End-of-life and palliative care take center stage in France

After a nearly year-long hiatus following the dissolution of the National Assembly in June 2024, the sensitive issue of end-of-life care was taken up again by French lawmakers on Monday, May 12. They took up the examination of two bills: one on palliative care, championed by Annie Vidal (Renaissance party), and the other on active "assistance in dying," put forward by Olivier Falorni (MoDem party).

The deputies will debate these two texts for two weeks, including weekends, before a formal vote scheduled for May 27. The debate is expected to lead to the creation of a “right to die,” which the executive branch wants to be “highly regulated,” but which is still opposed by many deputies, who have not yet said their final word.

The first bill, which enjoys a broad consensus, provides for the creation of an “enforceable right” to palliative care, a principle aimed at guaranteeing every patient access to such care at the end of life. This proposal responds to a recommendation in the July 2023 report of the Court of Audit, according to which only half of palliative care needs are currently met.

Annie Vidal, the first to speak in the chamber on Monday afternoon, called on her fellow deputies to adopt her bill unanimously, as occurred in committee. “Let us set ourselves the same goal, thinking of those who, thanks to us, will be able to approach death and die as peacefully as possible.”

The second bill, on assisted dying, was more controversial and was adopted in committee on May 2 by 28 deputies to 15. This vote has boosted the hopes of the rapporteur, Olivier Falorni, who could give his name to the future law.

“There is nothing more beautiful than life, but there is sometimes worse than death, (...) when life has become an ocean of suffering that nothing can alleviate,” he told his fellow deputies on Monday. He called for legislation that would offer “a last resort” to terminally ill patients suffering from intractable pain.

The question of eligibility criteria will be one of the major points of debate. Initially, Olivier Falorni's text stipulated that the patient must be suffering from a serious and incurable condition that is life-threatening in the “medium term.” This notion was rejected by the deputies, who deemed it too vague.

The final text now stipulates that the patient must be suffering from a serious and incurable disease, in an advanced or terminal stage, regardless of the cause. However, this definition was considered too broad by opponents.

But the creation of assisted dying, which refers to both assisted suicide and euthanasia (although the two are not the same), is meeting with fierce opposition. Some denounce it as an “anthropological break,” while others see it as a “lesser evil.”

The issue is causing tension within the government. Interior Minister Bruno Retailleau (of Les Républicains, LR) and part of his party, as well as members of the far right, are strongly opposed to this development. In an interview with Le Journal du Dimanche published on May 10, he denounced a “text of anthropological rupture.”

Similarly, seven other LR deputies, including emergency doctor Philippe Juvin, expressed their concerns in an op-ed in Le Figaro on May 7, criticizing the lack of solid guarantees regarding deadlines, the traceability of the procedure, the collegiality of decisions, and the verification of the patient's free will.

For his part, French president Emmanuel Macron reaffirmed his support for the measure on May 5 before the Freemasons of the Grand Lodge of France. Support for the law has also grown, notably from former Prime Minister Gabriel Attal, who published an op-ed in favor of the text in La Tribune, co-signed with Line Renaud.

Health Minister Catherine Vautrin said on Monday in the National Assembly that “refusing this debate, when our legal system does not provide answers to all situations, (...) is turning a blind eye to suffering from which only those who can find a way out by going abroad can escape.” 

The day before, in the columns of Le Parisien, she stressed that the aim was to respond to “strong expectations among the French people,” while ensuring that access to assisted dying is “highly regulated.”

While the opening of the debate on Monday is highly symbolic, it is only on May 27, the day of the vote, that the future of the proposed legislation on end-of-life care will be decided.