Roger-Luc Chayer (Image : AI / Gay Globe)
There is a wide-ranging debate in France on the issue of medical assistance in dying. It is primarily fueled by a segment of the religious right, which turns an act of profound humanity into a series of ideological interpretations that do nothing to help sick and suffering people who no longer have any hope of recovery.
One of the most ardent opponents of medical assistance in dying is the cleric Monsignor Jacques Benoit-Gonnin, who compares this medical act that allows a person to die with dignity to an execution. We will return to this point, but first it seems important to remind readers around the world that the separation of Church and State in France is a republican principle more than a century old. It is therefore essential to recall its foundations and objectives.
Separation of Church and State – Law of 9 December 1905 – Laïcité
The separation of Church and State in France is a fundamental principle of the Republic, established by the law of 9 December 1905 concerning the separation of the Churches and the State. It is one of the pillars of French laïcité and aims to guarantee both freedom of conscience for everyone and the neutrality of the State with regard to religions.
In practical terms, this separation means that the State does not recognize, salary, or subsidize any religion, except in certain specific situations provided for by law or in territories subject to a particular historical regime, such as Alsace-Moselle. Public institutions, governments, and parliamentarians are expected to make their decisions on the basis of the general interest, fundamental rights, and the laws of the Republic, and not according to the doctrines or prescriptions of any religion.
The scope of this principle is considerable. It guarantees every citizen the freedom to believe, not to believe, or to change religion without suffering pressure from the State. Conversely, it also protects religions against any interference by political power in their organization or practice.
In the context of societal debates, such as the one concerning medical assistance in dying, this separation means that no religious authority has any institutional power to dictate the law of the Republic. Representatives of religions are free to express their opinions, like any other citizen or civil society organization, but their religious convictions cannot, on their own, form the basis of legislative decisions. These must be taken in light of democratic principles, scientific knowledge, the law, medical ethics, and respect for individual freedoms.
This does not mean that believers or religious leaders should be excluded from public debate. They fully enjoy freedom of expression and may put forward their arguments. However, in a secular Republic, their positions are examined on the same footing as those of doctors, lawyers, philosophers, patients’ associations, or any other participant. They do not possess superior legal or political value solely by virtue of their religious character.
It is precisely this distinction that constitutes the strength of French laïcité: the State protects all beliefs but privileges none, so that the laws apply equally to all citizens, regardless of their religious or philosophical convictions. In the case of medical assistance in dying, this means that a person opposed to this practice for religious reasons remains free to refuse it for themselves, but cannot impose this conviction on society as a whole solely by invoking their faith. It is for the legislator, and not for religious authorities, to define the legal framework applicable to everyone.
Monsignor Jacques Benoit-Gonnin – Freedom of Expression and the 1905 Law
Does Monsignor Jacques Benoit-Gonnin violate the law of 9 December 1905 concerning the separation of the Churches and the State when he publicly declares: “The deputies have reinstated a barely disguised form of organized killing”? And according to a publication by Tribune Chrétienne, it is further stated: “Mgr Jacques Benoit-Gonnin, Bishop of Beauvais, had found the right words to denounce this ‘strange and painful parliamentary gesticulation.’ He condemns an ‘anaesthetizing semantics’ that seeks to present euthanasia as an act of care and calls for resistance in the name of the dignity of every human person.”?
The statements of Mgr Jacques Benoit-Gonnin illustrate the freedom that religious leaders have to participate in public debate. They do not, in themselves, constitute a violation of the French law of 9 December 1905 on the separation of the Churches and the State. This law does not prohibit representatives of religions from expressing their convictions or criticizing the actions of Parliament. On the other hand, it guarantees that the legislative decisions of the Republic are taken independently of any religious authority. In France, the Churches may seek to persuade, but they can neither dictate the law nor claim institutional power over the State.
Medical Assistance in Dying (MAID) in Quebec
What is medical assistance in dying in Quebec? In Quebec, medical assistance in dying (MAID) is a health care service legally framed by the Act respecting end-of-life care. It allows, at the free and informed request of an eligible person, a physician or a specialized nurse practitioner to administer medication in order to end physical or psychological suffering that has become intolerable. It is an exceptional form of care, offered only when all the conditions set out in the law are met.
Contrary to a widely held belief, medical assistance in dying is not available to anyone who requests it. The law imposes rigorous criteria. The patient must, in particular, be of legal age, be covered by Quebec’s health insurance plan (except in specific cases provided for), be capable of consenting to care or have made an advance request when the law allows it, and be suffering from a serious and incurable illness or a serious physical impairment causing an advanced and irreversible decline. The suffering must be persistent, judged intolerable by the person themselves, and cannot be relieved under conditions that the person considers acceptable.
Medical assistance in dying is distinct from assisted suicide. In Quebec, the patient never self-administers the medication: it is administered by an authorized health professional, in a health care facility, a palliative care home, or at the person’s home.
Medical Assistance in Dying Around the World – International Comparisons
How does medical assistance in dying work in other countries around the world? Medical assistance in dying is regulated very differently from one country to another, but all those that authorize it have in common the imposition of strict medical and legal criteria in order to protect vulnerable persons and to ensure that the decision is free and informed.
Medical assistance in dying is regulated very differently from one country to another, but all those that authorize it have in common the imposition of strict medical and legal criteria in order to protect vulnerable persons and to ensure that the decision is free and informed.
Canada (including Quebec) In Canada, medical assistance in dying is considered a health care service. It may be administered by a physician or a specialized nurse practitioner or, in certain cases, self-administered by the patient, although this latter option is very rarely used. The person must meet rigorous eligibility criteria and undergo assessment by at least two qualified professionals. Quebec also applies its own Act respecting end-of-life care, which provides for particularly strict regulation.
Netherlands The Netherlands was the first country in the world to legalize euthanasia in 2002. The patient must be suffering unbearably and without prospect of improvement. The request must be voluntary, well-considered, and repeated. Two physicians must confirm that the criteria are met. Each case is then reviewed by an independent committee.
Belgium Belgium applies a system similar to that of the Netherlands. Patients suffering from a serious and incurable illness may request euthanasia if they experience constant and unbearable physical or psychological suffering. Belgium is also one of the few countries where minors may, in exceptional circumstances and under very strict conditions, have access to euthanasia.
Luxembourg Luxembourg has authorized euthanasia and assisted suicide since 2009. The patient must be suffering from an incurable illness and experience persistent suffering judged unbearable. Several medical assessments are required before the request can be accepted.
Spain Since 2021, Spain recognizes assistance in dying as a right in certain medical situations. Two written requests are required, separated by a reflection period. The file is then examined by several physicians and an independent regional commission before the procedure can be carried out.
New Zealand Medical assistance in dying has been authorized since 2021 following a popular referendum. It is reserved for persons suffering from an incurable illness whose death is reasonably foreseeable in the short term. Two physicians must confirm that the criteria are met.
Switzerland Switzerland takes a different approach. Euthanasia remains prohibited, but assisted suicide is permitted when it is not motivated by a selfish interest. The physician prescribes the lethal medication, but it is the patient themselves who must administer it. Several specialized organizations accompany eligible persons in this process.
Austria Since 2022, Austria has also authorized assisted suicide in certain circumstances. Two physicians must confirm the diagnosis and the patient’s capacity to make a free and informed decision. A reflection period is provided before the medication can be dispensed.
Australia All Australian states now permit a form of medical assistance in dying. The criteria are comparable to those in Canada: incurable illness, significant suffering, capacity to consent, and independent medical assessments. Timeframes and procedures nevertheless vary from one state to another.
United States In the United States, euthanasia is prohibited in all states. However, several states authorize medically assisted suicide. The person must generally be suffering from a terminal illness with a life expectancy of six months or less. The physician prescribes the medication, but the patient must take it themselves. Two requests, including one in writing, as well as a medical assessment, are usually required.
Difference Between Medical Assistance in Dying and Assisted Suicide
What is the difference between medical assistance in dying and assisted suicide? Although both practices aim to allow a person suffering from a serious illness to end their suffering in a legal and regulated manner, their essential difference is as follows:
- Medical assistance in dying: the medication is administered by a health professional.
- Assisted suicide: the medication is provided or prescribed by a professional, but it is administered by the patient themselves.
The Issue from the French Perspective – Terminology and Debate
From the French perspective While this issue should have been addressed within the framework of a scientific, medical, legal, and moral debate, certain actors have derailed the discussions by resorting to expressions such as “euthanasia,” “disguised death penalty,” or “execution of persons.” These are particularly loaded terms that aim to influence not only public opinion but also the deputies of the National Assembly called upon to vote on this bill. Despite these positions, the text was ultimately adopted by a majority. It now only remains for it to pass the review of the Constitutional Council, which may either validate it in its entirety, censor certain of its provisions, or, in a more exceptional hypothesis, reject it in whole or in part.
But first of all, it is important to clearly understand the definition of certain terms used by the detractors of the bill. We have already explained above the difference between medical assistance in dying and assisted suicide. Let us now define the other expressions frequently used in this debate:
Euthanasia Euthanasia: Euthanasia is the act of intentionally causing the death of a person, at their request, in order to end suffering judged unbearable caused by a serious and incurable illness. In countries where it is legal, euthanasia is generally performed by a physician or another authorized health professional, within a strict legal framework. In medicine and law, euthanasia is distinguished from assisted suicide, where the health professional provides or prescribes the medication, but it is the person themselves who administers it.
Source: French National Academy of Medicine – Definition of euthanasia World Health Organization (WHO) – Glossary of palliative care
Disguised death penalty Disguised death penalty: The death penalty, for its part, is a criminal sanction handed down by a court following a conviction for a criminal offence. It is imposed by the State against the will of the condemned person. By contrast, medical assistance in dying is a care service framed by law, voluntarily requested by a person who meets very strict medical and legal criteria. Equating medical assistance in dying with a “disguised death penalty” therefore constitutes a political or ideological comparison, and not a definition recognized by medical or legal authorities.
Sources: Encyclopædia Universalis – Death penalty Council of Europe – Abolition of the death penalty Government of Quebec – Medical assistance in dying
Execution Execution: In law, an execution designates the carrying out of a sentence pronounced by a judicial authority, particularly when it involves the putting to death of a person sentenced to capital punishment. Execution is therefore the act by which the State implements a sentence handed down by a court at the end of a criminal trial. By extension, the term may also designate the accomplishment or realization of a decision or an order. However, in the context of debates on medical assistance in dying, the word “execution” generally refers to the idea of a killing imposed by the State, without the consent of the person concerned. Using this term to describe medical assistance in dying amounts to a rhetorical or ideological comparison and not to a legal or medical classification. There is therefore no legal or medical definition that equates medical assistance in dying with an “execution.” This expression constitutes a position taken in public debate rather than a term recognized by law or medicine.
Sources:
- Dictionary of the Académie française – Execution
- Le Robert – Definition of “execution”
- Council of Europe – Abolition of the death penalty
Protection of Life and Individual Autonomy
Why would a state want to force its citizens to live against their will? The answer depends on the conception a State has of its role, of human dignity, and of individual autonomy. Countries that prohibit medical assistance in dying generally consider that the State has a duty to protect life, even when a person wishes to end it. They also invoke the need to protect vulnerable persons against pressure or abuse, as well as the traditional mission of medicine, which consists in healing without intentionally causing death.
Conversely, countries that authorize medical assistance in dying emphasize respect for the person’s autonomy. They consider that a person suffering from a serious and incurable illness, experiencing intolerable suffering, should be able to choose to end their life with dignity, within a strict legal and medical framework.
The debate therefore pits two fundamental principles against each other: the protection of life and respect for individual autonomy. Each society chooses to establish its own balance between these two values.
An important fact to underline: to this day, in countries where medical assistance in dying or euthanasia is authorized, no documented case recognized by the authorities has established that a person was subjected to this procedure without their consent.
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