End of life: how civil society pushes European states to legislate


“The human being is called to die one day. “ This evidence carries with it a fundamental concern: how would we like to die? The philosophical, sociological and humanitarian question has taken on a political dimension throughout Europe, forcing, under pressure from civil society, several governments to legislate.“In France, and it seems similar in other countries, it is first through the activists that the debate was invited in the public”, explains Jean-René Binet, professor of private law at the University of Rennes.

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In fact, in France, the association for the right to die with dignity (ADMD) was created in 1980 by the doctor and politician, Pierre Simon, and the writer Michel Lee Landa. She is a member of the World Federation of Associations for the Right to Die – more than 46 associations in 27 countries – and of the European Federation of ADMD.

The recurring debate is fueled by the media coverage of painful cases such as the Vincent Lambert affair (2010-2020). “In France, a predominantly Catholic country, most people want to be able to say stop if they can no longer support treatment. However, very often, they do not know that the Leonetti law (see benchmarks) allows them, with deep and continuous sedation “, underlines Valérie Depadt, lecturer in private law and advisor of the Île-de-France ethical space.

Belgium takes another step

It was in the Netherlands, in 1973, that the movement on the right to die began, with the case of a general practitioner prosecuted for having killed his mother, victim of a cerebral hemorrhage, by administering a lethal dose to her. morphine. Very diminished, she asked for death.

The doctor is sentenced to a suspended prison week and a one-year suspension for not having administered progressive doses of morphine. The affair caused a stir. In 2002, the Netherlands legalized euthanasia. Several associations for the defense of “end-of-life” freedom are emerging, specialized clinics are created, while doctors are free to practice euthanasia or not.

The debate arose in Belgium in 1999, thanks to the departure of the Christian Democrats from the government coalition. The Socialists, Greens and Liberals then decide to tackle all outstanding ethical questions, including euthanasia. Three years later, on May 28, 2002, a law was passed. On February 28, 2014, Belgium took another step, becoming the first country in the world – and the only one today – to legalize euthanasia for minors without age limit, under stricter conditions than for adults.

→ THE FACTS. Spain: a first case of legal euthanasia

In Spain, it was the media coverage of the ordeal of Ramon Sampedro, suffering from quadriplegia since he was 25 years old, that changed the law. Prostrated for thirty years in a bed, he asked for assistance in suicide. He died in 1998, helped by 11 people. On March 18, 2021, Parliament passed a law authorizing not only euthanasia – which entered into force in June – when the caregiver kills the patient, but also assisted suicide, when the latter himself takes the prescribed dose. .

“Spanish society was ready for euthanasia before the policies “, Estimates Javier Velasco, president of the association Right to die with dignity (DMD). According to a latest study by the polling institute Metroscopia in 2019, more than 87% of Spaniards were in favor of euthanasia.

In Germany, the right to “self-determine one’s death”

Jean-René Binet recalls that Jean Leonetti was wary of polls. ” In reality, the term is so insidious that the answer to the question is irrelevant, because we do not know what question people think they are answering. Stopping treatment, which is provided for in the Leonetti law, for many people is euthanasia. While French law does not allow it.

→ CHRONICLE. Euthanasia, false debates and real questions

In Germany, for 150 years, suicide being legal, providing support to a person wanting to end his life was too. But in 2015, members of the Bundestag slowed down this practice by banning assisted suicide. “For commercial purposes” and at the same time the work of associations supporting people in demand. In 2020, the Constitutional Court has challenged this law in the name of the “Right to self-determine one’s death” and called on the legislator to review its copy.

→ TRIBUNE. The indecent bill on euthanasia

Today, the law continues to limit the ability of physicians to prescribe lethal drugs. “We are in a situation where assisted suicide is fully legal but not regulated. This is the worst possible combination », Recently declared Karl Lauterbach, the new Federal Minister of Health. At the beginning of the year, with elected liberal and radical leftists, they presented a bill intended to regulate assisted suicide.

Ireland, a country in the throes of major changes

In Ireland, where euthanasia and assisted suicide are illegal, the Supreme Court ruled in 1996 that a person in full possession of his mental faculties had the right to refuse treatment, even if that refusal resulted in his death. However, the “Dying with Dignity” Bill (2020), which aims to legalize euthanasia and professional-assisted suicide, is being debated by Parliament on a proposal from Gino Kenny, MP from the People Before party. Profit.

It aims to give doctors the legal right to provide assistance to people who wish to end their life, if they have terminal illnesses. The elected is optimistic: “Next year, a special committee will be formed to make recommendations on this bill. We will propose a new one that will respond to the problems raised and I hope that the law will be passed before the end of this government, in 2025. ”

Why now ? The country has been in the throes of major changes for two decades: the right to divorce in 1995, the legalization of same-sex marriage in 2015, the abortion referendum in 2018 … “These events were important stages in the transformation of this Catholic and conservative country into a liberal and secular country. It remains to be seen whether legalizing euthanasia or physician-assisted suicide will be part of it. », Explains Doctor of Geriatric Medicine Patrick Crowley at the University of Cork.

The majority of Irish people would be in favor of this option, but the majority of practitioners remain opposed to it. “They fear that the older and more vulnerable patients will be under moral pressure to end their lives so as not to be a burden on their families. It is very difficult, if not impossible, to prevent this », Continues Patrick Crowley.

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Euthanasia still prohibited in France

In France, the legislation relating to the rights of sick and dying people is based on two laws:

– The Léonetti law of April 22, 2005 : it prohibits therapeutic relentlessness, that is to say any treatment intended to prolong the life of a person at the end of life. The doctors are authorized to limit or stop the treatment, in order to allow the patient to die relieved and accompanied. Thus, palliative care must be administered to him to alleviate his suffering.

– The so-called Claeys-Léonetti law of February 2, 2016: in addition to strengthening the rights of the patient at the end of life provided for by the previous law, it authorizes a ” deep and continuous sedation until death », By medicinal means.

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