FRANCE
Embarrassing political manoeuvres to prevent MAID law

Despite the clear will of French citizens and a favourable majority in parliament, conservative forces continue to prevent a law on medical assistance in dying (MAID). Two bills to regulate self-determination over one's own end of life have been thwarted in recent months by undemocratic tactical manoeuvres. France thus joins Italy and the United Kingdom in an inglorious set of states whose legislators steadfastly refuse to enshrine in law the right of citizens to self-determination over the end of their own lives, despite clear support from the population and increasing public pressure.

A flood of legislative proposals and a lack of political will

In France, several bills to allow medical assistance in dying are up for political debate from the ranks of the “Assemblée Nationale”. The oldest of these bills, a proposal submitted by MP Olivier Falorni [1], in October 2017, was put on the agenda on 8 April 2021 as part of a so-called “niche parlamentaire” (“parliamentary niche”). Bills discussed in a "niche parlementaire" must be voted on the same day; this undertaking, ambitious from the outset, was prevented by a small group of conservative Republicans who submitted over 3,000 (!) amendments in advance; at the end of the correspondingly tense debate – which consisted of countless short statements on the individual amendments – only article 1 of the bill could be voted on. Although this was approved by a large majority, it is nothing more than a mere declaration of the will of parliament that voluntary euthanasia should be permitted in France.

Whether and when this bill will be dealt with in a regular session of the “Assemblée Nationale” and come to a vote is currently open. In the wake of the grotesque session of 8 April 2021, more than 300 parliamentarians attempted to put pressure on the President, via an open letter, asking for the issue to be dealt with conclusively during the current legislative period. France’s President Emmanuel Macron, who had spoken out in favour of MAID at the beginning of his term in office, continues to remain stubbornly silent on the issue.

Previously, on 11 March 2021, a bill submitted by Senator Marie-Pierre de La Gontrie [2] had been discussed in the Senate for several hours. However, it had already been rejected by the preliminary committee before the Senate debate; the debate therefore turned into a political showcase in which the individual party representatives verbosely set out their positions. The French Minister of Health, Olivier Véran, took the position that the existing end-of-life laws [3] provide sufficient options and he held out the prospect of expanding palliative care. It has long been known that palliative care cannot replace medical assistance in dying, but that both are ways of reducing suffering that complement each other.

Bogus arguments and transparent manoeuvres

The fact that politicians find it difficult to legislate on medical assistance in dying is not a new phenomenon; however, the way in which political manoeuvres prevent democratically legitimised bills from being discussed, let alone voted on, is more than alarming.

The majority in parliament for a bill is currently favourable – too favourable, it seems, for the opponents of self-determination over one's own end of life, most of whom come from the Republican ranks. Apparently, they have run out of arguments and, with a view to the presidential and parliamentary elections in spring 2022, their main concern is not to alienate party sponsors and their own core electorate. In view of the upcoming elections and the crisis in the French health care system, which has been further aggravated by Covid-19, it is highly unlikely that a law will be passed during the current legislative period.

Taboos and fearmongering

End-of-life issues have always been politically controversial in France, and conservative forces in medicine and bioethics still have great influence. Some progress has been made in recent years in the areas of living wills, withdrawal of life-sustaining measures and palliative care [4]. However, palliative continuous deep sedation is only permitted for individuals in their very last days of life. This means that many individuals who are grievously suffering are still excluded from the right to end their lives legally and safely in France at a time of their own choosing. They are forced either to undertake the often arduous journey to an assisted suicide in Switzerland, to procure a lethal medication illegally, or to resort to risky and unsafe methods to carry out a lonely suicide attempt; the majority of such attempts fail, often with dire consequences.

Despite the fact that, according to surveys, over 90 per cent of the population [5] and over 70 per cent of doctors [6] in France are in favour of medical assistance in dying in principle, the end of life, especially suicide, is still subject to many taboos in France. Anyone who wishes to end his or her life seems to be suspected of being either incapable of judgement or mentally ill. Suicide is not forbidden but giving access to information about suicide methods is a punishable offence; a person who knows about another person's intentions to end his or her own life but does not “save” them can be punished for failing to provide (life) support, and individuals who wish to end their lives can be psychiatrically detained under the pretext of protecting life.

Intending to circumvent the taboo of suicide by medicalising assistance in dying, especially through voluntary euthanasia, which means a doctor actively ending a patient’s life at that patient’s request, contains new potential for conflict. In the debates, opponents are never tired of arguing, among other things, that voluntary euthanasia is murder. So, in the eyes of the conservative forces, one does not want (and is not allowed) to talk about suicide, and voluntary euthanasia is a criminal act, the authorisation of which makes the doctor a sort of killing monster. The fact that the self-determined end of life is not a medical act but a (human) right, which was recognised by the European Court of Human Rights in 2011 in a DIGNITAS court case [7], is also completely ignored. In view of this starting position, it is not without irony that the opponents of voluntary euthanasia, of all people, repeatedly emphasise how important it is that a broad and open social debate is conducted. However, this debate has long been conducted among the population, without fearmongering, spectres and demonisation, and the legislative proposals are a result of this.

***

[1] https://www.assemblee-nationale.fr/dyn/15/textes/l15b0288_proposition-loi (in French)

[2] http://www.senat.fr/leg/ppl20-131.html (in French)

[3] LOI n° 2016-87 du 2 février 2016 créant de nouveaux droits en faveur des malades et des personnes en fin de vie;
https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000031970253?r=hMFAQjT2cS
(in French)

[4] LOI n° 2016-87 du 2 février 2016 créant de nouveaux droits en faveur des malades et des personnes en fin de vie; 
https://www.legifrance.gouv.fr/jorf/id/JORFTEXT000031970253?r=hMFAQjT2cS
(in French)

[5] http://www.dignitas.ch/index.php?option=com_content&view=article&id=70&Itemid=138&lang=fr (in French)

[6] http://www.dignitas.ch/index.php?option=com_content&view=article&id=70&Itemid=138&lang=fr (in French)

[7] ECHR judgment of 20 January 2011 in the case Haas http://hudoc.echr.coe.int/eng?i=001-102940

Newsletter 2021-2-2-e