Amicus curiae to the Conseil constitutionnel on euthanasia

Mr President,

Members of the Constitutional Council,

On 15 July 2026, the National Assembly passed the Act on the right to assisted dying (hereinafter ‘the Act’). The various appeals referred to you set out in detail the numerous grounds on which the Act creating a right to assisted dying is unconstitutional. There is no need to repeat them here. This voluntary submission therefore does not seek to repeat them, but rather to offer you a more concrete insight into the functioning of the operational framework created by this Act.

Because this Act creates a ‘right to die’, and thus also a ‘licence to kill’, it is necessary to carefully analyse the risks to which this framework exposes vulnerable people, including those posed by doctors.

This framework comprises three components: eligibility criteria (the entry point), an implementation procedure, and a monitoring procedure. These three components are like the links in a chain: the framework is only as strong as its weakest link. For the framework to be robust and protective, all three components must meet the same high standards. However, this is not the case.

I. First element: vague eligibility criteria (Article 4)

The adopted text grants access to assisted dying to any person ‘suffering from a serious and incurable condition, whatever its cause, which is life-threatening, at an advanced stage […] or in the terminal phase’. The terms ‘serious and incurable condition’, ‘life-threatening’, ‘advanced stage’, ‘unbearable suffering’, ‘irreversible process’, or ‘severely’ impaired capacity for discernment do not correspond to medical thresholds that can be objectively and uniformly defined and are open to varying interpretations depending on the medical condition and, above all, on the practising doctor.

This lack of precision undermines the constitutional principle of the law’s accessibility and intelligibility (see, for example, Decision No. 2014-694 DC of 28 May 2014). The accumulation of imprecise terms in the new text is all the more glaring given that the law decriminalises acts previously classified as the offences of murder or poisoning. The use of vague terminology in a matter as fundamental as the life and health of others contravenes the principle of legality of offences and penalties, guaranteed by Article 8 of the Declaration of the Rights of Man and of the Citizen.

II. Second component: the ‘assisted dying’ procedure

This phase of the system is intended to ensure that everyone’s rights are respected. In particular, it should make it possible to verify that the eligibility criteria are met and that the wishes of the person concerned are genuine. However, the procedure fails on these two essential checks. Consequently, the procedure lacks the necessary safeguards to prevent the risk of abuse. The procedure is effectively a ‘free-for-all’ that tends to facilitate the implementation of euthanasia and assisted suicide by removing all potential barriers and obstacles.

The following is a non-exhaustive list of the problems identified in this procedure:

A single doctor decides on the entire euthanasia procedure (Articles 5 and 6).

The adopted law entrusts the doctor to whom the request for assisted dying is made with the full range of functions relating to the assessment, evaluation, decision-making, organisation and implementation of the assisted dying procedure. The doctor also informs the supervisory committee. The legislator has not provided for any mechanism allowing for the intervention of a third party, nor any obligation to seek a second independent opinion. The process is based on the assessment of a single doctor. It stands in stark contrast to the procedure applied, for example, in the case of organ donation by a living person, where the applicant reaffirms their consent before a judicial body (Articles L. 1241-1 et seq. of the Public Health Code).

By entrusting control of all aspects of the procedure to a single person, the law precludes the possibility of correcting human error or preventing malicious intent, which may arise at any time.  Yet experience shows that some doctors believe they are doing the right thing by causing the death of people who are ill, disabled or bedridden. Such a concentration of powers in the hands of a single person lacks sufficient safeguards in light of the constitutional requirements concerning the protection of personal liberty (Article 2 of the Declaration of the Rights of Man and of the Citizen), human dignity (Preamble to the 1946 Constitution, para. 1) and respect for human life (Decree No. 94-343-344 DC of 27 July 1994, consid. 18).

The law does not lay down any formal requirements regarding the expression of the wish to die; it may be expressed in writing or ‘by any other means of expression appropriate to the person’s abilities’ (Article 5, paragraph 14).

Under French civil law, any serious legal act must be in writing (e.g. the drafting of a will, Civil Code, Article 970), regardless of the person’s state of health. By exempting the expression of the wish to die from any formal requirements, the adopted law trivialises the very purpose of a request for assisted dying, even though such a request carries particularly serious and irreversible consequences.

The referred legislation does not require that any written request be made in the presence of a witness, a judge or a notary.

The reference to ‘any other form of expression appropriate’ to the person’s capabilities demonstrates the absence of objective criteria for assessing the genuineness of the wish to die. Gestures, signs and facial expressions displayed by the person concerned are liable to be interpreted differently depending on the context and physical and physiological factors. The absence of any formal requirement regarding the expression of the wish to die is just one of the many provisions of the Act which fail to recognise the constitutionally enshrined objective of the accessibility and intelligibility of the law, as well as the protection of personal freedom and health.

In practice, it is sufficient for the doctor to state that the ‘eligible’ person wishes to die in order to be able to perform euthanasia on them (Articles 5, 6 and 7).

Consequently, as a request to die may be expressed in a non-written form, ‘by any other means of expression appropriate to the person’s abilities’, that is to say, in particular, verbally; that the presence of a witness is not required to attest to the authenticity of the non-written request to die; that the doctor may meet with the person concerned alone; and that the two people consulted by the doctor have neither the role nor the obligation to verify the authenticity of the request to die, then, a doctor may wrongly claim that an ‘eligible’ person has made a request to die.

The adopted law requires no intervention by a judicial authority, or even by a third party, to verify the person’s capacity to discern, the authenticity of the expression of their will, or its ‘free and informed’ nature. Consequently, no proof of the reality or nature of the wish to die is absolutely required, apart from the doctor’s statement alone. This undermines the constitutional principle of safeguarding human dignity and respect for human life (Decision No. 94-343/344 DC of 27 July 1994).

This doctor may meet the person for the first time on the day of the ‘request’ for death (Article 5, paragraph 4).

The doctor who initiates the procedure may be ‘visiting’, i.e. not based in the department. This may be a doctor specialising in the practice of euthanasia and assisted suicide. In Belgium and Canada, in particular, some doctors are known to be lenient in their assessment of compliance with the legal criteria. These doctors are generally known to organisations promoting euthanasia, as was the case in the Mortier v. Belgium case, in which the European Court of Human Rights ruled against Belgium (No. 78017/17, 4 October 2022). The same will be true in France. Furthermore, these doctors will have no direct knowledge of changes and fluctuations in the person’s physical and mental condition. This undermines the constitutional principle of safeguarding human dignity and respect for human life (Decision No. 94-343/344 DC of 27 July 1994).

The person requesting death does not receive sufficient support

The person requesting death does not have the right to palliative care. They do not even receive a consultation with a doctor trained in palliative care. Nor do they receive a mandatory consultation with a psychologist or psychiatrist. These consultations are necessary to protect the person from despair and to assess their will and capacity.

This lack of support undermines the right to respect for personal freedom, the principle of fraternity, and the objective of protecting health.

Euthanasia and assisted suicide are permitted in the case of persons under guardianship or curatorship (Art. 5, para. 7).

The law permits euthanasia and assisted suicide to be carried out on adults who lack legal capacity, and therefore assumes that these individuals are capable of making such a decision.

This provision is, too, extremely serious as it exposes these individuals to a serious risk, given that euthanasia has always primarily targeted the senile and the mentally disabled. Furthermore, this provision contradicts the requirement, on the one hand, for judgement that is not ‘seriously impaired’ and, on the other hand, for the expression of a ‘free and informed will’.

Finally, Article 5(7) of the referred Act provides that ‘The doctor shall ask the person whether they are subject to a legal protection measure’ and then requires the doctor to ‘verify this information by consulting the register referred to in Article 427-1 of the Civil Code’. To date, the aforementioned register does not exist. The protection of vulnerable persons is therefore inadequate and theoretical, and can only become effective, at best, once the said register has been established. This provision thus undermines the principle of legal certainty.

Furthermore, a person with a serious mental health condition, such as suicidal tendencies, is not excluded from the process (Art. 4, para. 4), which places vulnerable individuals at particular risk.

The right of appeal against a doctor’s decision concerning a person under protection is ineffective due to the extremely short time limit

The extremely short time limit – of two calendar days – allowed for the person responsible for the protective measure to bring the matter before the administrative court renders this right of appeal illusory. The illusory nature of this time limit is particularly glaring in the case of people placed under the care of an institution, whose response time is certainly longer than two calendar days. If the doctor makes their decision late on a Friday, the entire time limit for appeal elapses over the weekend, meaning it has already expired by Monday morning. A person’s life cannot be put at risk in this way.

It should be noted that only half of adults under protection are placed under the care of a relative. The other half are placed under the care of a legal guardian for adults. This may be a guardianship organisation, an independent professional or a member of staff at a health or medico-social care facility. These professionals will not have the same emotional attachment to the vulnerable person as their relatives do.

Furthermore, it is not the administrative court but the ordinary court that should have jurisdiction in view of the subject matter of the appeal.

The doctor may refuse a request made by the person under care to consult a relative or a trusted third party (Article 6, paragraph 13).

This power, conferred on the doctor by law, seriously infringes upon the right to respect for private and family life of the person concerned and their relatives. This right is guaranteed, in particular, by the tenth paragraph of the Preamble to the 1946 Constitution.

It is sufficient that the person’s judgement is not ‘seriously’ impaired at the time they are deemed to have expressed their request for death (Art. 6, para. 3).

The bill under consideration permits a person whose judgement is impaired to be the subject of a voluntary death procedure.

It also permits a person whose judgement is ‘seriously impaired’ to be the subject of a procedure for euthanasia or assisted suicide at any time other than ‘when making the request for assistance in dying’. However, the capacity for sound judgement often fluctuates in people who are ill.

The bill does not specify the threshold at which impaired capacity becomes ‘severely’ impaired.

The law therefore leaves this assessment solely to the deciding doctor. Indeed, the law does not provide for any procedure to assess the level of mental capacity of the person requesting death. However, a person’s mental capacity may vary depending on their psychological state, fatigue, or level of suffering. The law has not even provided for the involvement of a third party. The two people consulted by the doctor are not tasked with verifying this capacity for discernment.

Furthermore, the state of physical suffering (Art. 4, para. 8) required to qualify for assisted dying necessarily impairs the person’s capacity for discernment. The conditions relating to the existence of suffering (Art. 4, para. 8) and those relating to the requirement for a capacity of judgement that is not seriously impaired (Art. 6, para. 3) are therefore mutually exclusive and highlight the internal contradiction in the adopted text. It is therefore important to emphasise the inconsistency of the law on this point.

To accept that a person whose mental capacity is impaired may request assisted dying infringes the right to respect for personal freedom, which implies that any interference with the human body must be subject to effective safeguards (Decision No. 99-416 DC of 23 July 1999). The Constitutional Council reiterates that any interference with the integrity of the human body must be subject to the obtaining of free and informed consent (Decision No. 2004-498 DC of 29 July 2004).

Consultation with the ‘multi-professional panel’ does not provide sufficient protection for individuals (Art. 6)

The law stipulates that the doctor must consult two people of their choice, including a doctor specialising in the condition from which the person in question is suffering, and a medical assistant or care assistant.

However, the two people consulted

• are freely chosen by the doctor;
• do not necessarily meet the person concerned;
• do not necessarily verify the validity of their request for death;
• do not necessarily assess the person’s level of mental capacity;
• and simply give an opinion which is not binding on the doctor.

It should be emphasised that, under the law, no minutes are taken of the meeting of the multi-professional panel. The monitoring and evaluation committee is therefore not informed of the opinions of the participants in the multi-professional panel. The law does not provide for any mechanism enabling participants in the multi-professional panel to object to the implementation of ‘assisted dying’.

Furthermore, the medical assistant or care assistant may be under the hierarchical authority of the deciding doctor.

Moreover, this consultation may be conducted via videoconference.

Finally, the multi-professional panel is not even notified of the doctor’s decision; the doctor decides alone. The members of the multi-professional panel are therefore not even in a position to challenge the doctor’s decision.

This ‘collegial’ procedure is therefore rendered entirely ineffective and fails to protect the rights and freedoms of vulnerable individuals at risk of euthanasia and assisted suicide.

The doctor makes their final decision without further examination of the applicant’s state of health (Article 6, paragraph 16).

The law does not provide for a second examination of the applicant, nor does it stipulate a minimum time limit between the initial request for assisted dying and the doctor’s decision.

In accordance with Article 6(16) of the adopted law, the doctor ‘shall notify the person, both orally and in writing, of their reasoned decision within fifteen days of the formalisation of the request’. However, the Act does not impose any minimum reflection period for the doctor before making a decision on the request for assisted dying. A mandatory reflection period would have given the doctor the opportunity to carry out a further examination of the patient, to observe the progression of their illness and their mental state, to keep abreast of medical advances in the relevant field, and thus to make a more informed decision.

The individual’s reflection period is only two days from the doctor’s decision (Art. 6, para. 17).

The law does not impose any specific formalities when confirming the request at the end of the two-day reflection period provided for in Article 6(17). The legislature has not required this confirmation to be the subject of a further in-depth interview, nor of any specific formalities. No witnesses are required.

The brevity of this period is not sufficient to protect frail, suffering and vulnerable individuals, including from psychological fluctuations. This period contrasts with other cooling-off periods established by French law in the context of carrying out various civil law acts of lesser gravity than those relating to end-of-life matters (for example, in the case of a mortgage, the statutory cooling-off period is ten days (see Consumer Code, Article L.313-34).

The entire procedure can be completed in three days.

All stages of the assisted dying procedure (from the initial expression of the wish to die through to actual death) can be completed within an extremely short period of time. The assessment and consultation with the patient concerned, the expression of the wish to die, the formation and meeting of the multidisciplinary panel, the verification that the eligibility criteria have been met, any communication with the person responsible for protective measures (where applicable), any consultation with the ‘trusted person’, the doctor’s decision on the request for assisted dying, the confirmation of the request to die, and the administration of the lethal substance – all these steps can be completed within three days.

The brevity of the entire process is unprecedented. On 18 July 2025, the Committee on the Rights of Persons with Disabilities drew the Government’s attention to the extremely short minimum timeframe between a favourable decision and the implementation of assisted dying. The Committee’s appeal went unanswered.

The person’s family and close relatives are denied the right to be informed that a procedure for euthanasia or assisted suicide is underway (Art. 6, II, para. 13 and Art. 7).

The law does not provide for any obligation to inform family members prior to the decision to authorise assisted dying. It is therefore legally possible for a family member to learn of their loved one’s death after the lethal substance has been administered.

This constitutes a violation of the right to respect for private and family life of both the patient concerned and their loved ones. In particular, the tenth paragraph of the Preamble to the 1946 Constitution protects the family as the basic unit of society, the development of which necessarily requires the active participation of its members at decisive moments in life. The end of life constitutes such a moment. However, even if the person requesting assisted dying wishes for the ‘opinion of a trusted person, a carer or, failing that, a close relative’ to be sought, the doctor retains the power not to comply with this request (Art. 6, para. 13).

Relatives do not have the right to challenge the doctor’s decision in court (Article 12).

In accordance with Article 12 of the Act, the doctor’s decision on a request for assisted dying, as well as the decision to terminate the procedure, may only be challenged by the person who made the request. The fact that the patient’s relatives are unable to challenge the doctor’s decision in court is incompatible with Article 16 of the Declaration of the Rights of Man and of the Citizen, under which there must be no substantial infringement of the right of the persons concerned to an effective remedy before a court.

The doctor or nurse must ensure that the relatives of the person who is the subject of euthanasia do not exert any pressure on them to ‘withdraw their consent to the administration of the lethal substance’ (Article 9, paragraph 4).

The law prohibits the exertion of ‘pressure to proceed with or to refrain from administering the lethal substance’ against a patient wishing to seek assisted dying, without providing for any exception in favour of family members and loved ones acting with benevolent intent. Acts that constitute the exercise of the freedom to provide support – such as expressing one’s attachment to a loved one’s life, conveying that their loss would be insurmountable, or informing them of the options for enhanced palliative care – thus fall within the scope of criminal law.

The principle of fraternity, read in conjunction with the eleventh paragraph of the 1946 Preamble, which states that ‘the Nation guarantees the protection of everyone’s health’, requires the State not to abandon vulnerable people without an adequate safety net. However, the contested provision specifically arranges for such abandonment of people whose capacity to make decisions is impaired by suffering, isolation or the feeling of being a burden.

Furthermore, this provision is at odds with the duty to assist persons in danger, particularly where there is a risk of suicide. Article 223-6 of the Criminal Code punishes with five years’ imprisonment and a fine of 75,000 euros anyone who has wilfully failed to assist a person in serious and imminent danger, when they were able to do so without risk. This duty to assist applies in particular to situations involving attempted suicide. How, then, can two contradictory obligations coexist – one requiring assistance and the other requiring a refusal to assist – in relation to the same person who wishes to die? It would therefore suffice for a person to state their intention to die by assisted suicide or euthanasia to release third parties from their duty to assist them. The existence of the criminal duty to assist therefore depends on the method of suicide, which is not necessarily known to third parties.

Furthermore, if the person wishes to die by assisted suicide, then assistance is prohibited, whereas if they wish to die by unassisted suicide, then assistance is mandatory. The duty or prohibition to provide assistance therefore depends on the suicidal person’s intention regarding the manner of their death. In this respect, the provision undermines the constitutionally enshrined objective of the law being accessible and comprehensible.

The person is only informed ‘of the manner in which the lethal substance takes effect’ after having confirmed their request to die (Art. 6, paras. 19 and 20).

The lack of information on ‘how the lethal substance works’ prior to the confirmation of the decision to die does not allow the person concerned to make a fully informed judgement on the gravity of their act and its risks. Furthermore, this lack of information is incompatible with the duty to inform the patient under French and European law. Thus, Article 5 of the Oviedo Convention on Human Rights and Biomedicine, ratified by France in 2011, stipulates that ‘An intervention in the health field may only be carried out after the person concerned has given their free and informed consent. That person shall first be provided with adequate information regarding the purpose and nature of the intervention, as well as its consequences and risks. The person concerned may freely withdraw their consent at any time.”

Furthermore, the law does not require the doctor to inform the person of the risks and potential suffering associated with the various methods of administering the lethal substance. However, scientific studies confirm that these risks are very real and vary depending on the method used.

Doctors who are conscientious objectors to euthanasia are obliged to designate another doctor who agrees to perform euthanasia in their place (Article 14).

This obligation makes the doctors concerned directly complicit in the act to which they object, in violation of their freedom of conscience. This freedom is guaranteed, inter alia, in paragraph 5 of the Preamble to the 1946 Constitution, as well as by several instruments of international and European law.

Furthermore, this obligation is disproportionate, as it is unnecessary, given that the law provides for the creation of a list of doctors willing to carry out these acts.

Finally, and most importantly, this obligation is impossible to fulfil, as no doctor can prejudge what another doctor will decide in good conscience in a particular case. It is therefore impossible to ‘provide [with certainty] the names of healthcare professionals willing to participate in the implementation of these procedures’.

Private institutions, particularly religious ones, are obliged to accommodate and organise the practice of euthanasia and assisted suicide within their premises (Art. 14).

The obligation to accommodate mobile euthanasia teams and to accept the administration of assisted dying constitutes a clear violation of the freedom of these institutions, as well as of the principle of autonomy of entities characterised by their strong ideological identity. The principle of institutional autonomy, guaranteed under international and European law (see, for example, the Fernández Martínez judgment of the European Court of Human Rights) as well as by the case law of the French higher courts (see, in particular, the judgment of the Court of Cassation of 4 April 2025, Plenary Assembly, 21-24.439), stems from the constitutional principles of freedom of conscience (Article 10 of the Declaration of the Rights of Man and of the Citizen) and freedom of association (Decision No. 71-44 DC of 16 July 1971). This principle protects the organisational life of religious communities and ‘organisations based on religious or philosophical convictions’ against any unjustified interference by the State, such as the obligation to allow third parties to carry out lethal acts within their premises.

This obligation also infringes upon the right to property, guaranteed in particular by Articles 2 and 17 of the Declaration of the Rights of Man and of the Citizen, as well as the freedom to conduct business.

Furthermore, it is worth noting a disparity in treatment between the directors and managers of healthcare establishments and healthcare professionals, since only the latter benefit from a conscience clause, even though both groups find themselves in morally comparable situations.

Pharmacists are denied a conscience clause and are obliged to prepare the poison, on pain of disciplinary sanctions (Articles 8 and 14).

The pharmacist is directly involved in carrying out the lethal act in that they prepare the poison and are the only ones able to do so. The absence of direct involvement in the administration of the lethal substance does not detract from the direct and close nature of their involvement in the contested act, since, without the pharmacist’s preparation of the poison, assisted dying cannot take place. Given their essential role in the entire process, pharmacists’ freedom of conscience must be respected (On this subject, see: Nicolas Bauer and Agnès Certain, ‘Responsibilities, rights and duties of the pharmacist’ in Emmanuel Hirsch (ed.), End-of-life issues: the duties of a democracy, Éditions du Cerf, 2025, pp. 407–418). However, under Articles 8 and 14 of the Act, unlike doctors, who may object to direct participation in the process of administering assisted dying, pharmacists have a legal and professional obligation to cooperate in euthanasia and assisted suicide.

Imposing such an obligation constitutes a clear violation of their freedom of conscience, as guaranteed by Article 10 of the Declaration of the Rights of Man and of the Citizen and by paragraph 5 of the Preamble to the 1946 Constitution.

Furthermore, the differential treatment of doctors and pharmacists involved in the euthanasia process undermines the constitutional principle of equality enshrined in Article 1 of the Declaration of the Rights of Man and of the Citizen.

III. Third component: the ‘monitoring’ and evaluation phase

The aim of this monitoring phase should be to safeguard the entire system. However, this ‘monitoring’ proves incapable of preventing the misuse of this law, and thus the deaths of individuals.

The ‘monitoring’ takes place after death (Articles 11 and 15).

The adopted law provides for no prior review of the legality of the procedure by an independent authority or by any court. Oversight only takes place after the lethal act has been irreversibly carried out. It therefore fails to fulfil a protective role. The absence of independent ex ante oversight sets French law apart from other European legislation, which establishes various mechanisms for verifying the process prior to the administration of the lethal substance (see, for example, Spanish Organic Law No. 3/2021 of 24 March 2021 on the regulation of euthanasia).

The ‘review’ is carried out on the basis of information provided solely by the doctor (Articles 11 and 15).

The ‘review’ is carried out on the basis of information provided by the doctor who personally conducted the entire procedure. Consequently, it is not an adversarial process.

As mentioned previously, no minutes are taken of the meeting of the multi-professional panel. The review and evaluation committee is therefore not even informed of the views of the participants in the multi-professional panel.

The ‘review’ is carried out by a committee comprising four members from associations and professionals in the humanities and social sciences, as well as two doctors and just two judges (Art. 15, paras. 13–18).

Given the committee’s composition, the review will not be primarily medical or judicial in nature.

Under the adopted law, the composition of the ‘monitoring and evaluation committee’ and its operating rules are determined by decree of the Council of State (Art. 15, para. 13). It should be emphasised that this transfer of powers from the legislature to the regulatory authority regarding the monitoring of the implementation of assisted dying is just one of many key aspects of the new ‘framework’ that will be determined by decree (see, for example, the provisions relating to the procedures for informing the patient or to the form and content of the request for assisted dying and its confirmation).

The excessive references to regulatory powers contained in the new Act demonstrate a failure on the part of the legislature to fulfil its duty, as it alone is responsible for establishing ‘the fundamental guarantees afforded to citizens for the exercise of their freedoms’ (Article 34 of the Constitution). In this regard, there are grounds to note a possible breach of Article 34 of the Constitution.

The main role of this commission will be to assess the practice of assisted dying, with a view to future revisions of its regulatory framework, and to facilitate its practice, in particular by maintaining a register of healthcare professionals willing to provide assisted dying.

In conclusion, this Act does not protect vulnerable people, particularly from certain doctors who believe they are doing good by ending their lives.

When assessing the scope of this law, the following realities must be taken into account:

• 10 per cent of French people are on antidepressants.
• One million French people are eligible, according to the French Society for Support and Palliative Care (SFAP).
• Around twenty departments have no palliative care units, and less than half of the demand for palliative care is currently being met. Furthermore, this coverage will decrease in line with the ageing of the population.
• The number of hospital beds is falling sharply in France.

Legalising assisted dying will save around 1.4 billion euros a year in healthcare, old-age care and pension costs (Fondapol estimate, 2025).

As you can see, the so-called ‘freedom to die’ that this law introduces will also, and above all, be a ‘right to kill’. It will be virtually impossible to challenge and bring to justice all the abuses that this procedure is bound to facilitate and multiply.

People suffering from senility, those bedridden and those with mental disabilities are particularly at risk from this bill. If this bill is enacted, it will make it possible to eliminate hundreds of thousands of people.

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