France's National Assembly on Wednesday gave final approval to a bill that would allow adults with incurable illnesses to receive lethal medication under strict conditions, marking the culmination of years of debate over end-of-life care.
The bill was approved by a 291-241 vote in the lower house of parliament. However, it will not become law immediately, as it must first undergo a constitutional review to determine whether it complies with the French Constitution.
The National Assembly approved the legislation after supporting it in three previous readings. French President Emmanuel Macron, who first announced the proposal more than three years ago, welcomed the vote.
"In 2022, I committed to opening this path with the French people," Macron wrote on X. "With seriousness, with humility, and with full respect for our democracy, that commitment has been fulfilled."
According to various estimates, around 300 million people worldwide have access to some form of assisted dying. Euthanasia is legal under certain conditions in several countries, while medically assisted suicide is permitted in others, including some US states.
France, which has a growing elderly population and increasing numbers of people living with chronic illnesses, has long debated the legal, ethical, medical and religious issues surrounding end-of-life care. Existing French law allows doctors to place terminally ill patients under deep sedation before death but does not permit assisted suicide or euthanasia.
"The national representation has risen to the occasion during these debates. This has been the longest debate since the 1980s," National Assembly President Yael Braun-Pivet said.
Many French patients have previously traveled to neighboring countries where assisted suicide or euthanasia is legal. Medically assisted suicide involves patients taking prescribed lethal medication themselves, while euthanasia involves a healthcare professional administering a lethal injection at the patient's request.
The issue is also under discussion in the United Kingdom, where a bill to legalize assisted dying in England and Wales is due to return to Parliament on Sept. 11 after failing to complete the legislative process during the previous parliamentary session.
Strict eligibility criteria
The proposed French law mainly allows medically assisted suicide by enabling eligible patients to receive and self-administer lethal medication under strict conditions. Patients who are physically unable to administer the medication themselves could receive assistance from a doctor or nurse.
Applicants would have to be at least 18 years old and either French citizens or legal residents.
Before approval, a doctor would be required to consult a team of healthcare professionals and confirm that the patient has a serious, incurable and life-threatening illness, is in an advanced or terminal stage, is experiencing unbearable pain that cannot be relieved, and is making the request voluntarily.
Lawmakers also specified that psychological suffering alone would not qualify someone for medically assisted dying. People with severe psychiatric disorders or neurodegenerative diseases, including Alzheimer's, would not be eligible.
Patients would initiate the request, which healthcare professionals would review within 15 days. After a mandatory reflection period of at least two days, eligible patients could choose when and where to take the medication, including at home or in a healthcare facility, with loved ones present if they wish.
On the chosen day, the attending doctor or nurse would confirm that the patient still wishes to proceed and remain nearby in case complications arise.
All related costs would be covered by France's national health insurance system.
Public support and opposition
A 2023 report found that most French people support legalizing assisted dying, with opinion polls showing growing public backing over the past two decades.
The Association for the Right to Die With Dignity welcomed the legislation, saying it would allow people "to choose to end unbearable suffering, freely and with full awareness."
Its president, Jonathan Denis, said the law would create a new right without forcing anyone to use it, while ensuring that patients remain central to decisions about their own medical care.
Opponents, however, argue that the measure could place pressure on elderly people and those living with serious illnesses or disabilities.
The anti-euthanasia group Alliance Vita, in an open letter to Macron, said priority should instead be given to ensuring immediate access to palliative care and support.
"Presenting death as a desirable solution can never be an acceptable response to suffering and is contrary to human dignity," the group said.
Constitutional review before becoming law
The French Senate, where conservatives hold a majority, rejected the bill. However, under France's legislative system, the National Assembly has the final say when the two chambers disagree.
Senate President Gérard Larcher and Prime Minister Sebastien Lecornu said they would refer the legislation to the Constitutional Council, which has up to one month to decide whether it complies with the Constitution. The law will only take effect after that review is completed.
Lecornu said that although the National Assembly held extensive debates on the bill, discussions in the Senate did not allow for the same level of detailed examination needed to address both supporters' expectations and opponents' concerns.
Meanwhile, debate over assisted dying continues elsewhere in Europe. In the UK, legislation to legalize assisted dying in England and Wales was delayed after opponents in the House of Lords filed more than 1,200 amendments, citing concerns including possible coercion of vulnerable people and insufficient safeguards for people with disabilities.
The bill, expected to return in September, would allow terminally ill adults in England and Wales with fewer than six months to live to apply for an assisted death, subject to approval by two doctors and an expert panel.
In Germany, the Bundestag considered two separate proposals to regulate assisted dying in 2023 but rejected both.