FRANCE – The great debate about a self-determined end of life
22 February 2023
With the “Convention citoyenne sur la fin de vie” still ongoing, the media and the public are currently debating the question of whether and under what conditions voluntary assisted dying should be permitted in France. Politicians, too, are seeking to have a fact-oriented discussion about models in other countries and the experiences from their practical implementation. However, it is far from certain when a draft law will be available, whether it will actually guarantee freedom of choice over one’s own end of life and whether it will find a majority in parliament.
The “Convention citoyenne” begins its work
The “Convention citoyenne” – a Citizen’s Committee – on end-of-life issues announced by French President Emmanuel Macron on 13 September 2022 began its work in December 2022. As part of the first working sessions of this body, DIGNITAS had the opportunity to present the Swiss model of (physician-supported) assisted suicide and answer questions in Paris on 11 December 2022 (link).
The committee, a lay body of 185 citizens, its members selected by certain socio-demographic criteria, is seeking to get a comprehensive view on end-of-life issues until March 2023. In particular, it is examining the question of whether and to what extent the existing legal end-of-life options sufficiently address individual situations and whether adjustments or changes are needed. The committee can then make corresponding (although non-binding) recommendations. Parallel to this, regional events and debates on the topic are taking place with the aim of achieving broader support for future solutions.
Discussion of models in other countries
On the political side, too, efforts are being made to engage in a long overdue, fact-based debate about models from other countries, including assisted suicide in Switzerland. A parliamentary delegation accompanied by various media representatives travelled to Geneva at the beginning of October 2022 to find out about assisted suicide in Switzerland, meeting, among others, representatives of DIGNITAS. A delegation led by the former French Minister of Health and current government spokesman Olivier Véran visited the University Hospital of Geneva at the end of January 2023 to get a better idea of how end-of-life wishes are dealt with in Switzerland.
What law is needed?
Since its foundation, DIGNITAS has repeatedly contributed to legislative processes through submissions, hearings, and meetings with political delegations. The association also shares its knowledge and practical experience with interested parties in the context of public and political debates in numerous countries.
Important practical questions in the debate on the legalisation of assisted suicide and / or voluntary euthanasia, which has been going on in the French media for quite some time, are essentially the same as those we know from other countries: the role of doctors and nurses, improved education and information, and better access to existing legal options (e.g., palliative care, living wills).
Despite all the debates, it is far from certain when a draft law might be available, whether it will actually guarantee freedom of choice over one’s own end of life, and whether it will find a majority in parliament. Regardless of which model France ultimately chooses, DIGNITAS considers the following points to be essential for granting genuine freedom of choice:
Legal framework: Enabling access to a humane and safe option for ending one’s own life, in conformity with existing (human) rights. The maxim should be: “As many rules as necessary, as few as possible”.
Open and unbiased counselling: Persons who wish to have a self-determined end of life must have the opportunity to get information about all existing options, voluntarily, in an open, unbiased manner, and without having to fear negative consequences.
Capacity of discernment: The conditions for lasting and well-considered decisions in life also apply to one’s choices regarding a self-determined end of life. The basic prerequisite for exercising this human right is the person’s capacity of discernment.
Access to a safe means: The safe implementation of a wish for a self-determined end of life must be respected and protected. This also means that there must be no blanket ban on access to the medication sodium pentobarbital, which has been used for assisted suicide in Switzerland for many years.
Practicability: No one can be forced to assist another person in ending their own life. However, there must be no discriminatory clauses or unreasonable administrative hurdles for a person to exercise the human right to a self-determined end of life at home and to be assisted as needed.
Breaking the taboo around suicide and suicide attempts: Most lonely “do-it-yourself” suicide attempts fail – with serious consequences for the person, their loved ones, and others. Education and an open approach to this topic are important and have a preventive effect.
Availability of data and information: Facts help to make an informed and well-considered decision. That is why it is important to speak openly about and conduct research regarding all areas and options of a self-determined end of life, and to make them comprehensible.
Court judgment in DIGNITAS’ legal proceedings in France
In the two legal proceedings in France initiated by a lawyer in Paris in 2020 and 2021 on behalf of DIGNITAS, a judgment was rendered by the highest administrative court, the “Conseil d’État”, on 29 December 2022. The Conseil d’État decided not to follow the arguments and questions raised by DIGNITAS in the two cases. Previously, it had also refused to refer the constitutional issues raised to the Constitutional Court. The first proceeding dealt with the legality of the current complete ban on the medication sodium pentobarbital (NaP) in human medicine. The second case dealt with the question of whether it is lawful for the legislation currently in force in France (the so-called “Loi Claeys-Léonetti”) to rule out any type of voluntary assisted dying. DIGNITAS is now examining further legal steps.
