End of life: words to better understand the debate
This is a crucial step in the long legislative journey on the delicate issue of end-of-life. While the debates were abruptly interrupted in the summer of 2024 by the dissolution of the National Assembly, MPs will begin examining two texts on the subject—one on palliative care, the other on assisted dying—starting Monday, May 12.
Currently, the end of life in France is governed by the Claeys-Léonetti law , adopted in 2016, which provides in particular that terminally ill patients can benefit from “deep and continuous sedation until death” .
Euthanasia, assisted suicide, assisted suicide, active aid in dying or deep and continuous sedation until death... Le Monde takes stock of the terms and concepts relating to the end of life.
EuthanasiaAccording to the definition adopted by the National Consultative Ethics Committee (CCNE), in a 2013 opinion , euthanasia is an "act intended to deliberately end the life of a person suffering from a serious and incurable illness, at their request, in order to put an end to a situation that they consider unbearable." For Emmanuel Macron, "euthanasia means ending someone's life, with or even without their consent, which is obviously not the case " in the bill, he assured in his interview with Libération and La Croix .
In Belgium, euthanasia – in which the doctor injects the lethal product – has been authorized since May 28, 2002. According to the text, the request must be "voluntary, considered and repeated" and "without external pressure." In 2021, this country recorded 2,700 euthanasias, or 2.4% of the total number of deaths.
The Netherlands has regulated euthanasia since 1 April 2002. The law stipulates that the doctor and an independent expert must establish that the patient is suffering unbearably and without hope of improvement.
Assisted suicideUnlike euthanasia, in assisted suicide, it is the person themselves who performs the fatal act, and not a third party. Assisted suicide "consists of giving a person the means to commit suicide themselves (...) by absorbing a lethal product that has been previously delivered to them," defines the CCNE.
Assisted suicide has been legal in Switzerland since 1937 , but euthanasia is not. The person does not necessarily have to be terminally ill, but must provide proof of their capacity for discernment.
Austria legalized assisted suicide in December 2021, ahead of the law coming into effect on January 1 , 2022.
Italy, for its part, decriminalized it in 2019 for fully conscious patients "kept alive by treatments (...) and suffering from an irreversible pathology, a source of physical and psychological suffering that they consider intolerable."
Assisted suicideIn common parlance, assisted suicide is often referred to as "assisted suicide." However, it refers to a different situation, particularly in the eyes of the CCNE. Strictly speaking , assisted suicide refers to the situation of a person who wants to commit suicide but is not physically capable of doing so and needs the help of a third party. Assisted suicide "involves a third party more closely than assisted suicide," the committee notes, but "the difference is tenuous with the concept of euthanasia."
The CCNE, however, points out a "real difference" between assisted suicide and euthanasia: "The will of the person who wants to die and who decides to do so, but who is unable to kill themselves, is supposedly primary and clearly stated. They ask a third party (...) to do what they cannot accomplish by themselves," the opinion states. Euthanasia "therefore concerns people who do not wish to commit suicide, even with assistance."
"Some people, in fact, can express both the desire to die and their refusal, or their psychological inability to kill themselves by committing suicide - and this without any impediment linked to the illness -, or even their preference for a doctor to end their existence, at their request, rather than doing it themselves" , details the same opinion.
Emmanuel Macron, for his part, defines assisted suicide as a "free and unconditional choice of a person to dispose of their life," without specifying who performs the final act . The head of state excludes this term, like euthanasia, from the future bill.
“Active assistance in dying”Euthanasia and assisted suicide can be considered as variations of the concept of "active aid in dying", the legalization of which was already deemed possible in France by the CCNE in September 2022. The majority of members of the citizens' convention on the end of life, whose final report was submitted in April 2023, also spoke out in favor of the legalization of both assisted suicide and euthanasia . "The term we have chosen [in the bill] is "assisted dying", because it is simple and humane" , justified Emmanuel Macron.
In Luxembourg , active assistance in dying, which allows the choice between euthanasia and assisted suicide, has been legal since 2009. For a request to be legal, the patient must be conscious, not have been subjected to external pressure and be "in a medical situation with no way out, with no prospect of improvement" .
Spain has also allowed both routes since March 2021. Spanish law provides that anyone with "a serious and incurable illness" or "chronic pain that leaves them in a situation of incapacity" can request medical assistance to die, and thus avoid "intolerable suffering" .
“Deep and continuous sedation until death”The Claeys-Léonetti law, currently in force in France, allows for "deep and continuous sedation until death" for terminally ill patients in extreme pain, whose lives are threatened "in the short term ." People are put to sleep permanently by injecting midazolam, a powerful, fast-acting substance.
At the same time, treatments are stopped when "they appear useless, disproportionate, or when they have no effect other than artificial life support," according to the law. Hydration and nutrition are also suspended, and painkillers are administered. According to specialists, death occurs around a week. It is due to organ failure, which stops functioning after the treatment is stopped. Due to kidney failure, potassium accumulates in the blood and eventually causes the heart to stop.
The healthcare team must support the patient until the end, providing palliative care, including personal hygiene, touch-massage, mouth care (moistened compresses against dryness, etc.) or eye care (drops).
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