Assisted dying, the concept of vital prognosis... What you need to know before the examination of the texts on the end of life in the National Assembly

Two texts for an extremely sensitive social issue. The cross-party bill on the end of life will be discussed in the Chamber starting this Monday, May 12, with a view to a formal vote on the entire law on May 27. It was split into two texts, following the dissolution of the National Assembly and especially due to the hostility of François Bayrou, who became Prime Minister, to the legalization of euthanasia. A choice that the Minister of Health, Yannick Neuder, justified in March in Le Monde : "having two texts allows each parliamentarian to make a decision in his or her own conscience."

The first text on palliative care, led by Anne Vidal (EPR) and more consensual, was unanimously adopted in committee on April 11. It is unsurprisingly the second, on assisted dying, which will be the most discussed , because it is the most divisive. Long defended by MP Olivier Falorni (MoDem), it was validated on May 2 in committee (28 votes against 15, 1 abstention). This assisted dying "consists of authorizing and supporting a person who has expressed a request to resort to a lethal substance" , according to article 2 of the text, opening the way to assisted suicide or euthanasia for patients in the advanced stages of an incurable illness.

Among the changes made to the original text, several come from the left. The amendment by Élise Leboucher (LFI), adopted, allows the patient to choose between self-administration of the lethal product and injection by a caregiver, a right extended even if the patient is physically fit. A modification denounced by the right. "What has just been removed is this euthanasia exception (which states that only the patient, unless physically incapacitated, is responsible for his action – Editor's note). This is not insignificant," denounced the MP and former Minister of Research Patrick Hetzel (LR), believing that the balance of the text had been upset.

Another development: the addition of the "right to" assisted dying, supported by Yannick Monnet (PCF) , so that it is no longer just a "possibility" . Conversely, the amendment by Danielle Simonet (related to the Greens), aimed at relying on the advance directives of patients unable to express their wishes, was rejected.

An amendment by René Pilato (LFI) expands access to assisted dying to victims of serious accidents by adding "whatever the cause" to the criterion of life-threatening illness. As a reminder, the five criteria are: being of legal age, French or a stable resident, suffering from an incurable, life-threatening illness in its advanced or terminal stages, suffering from treatment-resistant illness, and being able to express one's wishes. Supporters of the bill point out that all criteria must be cumulative to access assisted dying.

The concept of vital prognosis crystallizes a large part of the debate. In the initial draft, the text indicated that it should be initiated "in the short or medium term." However, this does not allow for a clear scope to be established. In an opinion published on May 6, the High Authority for Health considers that no medical consensus allows for an objective definition of "medium term" or "advanced phase" in "an individual approach ." This vagueness does not fail to fuel the debates.

On the far right, the National Rally (RN) is proposing to restrict access to end-of-life care in cases where prognoses are made within six months. Olivier Falorni believes the purpose of this amendment is to "ensure that the text will not be applied," while the National Rally (RN) group and, more broadly, the far-right, outside the walls of the National Assembly, are generally very opposed to the law. The Republicans, for their part, are advocating a "short-term" deadline, ranging from a few hours to a few days.

After 42 hours of debate in committee, the two texts will be examined together in the Assembly between May 12 and 19, with a formal vote scheduled for May 27. Olivier Falorni wants a simultaneous vote to avoid any obstruction: "It will be two votes or nothing," he told AFP.

"There can be no evidence when it comes to assisted dying," said communist Yannick Monnet (PCF). While the text on palliative care does not suffer from any major divergence, assisted dying raises, in the chamber as in public opinion, a profound ethical, medical and philosophical debate, which often goes beyond the traditional divisions between conservatives and progressives.