Assisted dying has long been one of the most contested ethical issues in French healthcare. The National Assembly approved the bill by 291 votes to 241, with 29 abstentions, following a legislative process that has lasted for more than a year.

Who would be eligible – and who would not?

Under the proposed law, assisted dying would be available to people aged 18 or over who are French citizens or lawful permanent residents of France and who have the mental capacity to make an informed decision. They would need to have an incurable and life-threatening condition at an advanced or terminal stage, accompanied by pain or other suffering that cannot be relieved or that the patient considers unbearable.

One important restriction is that people with psychiatric conditions or neurodegenerative diseases, such as Alzheimer’s disease, would not be eligible.

Applications would be assessed by a doctor through a collegial review process, followed by a waiting period before the patient could proceed. If the application were approved, a lethal substance would be prescribed. The patient would normally administer it themselves, but a doctor or nurse could assist if this were not possible. A conscience clause would allow healthcare professionals to decline to take part.

The bill also includes a safeguard introduced in response to criticism. Doctors would be required to ensure that patients had access to palliative care if they requested it. This reflects concerns that inadequate access to palliative care, rather than a genuinely free choice, could lead some patients to seek assisted dying.

France in a European context

If the law takes effect, France will join a group of European countries that already permit some form of assisted dying or active euthanasia, including the Netherlands, Belgium, Switzerland and Spain. The rules differ considerably between countries, both in terms of eligibility and how the process is carried out.

A contested issue

The debate has largely centred on two concerns. One is that seriously ill or older people could feel pressured to choose assisted dying. The other is that the introduction of such a system could affect resources for palliative care. The safeguard concerning access to palliative care is a direct response to those concerns.

The situation in the Nordic countries

None of the five Nordic countries currently permits active euthanasia or has introduced a system comparable to the French proposal. The issue is nevertheless being discussed to varying degrees in Sweden, Norway, Denmark, Finland and Iceland.

Active euthanasia is prohibited in Sweden and Norway, and neither country has introduced comparable legislation. In Finland, Parliament is considering a new citizens’ initiative calling for a euthanasia law, after an earlier initiative was rejected in 2018. In Denmark, killing another person at their explicit request is a criminal offence, while palliative sedation and decisions to withhold life-sustaining treatment form part of lawful end-of-life care. Assisted dying is also prohibited in Iceland, although the issue has been the subject of political initiatives.

What happens next?

The law cannot take effect until it has been reviewed by France’s Constitutional Council. Prime Minister Sébastien Lecornu has said that he wants the council to examine three issues in particular: how long a person should have to withdraw their application, how people under guardianship or another form of legal protection can provide free and informed consent, and how the conscience clause should apply to institutions specialising in palliative care. The council may approve the legislation, amend it or strike down parts of the bill.

Facts: What is the difference?

Active euthanasia
Another person, usually a doctor, administers the treatment that causes death.

Assisted dying
The patient makes the final decision and normally administers the prescribed medication themselves.

Palliative care
Care intended to relieve suffering and provide the best possible quality of life when a cure is no longer possible.

Sources: AP News, Assemblée nationale, Conseil constitutionnel, Store medisinske leksikon, Retsinformation, Sundhedsstyrelsen, Eduskunta, the Swedish National Council on Medical Ethics (SMER), and Althingi.