Emmanuel Macron was predictably theatrical when he introduced his Bill on the end of life yesterday. In the proposed legislation, medical staff would be authorised to help their patients to die – which Macron described as a law of ‘fraternity’. He pronounced: ‘With this text, we look death in the face.’ A guaranteed headline in the Catholic daily La Croix.

The President has often favoured dark suits and I have previously described him as having a funereal mien. But he was positively bouncy extolling the Bill, which will be debated by the National Assembly this spring.

Macron is swimming with the tide of popular opinion

He chose to kick off the debate on death with an unprecedented joint interview with La Croix and the leftist Libération: the choice of the newspapers was calculated and calibrated. The questions were predictably anodyne but Macron’s opinions on death were nonetheless fascinating.

Why this and why is Macron addressing it now? It’s easy to assume that the debate on assisted dying would provoke no riots, so as a domestic project it’s probably a pretty safe topic for the President, diverting attention from the multitude of social, economic, political and strategic questions facing the nation. The same could be said of his recent decision to insert the right to abortion in the country’s constitution, a popular gesture but performative since abortion has been legal in France since 1975.

Not everyone, however, is convinced. La Croix has editorialised against it and there have been warnings from the Chief Rabbi of France, Haïm Korsia, and the president of the French Bishops’ Conference, Bishop Éric de Moulins-Beaufort, that creating new legislation would create more difficulties than freedoms.

But they know they’re fighting a losing battle and even their congregants disagree. Macron is swimming with the tide of popular opinion. Many have observed loved ones die prolonged and miserable deaths. Polls show 83 per cent of French voters favour euthanasia. Macron isn’t even asking France to lead the way: variations of assistance in dying and euthanasia are already established in Belgium, Holland, Spain, Switzerland and Canada.

Sometimes these measures have proven controversial, such as in Canada, where the number of MAID (medical assistance in dying) provisions has grown rapidly. In 2022, their number increased by 32 per cent, accounting for close to 4 per cent of all deaths that year. There are now fiercely contested calls in Canada for MAID to be made available to the mentally ill, although the government has backed away from this for now.

How will the end-of-life Bill in France open access to active assistance in dying? What form could it take: euthanasia or assisted suicide? Both, seems to be the President’s response. When possible, the final medical procedure would be initiated by the patient directly. But when incapable, it might also be initiated by a medical professional. This has the makings of a slippery slope.

‘We thought of this law as a law of fraternity, a law that reconciles the autonomy of the individual and the solidarity of the nation. In this, it does not create, strictly speaking, a new right or a freedom, but it traces a path that did not exist until then and that opens the possibility of asking for help in dying under certain strict conditions,’ explained the President.

The term we have retained is that of ‘helping to die’ because it is simple and humane and it clearly defines what it is. The term euthanasia refers to ending someone’s days, with or even without their consent, which is obviously not the case here. It is also not assisted suicide that corresponds to a person’s free and unconditional choice to dispose of his life. The new framework proposes a possible path, in a specific situation, with precise criteria, where the medical decision has its role to play.

This support will be reserved for adults, as the citizens’ convention had recommended, the President said. Candidates will have to be capable of full discernment, which means that patients with psychiatric diseases or neurodegenerative diseases that alter a person’s decision-making abilities, such as Alzheimer’s, are excluded. To qualify, the patient must also have an incurable disease and a prognosis of death and, crucially, must be suffering – physically or psychologically – in some way. If all these criteria are met, the possibility opens up for the person to ask for help in order to die. Then, it is up to a medical team to decide the follow-up to this request.

Whether the President can maintain the fiction that this isn’t euthanasia probably doesn’t matter. Doctors have been helping patients on their way since forever. But now it will be legal.