The bill has been sitting on a minister’s desk for months. Emmanuel Macron had promised it for his second term. He finally chose this very hectic period of the European election campaign to present his end-of-life bill. The debate will therefore open in the National Assembly just before the June 9 vote.
This is in a long joint interview with the daily newspapers Release And The cross that he presented the text which will soon be submitted to elected officials. A project opening “the possibility of requesting assistance in dying under certain strict conditions”, he specifies.
From the outset, Emmanuel Macron assures that this “aid” will be “reserved for adults, […] capable of full and complete discernment.
There is no question, therefore, of offering it to minors and patients suffering from psychiatric or neurodegenerative illnesses which impair discernment, such as Alzheimer’s. Only people suffering from an “incurable illness” that threatens their “short or medium-term vital prognosis” and experiencing “physical or psychological suffering” that “cannot be relieved” will be able to request it. Accompanied by a medical team, the patient will have two days to reconsider their decision, and their wish must be granted within the following 15 days.
A hybrid model
In practice, France seems to have opted for a form of compromise between assisted suicide practiced in Switzerland, Austria and many American states (where the patient administers lethal treatment to themselves) and euthanasia practiced in Belgium and Quebec (where a third party is authorized to do so). “Concretely, a person who wishes to die will have to administer the lethal product themselves, except in the extremely specific case where they will be physically prevented from doing so,” explained to Figaro Giovanna Marsico, director of the National Center for Palliative and End-of-Life Care.
Even if the subject is apparently consensual – according to an IFOP survey carried out in 2023, 70% of French people are in favor of active assistance in dying – it did not take 24 hours for it to provoke very strong reactions. Particularly in the medical profession.
By mid-February, 13 organizations representing 800,000 health professionals had published an article in Le Figaro considering the practice of care “incompatible” with that of a medically administered death. Professionals see it as “a major ethical shift”. On the other hand, the former sports journalist Charles Biétry publicly congratulated of this decision. Suffering from Charcot’s disease, he had already planned his suicide in Switzerland.
“It will be quicker to have access to a doctor to request assistance in dying than to be treated,” lamented Claire Fourcade, president of the French Society for Support and Palliative Care (SFAP).
The choice of words
At the origin of this debate, there is first of all the choice of words. In December 2022, the Minister Delegate in charge of Territorial Organization and Health Professions, Agnès Firmin Le Bodo, commissioned the writer Erik Orsenna to find the most appropriate terms. The president visibly decided in favor of the Quebec terminology – “assisted dying” – rather than the more clear-cut one of Belgium and Austria, where we openly speak of “assisted suicide” and “assisted suicide”. euthanasia”.
Simple propaganda artifice? According to the president, the formula “assisted suicide” is not appropriate since it would correspond to “the free and unconditional choice of a person to dispose of their life”. As for “euthanasia”, it would designate, he said, “the fact of ending someone’s life, with or even without their consent”.
However, this way of saying things is not unanimous among certain supporters of the law nor among some of its opponents. Among the latter, Jacques Ricot, philosopher and member of the SFAP. Anyone who knows Quebec well believes that this term is an illusion. “It is clear that Emmanuel Macron has opted for a form of assisted suicide and euthanasia, but that he does not want to say it. » Supporter of an even more liberal law, the president of the Association for the Right to Die with Dignity (ADMD), Jonathan Denis, judges that what the president is proposing, “is an assisted suicide. And if this gesture requires the intervention of a third party or a caregiver, it is called euthanasia,” he told the magazine. Point.
On both sides, President Macron is also criticized for not having kept his promise to present before such a bill a vast program for the development of palliative care, of which half of French people at the end of life would today be private. At most, he promised that the 21 departments which do not have them will be equipped with palliative care units. In concerned circles, it is estimated that the billion euros promised over 10 years will only cover the increase in the number of deaths during the same period.
As in Quebec, French law should allow caregivers to invoke a conscience clause to not participate in the death of a patient. The other major subject of debate relates to this choice of authorizing the administration of a lethal cocktail by a loved one. A grandson could therefore euthanize his grandmother, we could read in the press. A practice that does not exist anywhere else in the world.
The end of the “French model”?
The assertion that, in the current state of medicine, certain suffering cannot be relieved is also contested. The so-called Léonetti law, named after the deputy who sponsored it, obliges caregivers to relieve the physical suffering of patients at the end of life by all possible means, including sedation which would plunge them into a deep coma that could cause death.
Adopted in 2005, this law, considered until now as a “French model”, was modified in 2016.
“What the president says is false,” says philosopher Jacques Ricot. “Today, if we put in the resources and personnel, we can treat 100% of physical pain using various methods, even if it means death. But no one knows and we let ourselves be fooled. The law is not enforced, and 500 people die every day without having access to it. » He cites in particular a study carried out at the Jeanne Garnier medical center where, out of 2557 patients, 9% had expressed in one way or another a desire to die. Once palliative care had been administered, only 3% made a formal request. Request subsequently reiterated by barely 0.3% of patients.
While some fear that this bill is only “a first step”, others are openly calling for it. The ADMD deplores that the intervention of a third person is only possible for people who are physically incapable of killing themselves. She also hopes that — as in Quebec since a Superior Court judgment — the law does not exclude patients suffering from degenerative diseases such as Alzheimer’s. Jonathan Denis fears that by imposing too strict conditions, this law could become “inapplicable”.
“A dam will fall, and we will witness an unprecedented increase in cases of assisted suicide and euthanasia,” deplores Jacques Ricot on the contrary. As proof, he cites the figures from Quebec, where, 10 years after the adoption of the law, more than 7% of deaths result from assistance in dying. A rate which far exceeds those of Belgium and the Netherlands. We see in fact that offering euthanasia leads to many more deaths than offering assisted suicide; the ratio would be 8 to 1.