The National Assembly definitively adopted, this Wednesday, the bill creating a right to assisted dying. In this final vote, 291 members voted in favor, 241 against, and 29 abstained. An absolute majority was set at 267 votes.
The vote brings to a close a parliamentary process lasting over a year, marked by several readings, two rejections by the Senate, and the failure of the joint committee tasked with finding an agreement between the two chambers. The National Assembly ultimately had the final say and reinstated the text it had adopted on second reading on June 30.
A right reserved for patients meeting five conditions
The system will not be accessible to everyone who wishes to die. The five conditions stipulated in the text must be met.
The applicant must be at least 18 years old and be a French national or reside in France on a stable and regular basis. They must be suffering from a serious and incurable illness that threatens their life, either in a terminal phase or in an advanced phase characterized by an irreversible deterioration of their health and quality of life.
The illness must cause suffering that is resistant to treatment or deemed unbearable by the patient, leading them to refuse or discontinue treatment. Suffering that is purely psychological will not qualify for medical assistance in dying.
The person must be capable of expressing a free and informed will. A patient whose judgment is severely impaired at the time of their request will not be eligible for this measure.
A lethal substance administered by the patient or a caregiver
Assisted dying is defined as the authorization given to a person to use a lethal substance. The principle adopted is that of self-administration: the patient must take the substance themselves.
When the patient is physically unable to perform this action, the substance can be administered by a doctor or nurse. This second option will therefore not depend on personal preference, but on a confirmed physical impossibility.
The request must be submitted to a practicing physician. This physician cannot be a relative, spouse, partner, civil union partner, or legal guardian of the patient. The request and its confirmation cannot be collected during a teleconsultation. If the patient is unable to travel, the physician must visit their home or place of care.
Palliative care, treatments and psychological support should be offered
Before proceeding with the procedure, the doctor must inform the patient about their state of health, its foreseeable evolution, the treatments still available and the existing support mechanisms.
He will also need to explain the options offered by palliative care and allow the patient to access it whenever they wish. A referral to a psychologist or psychiatrist should be offered to the patient and their family.
The doctor should remind the patient that the request can be withdrawn at any time. After receiving this information, the patient will formalize their wishes in writing or, if unable to write, through another means of expression adapted to their abilities.
A collegial procedure before the doctor's decision
The doctor responsible for reviewing the application must convene a multidisciplinary team. This team will include, in particular, a specialist in the disease in question, independent of the treating team, as well as a paramedical professional or a nursing assistant involved in the patient's care.
Other healthcare professionals, psychologists, or members of the facilities caring for the patient may be involved. For individuals under legal guardianship, the person responsible for that guardianship must be informed and may submit their observations.
The final decision will rest with the physician who received the request. It must be justified and communicated orally and in writing within a maximum of 15 days of its submission.
A minimum reflection period of two days
After a favorable decision, the patient must observe a reflection period of at least two days before confirming their request. The administration date will then be scheduled with the doctor or nurse assigned to them.
When confirmation or administration is scheduled more than three months after the decision, the physician must verify again that the patient's wishes remain free and informed. The patient will retain the option to postpone the date or abandon the procedure altogether.
The administration may take place at the patient's home or that of a relative, in a healthcare facility, a nursing home, a medical-social establishment, or another facility housing healthcare professionals. The patient may be surrounded by people of their choice.
Confirmation required until the last minute
On the scheduled day, the healthcare professional will need to verify once again that the person truly wishes to receive the lethal substance. They will also need to ensure that the person is not under any pressure from their family or friends.
In case of suspected coercion, the procedure will be suspended. If coercion is confirmed, the doctor may terminate the request and must report the facts to the public prosecutor.
The healthcare professional will prepare the medication, monitor its administration by the patient, or administer it themselves if the patient is unable to do so. After the medication has been taken, the doctor or nurse will remain in the same room so they can intervene if necessary.
A conscience clause for healthcare professionals
Doctors, nurses, and other relevant professionals will not be obligated to participate in assisted dying procedures. Those who refuse must immediately inform the patient or colleague requesting their assistance.
They will, however, have to provide the contact details of professionals willing to take over. Healthcare facilities, nursing homes, and social care facilities must allow access to caregivers who agree to support the patient. Therefore, management cannot generally prohibit the implementation of this system on its premises.
Comprehensive care and monitoring after each procedure
The costs associated with assisted dying will be covered by national health insurance, with no out-of-pocket expenses or deductibles for the patient. Healthcare professionals will not be able to charge any additional fees.
Each step will be recorded in a secure information system. A national commission under the Ministry of Health will review the procedures after their completion. It may refer cases to disciplinary bodies when it observes professional misconduct and forward a file to the public prosecutor when it suspects a crime or offense. A report must be submitted annually to the Government and Parliament.
The text is not yet applicable
Final adoption concludes the parliamentary debate, but it does not immediately make the system accessible to patients. Several appeals to the Constitutional Council have been announced. The review will suspend the promulgation period until the Constitutional judges' decision.
After this step, the President of the Republic will be able to promulgate the law. Decrees issued by the Council of State, medical recommendations, and several regulatory texts will still need to precisely define the forms, the products used, the functioning of the oversight committee, and the practical organization of the procedures. Therefore, no effective date for the right to assisted dying has yet been set.
