A panel of 150 members of the public are meeting Friday to begin discussing whether or not to adopt legislation that would legalise assisted dying, in line with President Emmanuel Macron’s wish to “serenely” debate this deeply divisive issue.
The 150-citizen assembly, modelled on the 2019-2020 Citizen’s Climate Convention, was chosen at random but weighted according to age and geographical origin.
Participants will consider whether to change the 2016 Claeys-Leonetti law which bans euthanasia (where doctors administer lethal drugs) and medically assisted suicide (where doctors make such drugs available), but allows terminally ill patients to refuse treatment and receive "deep and continuous sedation until death".
The question they’re asked is a simple one: "Is the framework accompanying the end of life adapted to different situations or should changes be introduced?”
The assembly will meet for regular three-day sessions between now and March before sending their recommendations to parliament.
As with the Citizen’s Climate Convention, there is no guarantee the government will implement the group's findings.
Major ethical change
A recent poll showed 78 percent of French citizens are in favour of establishing a “right to die”.
But public opinion should not be the gauge in bringing about such a significant change in the law says Thierry Beaudet, the head of the Economic, Social and Environmental Council (Cese) organising the panel.
“The end of life is a subject that requires nuance, we cannot be satisfied with polls,” he says.
There is, however, little consensus among decision makers and medical professionals about the route to take.
A majority of health workers have expressed concern or outright opposition.
“These extremely complex questions put us, as doctors, under strain,” said the head of France's ethics committee, Jean-François Delfraissy, in September.
Eight health worker organisations and palliative care units have also sounded the alarm over what they call a “major ethical change”.
“Ending life is not treatment,” said the French Society of support and palliative care (Sfap).
France’s Ordre des Medecins – a medical ethics regulatory body – is “not favourable to euthanasia”. Any change to the law, it said, must include a “conscience clause” allowing doctors to opt out of administering lethal drugs.
However, some doctors, who have testified anonymously to assisting relatives who “begged for help” in order to die, have called for an end to “underhand" methods, arguing end-of-life care could be handled correctly by doctors who know what they're doing.
Those in favour of a change to the law also argue that palliative care is simply not available widely enough, with residents in 26 of France's 101 administrative departments having no access to palliative care at all.
Left/right divide
Left-wing parties support a change in the law in the name of a “dignified end to life”, as well as freedom to choose one’s death when a terminally ill patient's suffering becomes unbearable.
The right and far right are by and large opposed, evoking the risk of “trivialising euthanasia”. They favour a better application of the existing law and palliative care. Far-right MP Marine Le Pen supports a referendum on the subject.
In April 2021, the National Assembly debated a bill on end-of-life care. It did not go to a vote after 3,000 amendments were tabled. But 240 of the chamber's 577 MPs approved the principle of “active medical assistance in dying”.
The government has not taken a position on the matter.
President Macron promised the Citizen’s Convention as a way of reaching consensus over such a sensitive issue.
He announced the panel in September after a report by France’s national ethics committee (CCNE) concluded that “active assistance in dying" could be envisaged, subject to "strict conditions".
Religious divides
In recent weeks, representatives of France's Catholic, Protestant, Jewish and Muslim faiths have expressed concerns over a change in the law, while stressing they are not presenting a united, political front.
They all want to see palliative care developed and the Claeys-Leonetti law evaluated, but defend the “absolute” respect for life.
The Roman Catholic Bishops’ Conference of France said the citizen's panel marked a departure from France’s “ethical heritage” as a Catholic country.
“Over the last few decades, France has gradually found a balance in refusing futile therapeutics and promoting palliative care. This 'French way' says something about our country’s ethical heritage,” it said in a statement.
France’s chief rabbi, Haïm Korsia, has said allowing assisted suicide would mark an “anthropological rupture”, “bordering on eugenics”, while the rector of Paris’s Grand Mosque Chems-eddine Hafiz underlined that “suicide is a sin” in Islam.
Necessary follow-up
Very few of the Citizen's Climate Convention findings were implemented and there are concerns the Citizen’s Convention on end of life might face the same fate.
"I can't imagine that there will be no follow-up to the convention’s work," Beaudet said in an interview with the JDD newspaper on Sunday.
Nonetheless, the government has suggested that the future recommendations may simply be food for thought.
"Debating always serves a purpose,” said Agnès Firmin Le Bodo, minister for health professions, but "it's the President of the Republic who decides."
If France legalises medically assisted suicide, it would join a growing list of European countries such as Germany, Spain, Belgium, Luxembourg, Switzerland and the Netherlands.
