The government’s text, retouched by the deputies in committee, arrives in the hemicycle on Monday afternoon, for approximately two weeks of debate, before a solemn vote on June 11.
The end-of-life bill enters the Palais-Bourbon arena. The text aimed at strengthening access to palliative care and legalizing assistance in dying is examined in the National Assembly, Monday May 27, from 4 p.m. For two weeks, elected officials will look into this project, as much anticipated as it is feared, presented by the government in April. The document arrives in the hemicycle in a version revised by the deputies in committee, where some of the conditions of access to assisted suicide or euthanasia have notably been modified. The criterion of “vital prognosis committed in the short or medium term” was thus replaced by that, considered broader, of an affection “serious and incurable in advanced or terminal phase”.
Franceinfo presents to you the new version of this bill, which promises to be further amended between now and its solemn vote at first reading, scheduled for June 11. The bill will then continue its long legislative journey in the Senate, the outcome of which is not expected before the summer of 2025.
Palliative care guaranteed by an enforceable right
Article 1 of the bill establishes the “palliative and supportive care”, a new concept more ambitious than current palliative care. They aim to “offer comprehensive care for the sick person, accessible throughout the national territory, in order to preserve their dignity, quality of life and well-being”. To do this, they must respond to the “physical needs” of the patient, but also to his “psychological and social needs”. They involve the use of palliative care and include other forms of support, “from the start of the illness”.
To better combat inequalities in access to palliative care, the deputies of the special commission have, against the advice of the government, established an enforceable right to benefit from it. A judge can thus order the provision of palliative care to a patient who has requested such care in vain. Through several amendments, elected officials have also consolidated the place of palliative and supportive care in medical studies, now defined in the Education Code as necessarily integrating “training in end-of-life support and the palliative approach”. They also included in the bill the ten-year strategy for supportive care presented in April by the executive, as well as the associated budgets.
“Support homes” for the sick
Article 2 introduces a new family of medico-social establishments: “support and palliative care homes”which will aim to“welcome and support people at the end of their lives and their loved ones”. These small structures, which deputies have restricted to the public or private non-profit sector, will have to fill the gap which sometimes exists between the home and the hospital. They will represent a new solution for patients who are no longer able to stay at home, but who do not necessarily require highly medical care.
A “personalized support plan”
The desire for early treatment of patients is concretized, in article 3, by the creation of a “personalized support plan”which may be proposed “as soon as the diagnosis of a serious condition is announced”. The patient will be able to express their needs and preferences, in order to plan coordinated follow-up in terms of care and social support. In accordance with the wishes of the deputies of the special committee, caregivers will also be made aware of the issues related to the end of life and the assistance to which they are entitled. Once drafted, the plan will be annexed to the advance directives, the importance of which is reinforced in article 4 of the bill.
Legalization of assisted dying
Article 5, the most symbolic, concerns the introduction of assisted dying in France, in the form of assisted suicide, or even, exceptionally, euthanasia – two terms which do not appear explicitly in The law project. “Assistance in dying consists of authorizing and supporting a person who has expressed the request to use a lethal substance (…) so that they can administer it to themselves or, when they are not able physically to do so, have it administered by a doctor, a nurse or an adult whom they designate and who comes forward to do so.”, details the text. It will be completely free.
To access assistance in dying, a person must meet all of the five conditions defined in article 6:
- “Be at least 18 years old”
- “Be of French nationality or reside stably and regularly in France”
- “Being suffering from a serious and incurable illness in the advanced or terminal phase”
- “Present physical suffering, possibly accompanied by psychological suffering linked to this condition, which is either refractory to treatment or unbearable when the person does not receive treatment or has chosen to stop receiving it”
- “To be able to manifest one’s will in a free and informed manner.”
A request subject to the green light from a doctor
Article 7 governs the formulation of the request to a doctor. The practitioner contacted, who must not be close to the patient, will be required to inform them of the assisted dying procedure, of other “treatments and support available”but also the possibility of waiving your request “at any time”. He must also offer to “benefit from palliative care” and, where applicable, ensure that it can “to access”. A referral to a psychologist or psychiatrist should also be suggested to the patient.
According to article 8, the doctor must, within fifteen days of the request, decide whether the patient meets the five criteria provided. For this, he will be required to “collect feedback” several caregivers, including at least one external doctor, specialist in the patient’s pathology, and “a medical assistant [infirmier, par exemple] or a caregiver”. The opinion given by other caregivers will only be advisory, with the practitioner initially requested remaining the sole decision-maker.
In the event of a green light, the patient will have to respect a reflection period of two days, which could, as the deputies wanted, possibly be “abbreviated” by mutual agreement with the doctor. In the event of a negative response to the request for assistance in dying, the patient may challenge the decision before the administrative courts. Even after making his decision, the doctor may cancel it if new information leads him to consider that the conditions “were not fulfilled or ceased to be fulfilled”.
A procedure performed under the supervision of a caregiver
Under Articles 9, 10 and 11, once the patient’s request has been approved and confirmed, the doctor will prescribe the product and agree with the patient on “the doctor or nurse responsible for accompanying him for the administration of the lethal substance”. It is this professional, and not the patient himself, who will be able to pick up the product at the pharmacy. The date and place of the act will be determined by mutual agreement between the caregiver and the applicant. If assistance in dying is scheduled more than a year after the green light, a new evaluation of the “free and enlightened character” of demand will be necessary.
After a final verification of the patient’s wishes, assistance in dying can be carried out, in the presence of their loved ones if they wish. If the patient requests a postponement, a new date can be scheduled. The doctor or nurse will set up the device and monitor the procedure. He will not be required to stay “alongside the person”but will have to “be in sufficient proximity to be able to intervene in the event of difficulty”.
As a matter of principle, “the administration of the lethal substance is carried out by the person himself”, recalls the text. It is only when the patient is faced with a physical impossibility (total paralysis, for example) that the procedure can be entrusted to the professional present or to “an adult who has accepted this responsibility”.
A conscience clause guaranteed to professionals
Under article 16 of the bill, any health professional may refuse to treat or be associated with a request for assistance in dying made by a patient. Likewise, any doctor or nurse may refuse to accompany the patient in the administration of the lethal product, unless they have agreed to do so after their request has been approved. “The health professional who does not wish to participate (…) must inform, without delay, the person of his refusal and communicate the name of health professionals willing to participate in this implementation”provides the bill.
To facilitate the identification of voluntary caregivers, they will declare themselves to a commission responsible for monitoring assisted dying. Missions carried out within the framework of assisted dying cannot give rise to excess fees and the procedure will be free for patients.
A commission responsible for a posteriori control
To facilitate monitoring of the system, Article 17 provides for the establishment of a “evaluation and control commission” attached to the Ministry of Health. Each professional who has agreed to follow a patient must transmit the documents produced throughout the process. On this basis, the commission will be responsible for monitoring compliance with “each assisted dying procedure” at the end of it.
In the event of suspicion of a crime or misdemeanor, this body must take legal action. Faced with a possible “breach of ethical or professional rules” on the part of a caregiver, she can report it to the disciplinary chamber of the competent order (order of doctors, order of nurses, etc.). Finally, it will have to deliver a report to the government and Parliament, each year, with recommendations to develop the system in the event of an identified need.
An offense of obstructing assisted dying
The deputies introduced an article 18 bis which provides for a sentence of one year in prison and a fine of 15,000 euros for any attempt “to prevent practicing or finding out about assisted dying”. This offense of obstruction, inspired by that which already exists in matters of abortion, could particularly apply in the event of “pressures” on caregivers, patients or relatives. Possible publications are also covered. “likely to intentionally mislead, with a deterrent purpose, about the characteristics or medical consequences of assisted dying”.