With the final adoption of the law on assisted dying (aide à mourir), the French National Assembly has made a decision that extends far beyond the legal framework. Few other political initiatives touch so directly on fundamental questions of humanity, medicine and the state as the legal regulation of assistance in dying. France is thus joining a small group of European countries that permit medically assisted ending of life under clearly defined conditions. But before the law can enter into force, the Constitutional Council will examine whether the balance between individual freedom and the protection of life complies with the requirements of the French Constitution.
The vote marks a historic turning point. Not because France has suddenly enacted far-reaching liberalization, but because, after decades of ethical controversy, the country has found a political compromise that seeks to reconcile two seemingly incompatible principles: the individual’s right to self-determination and society’s responsibility to protect particularly vulnerable people.
A Law with Strict Conditions
Those who have followed the public debate might get the impression that France has legalized euthanasia. The opposite is true. The adopted law is deliberately restrictive in its wording.
Only adult patients suffering from a serious and incurable illness, whose condition is at an advanced or terminal stage and who must endure unbearable physical or psychological suffering, are eligible. In addition, the wish for assistance in dying must be expressed freely, in an informed manner and repeatedly.
One decision by the legislature is nevertheless noteworthy: unlike some other European regulations, France dispenses with a fixed definition of remaining life expectancy. At first glance, this may seem surprising, but it reflects a medical reality. Particularly in neurodegenerative diseases such as ALS or certain forms of Parkinson’s, the timing of death is often difficult to predict. A rigid time frame would inevitably have led to unequal treatment and turned medical prognoses into legal decisions of fate.
The French solution thus acknowledges a simple fact: medicine knows probabilities, but rarely certainties.
Between Autonomy and the Duty of Protection
The real political challenge lies in weighing two legitimate values against each other.
Modern democracies increasingly understand human beings as autonomous individuals. Decisions about one’s own body are among the strongest expressions of personal freedom. Supporters of the reform infer from this that the end of life, too, should not be subject entirely to state paternalism.
Yet there is an equally weighty tradition. Since Hippocrates, medicine has been regarded as committed to life. The state, in turn, has a duty to protect the weak, the sick and the elderly. Critics of the reform therefore fear that social pressure could develop on people who see themselves as a burden on relatives or the health care system.
This concern deserves to be taken seriously. Not because the French law would create such pressure, but because social developments are rarely determined solely by legal texts. They often emerge gradually – through expectations, economic constraints or cultural changes.
This is precisely why the multi-stage oversight of the procedure is of central importance.
A Procedure with High Thresholds
France has deliberately chosen against a simple approval procedure. Several medical professionals must be involved before an application can be approved. A reflection period follows the decision. Only then does the patient confirm the wish again. Immediately before the procedure is carried out, it is checked once more whether the wish remains unchanged and whether there has been no outside influence.
These numerous safeguards may appear bureaucratic. In fact, they form the core of the law’s legitimacy. Assistance in dying must never become an administrative routine.
The conscience clause is also of particular importance. Doctors and nursing staff may refuse to participate for ethical or religious reasons. At the same time, the law prevents entire institutions from collectively withdrawing from their responsibility. The legislature thus seeks to safeguard both the freedom of conscience of medical staff and patients’ access.
This balance is characteristic of the French Republic: individual freedom, but embedded in institutional responsibility.
No Alternative to Palliative Care
Equally important as the assisted dying law is the law adopted in parallel to expand palliative care.
This connection is politically astute. A society that permits assistance in dying must also do everything possible to enable people to live with dignity until the end. No one should have to choose death because pain is inadequately treated or because medical support is lacking.
France still has considerable catching up to do in this area. Regional disparities in access to specialized palliative services have existed for years. The investments announced through 2034 are therefore more than a social policy support program. They are a prerequisite for the ethical credibility of the entire reform.
Assistance in dying can only be an expression of free choice when genuine alternatives are available.
Europe Remains Divided
The French decision fits into a broader European development, without suggesting a uniform trend.
While countries such as Belgium, the Netherlands and Luxembourg have had more extensive regulations for years, other states continue to rely exclusively on palliative care or categorically reject every form of active euthanasia. Germany permits assisted suicide under certain conditions, but so far has no comprehensive legal procedure. Other European states, meanwhile, pursue significantly more restrictive approaches.
These differences do not reflect differing appreciation for human life. Rather, they show that democratic societies can give different answers to the same ethical questions.
France has chosen neither the most liberal nor the most conservative model. Instead, it is seeking a middle path that enables self-determination without crossing the threshold into the general availability of medically assisted ending of life.
Whether this balancing act s쳮ds in the long term will depend less on the legal provisions than on their practical application.
The real test will therefore begin only after the law enters into force – provided the Constitutional Council approves the reform. It will then become clear whether the numerous safeguards are sustainable, whether palliative care is actually expanded and whether public trust in medicine is preserved.
Laws cannot resolve ethical conflicts. They can only create a framework in which freedom and responsibility remain compatible. France has chosen such a framework. Whether it endures will be decided not by politics alone, but by the culture of dealing with illness, old age and human dignity.
Author: P. Tiko