsible for checking the criteria and implementing a collegial procedure preferably in physical presence, including at least a specialist doctor for the pathology which the patient is suffering from and a carer directly involved with the patient. Other professionals may be called, subject to the free will of the doctor, and the advice of the person of confidence called. The doctor alone takes the final decision to judge whether the criteria are satisfied. As for the patient’s family members, they will be neither consulted, nor informed.
- A particularly expeditious decision period
The doctor must make his/her decision within a maximum of 15 days and the patient then has a further two days for reflection. In Belgium the decision period is one month if the person is not at his/her end of life, and in Canada it is 90 days.
The request must be renewed and the criteria re-evaluated if death has not been administered within three months and the patient must re-confirm his/her request.
- Doctor or nurse to administer death by prescription
A doctor or a nurse must be present with the patient in the event of self-administration or administration if he/she is physically incapable of doing so. The doctor may be different from that who prescribes the lethal product. The location and date of the administered death is at the choice of the patient, whereas the High Authority for Health (HAS) will be responsible for defining “the lethal substances liable to be used.”
- Deletion of death by natural causes
The Orwellian phrase “considered to have died naturally” was deleted but the positive connotation of the term “assistance in dying” does not diminish the gravity of the text of the bill which in fact constitutes killing without saying so, for patients not necessarily at their end of life.
That wording is aimed in particular at the insurance code which states: “the insurance in the event of death is null and void if the insured person wilfully causes his/her death during the first year of the contract.” Article 19 of the bill modifies that provision by claiming that the provision is not applicable in the event of assisted suicide or euthanasia and that the insurance must be applicable as in the case of a death by natural causes.
A restricted conscience clause
The conscience clause included for health workers is limited to only those professionals who take part actively and the latter must inform their patients about “assistance in dying” by assisted suicide or euthanasia, and not attempt to dissuade them, and must direct them to another doctor if necessary. Furthermore, chemists and institutions, such as palliative care centres or care homes, are deprived of such clauses. Several MPs called for a conscience clause for chemists as requested by the national union of chemists, public health establishments (Synprefh) and a chemist collective as is the case in those foreign states which have legalised such practices. That request was rejected.
The most repressive bill in the world through the obstruction offence
During the examination session, MPs extended the sentence to two years in prison and a 30,000 euro fine for any person attempting to dissuade a person from ending it, notably by “applying moral or psychological pressure”. Conversely, all the requests to penalise administered death by incitement and publicity were rejected. Double standards which will endanger the most vulnerable. A flagrant injustice, only those associations whose aim includes “The defence of the rights of people to access assistance in dying” will be able to undertake a court action in the event of an obstruction offence allegation.
The reporter Olivier Falorni denied any collusion with suicide prevention. He refers to a report published by the national suicide observatory which claimed that there would be no interaction between “suicide and assistance in dying”. However, the authors admit “that there exists quantitatively little research and data on the possible links between suicide and assistance in dying”.
A posteriori checks
Despite the attempts by several MPs to propose stricter a priori checking in view of the irreversibility of the fatal consequences, the criteria will only be checked once the person has deceased.
Opposition to the text, with neatly presented arguments, is rising and diversifying. In the coming months the legal process will follow its course but the result is far from certain: the time is ripe for multiplying actions against any form of assisted suicide or euthanasia and to ensure ready access to palliative care and pain relief everywhere in France. The next stage is to encourage the senators to vote for palliative care, for suicide prevention and against therapeutic obstinacy and euthanasia.
Suivez-nous sur les réseaux sociaux :
