The French National Assembly voted 291 to 241 on Wednesday in favour of a law permitting assisted dying, giving the lower house the final say under a constitutional mechanism that bypasses Senate consent.

It was the fourth time the Assembly has approved the text. The Senate rejected an earlier version of the bill last year, and resistance in the upper chamber — led largely by the traditional right, drawn from Les Républicains, the largest party in the Senate — never subsided. The government therefore allowed the Assembly to adopt the law without the Senate's agreement, a procedure the French constitution permits.

President Emmanuel Macron, who promised to pursue the reform during his 2022 re-election campaign, welcomed what he called lawmakers' considered and respectful debate on the issue. Olivier Falorni, the former MP and current mayor who authored and steered the bill through parliament, described the process to AFP as "a marathon with hurdles".

The law is not yet settled. Prime Minister Sébastien Lecornu intends to refer the text to the Constitutional Council, France's highest constitutional authority. His office said the referral followed a lack of proper debate in the right-leaning Senate, which meant the text fell short of a version that could satisfy both the bill's supporters and those anxious about how it would be put into practice. The Council's rulings are binding: it can strike down the whole law in extreme cases, or raise objections to particular provisions.

The eligibility criteria

The law reserves the right to assisted dying for adults suffering from an incurable condition who can express their wishes in a free and informed manner and who are experiencing physical pain. That pain must either fail to respond to treatment or, in the patient's own judgement, be unbearable in cases where they have chosen to refuse or discontinue care.

The procedure is layered. A physician first confirms the patient's eligibility, after which a panel assesses the case against the criteria. The final decision rests with the doctor alone, and the patient remains free to withdraw consent at any stage.

Ordinarily the patient administers the lethal substance themselves. Where they are physically unable to do so, a doctor or nurse may assist.

A long-running debate

France, a country with strong Catholic traditions and a rapidly ageing population, has long grappled with the legal, medical, moral and religious dimensions of end-of-life care. Existing law already allows doctors to keep terminally ill patients sedated in their final days, but stops short of permitting assisted suicide or euthanasia. Many French citizens have travelled to neighbouring countries where such practices are legal, Switzerland chief among them.

The distinction matters. Euthanasia involves a doctor or other healthcare professional administering a lethal injection at the patient's request, while medically assisted suicide typically involves the patient voluntarily taking lethal medication a doctor has prescribed.

By various estimates, around 300 million people worldwide currently have access to assisted dying, with euthanasia permitted under certain conditions in some countries and assisted suicide allowed in others, including several US states.

The question is also live in the United Kingdom. A bill to legalise assisted dying in England and Wales is due to return formally to parliament on 11 September, five months after MPs ran out of time to vote on it in the previous session.

What practitioners should watch

The immediate practical question is the Constitutional Council's decision. Until it rules, nothing in the text takes effect. If the Council strikes down individual provisions rather than the whole law, the eligibility criteria and the role-splitting between physician and panel could emerge altered, and medical practitioners, hospitals and legal advisers will need to track which provisions survive. A referral premised on defective Senate deliberation also signals that the government itself anticipates challenge, suggesting a further legislative round is possible even after the Council rules.