The French Euthanasia Debate

Abstract

In several countries, the debate about the legalization of active euthanasia and/or assisted suicide has been going on for thirty years. Although universal considerations are brought to bear on the issue (respect for autonomy, right to privacy, and medical integrity), the cultural context influences the way in which the discussion unfolds, both in the medical community and in society at large. Whether or not a ‘‘French exception’’ truly exists, the French are fond of invoking it, in education, politics, and culture, to mention just a few. Indeed, the term does provide us with some insight into certain aspects of the euthanasia debate, and more generally the treatment of end-of-life issues, that are specific to the French context. One contingent reason adds some urgency to this analysis: the French debate may well be drawing to a close in the near future. The current president, Franc xois Hollande, has promised to take up the issue and legalize ‘‘medical assistance to end one’s life with dignity in cases of incurable diseases causing unbearable and intractable physical and psychological suffering’’ (campaign pledge number 21). In order to make a more informed decision, he commissioned Dr. Didier Sicard, the former president of the National Consultative Ethics Committee (CCNE), to draft a report that was delivered to the president on December 18, 2012. In this article I describe the history and the intellectual underpinnings of the French debate. The 2005 Leonetti End-of-Life Act, named for Jean Leonetti, the conservative member of parliament who authored an earlier report on the issue, was a significant turning point in a debate that can now be divided into three main stages. I shall review the period prior to the 2005 End-of-Life Act, the main provisions of the law itself, and its consequences, both in medical practice and in the ethical debate. I draw two broad lessons from this brief history. First, the euthanasia debate in France is founded on principles of solidarity and justice rather than autonomy and individual rights. Second, the paternalistic tradition in medical care does not preclude the possibility of legalizing ‘‘active aid in dying’’ in the future, if only as an ethical ‘‘exception,’’ most notably in the form of assisted suicide, as recommended in the Sicard report. On the contrary, doctors’ responsibility toward their patients as an element of the social contract—what the French call ‘‘living together’’—might support the decision to hasten death in certain situations.