The Right to Die, or the Right to Care?

Recently, five young mothers in Rajasthan, India, suffering from kidney failure following C-sections, wrote to President Droupadi Murmu, seeking either urgent kidney transplants or euthanasia, citing the relentless burden of prolonged dialysis. Their appeal is unsettling, not just because it raises the question whether India should permit assisted dying, but because it points out a more fundamental question: how meaningful is a choice to die when the alternatives to suffering are themselves inaccessible?

The question is particularly relevant as France moves in the opposite direction. In July 2026, the Assemblée nationale, the lower house of the French parliament, approved the End-of-life bill, despite repeated rejections by the upper house (Sénat), where the conservative right holds a majority. Parliament has voted to grant terminally ill adults the right to a medically assisted death. The bill follows more than three years of ethical, political and societal wrangling over one of the most disputed questions in French public life. 

The proposed law allows terminally ill adults experiencing unbearable physical or psychological suffering to have the right to voluntarily end their lives. It allows eligible patients to receive a lethal substance, under strict conditions, which could be self-administered or given by a health practitioner if the patient cannot do so themselves. The French legislation permits medically assisted dying, encompassing both euthanasia and assisted suicide, which are often used interchangeably but are two separate practices. In euthanasia, a third person, mostly a medical practitioner, administers the means of death, for instance by injecting a lethal substance. However, in the case of assisted suicide, a person is prescribed a lethal substance that they must take themselves to die. 

Yet France’s decision should not be seen as a sign for India to go down the path of assisted suicide. Therefore, in this context, the more important question for any country is whether there is genuinely any autonomous choice to die when meaningful alternatives to suffering remain inaccessible to the patients. France’s own trajectory is worth noting in this regard. Its decision to recognise assisted dying did not emerge in isolation, but followed two decades of gradually expanding patient autonomy in end-of-life care.

France’s End-of-Life Laws

This new bill is not a sudden departure from its past. It is a culmination of France’s end-of-life laws built up in stages over two decades. Each step edges the country closer to recognising a patient’s say over their own death. The first, the 2005 Leonetti Law, gave patients the right to refuse treatment. Relief from unmanageable pain has long been recognised as a fundamental human right for patients around the world. The law allowed doctors to use pain management treatments, even when the foreseeable side effects could hasten death. It banned “unreasonable therapeutic obstinacy,” basically prolonging treatment with no real benefit to the patient. It was the first step towards partially recognising a patient’s bodily autonomy. The law thus established that a patient's own account of their suffering and their choices of treatment mattered legally and not just clinically.

The 2016 Claeys-Leonetti Law was a step ahead in that direction. It amended the 2005 law and introduced the right to deep and continuous sedation until death for patients. It legalised terminal sedation while still explicitly forbidding euthanasia. However, the law prioritised ‘the wishes of the patient’ on matters relating to terminal sedation and unreasonable obstinacy, while raising a fundamental ethical tension with the traditional Hippocratic model, in which a physician alone judges what best serves the patient rather than simply carrying out the patient's own wishes. Attributed to the ancient Greek physician, Hippocrates, the Hippocratic Oath ensures the role of a physician as a healer, bound by the ethical principle of avoiding intentional harm. What the Claeys-Leonetti Law withheld was the last step i.e. a patient’s own request to actively end their life. That is the gap the 2026 legislation proposes to close.

What Explains France’s Policy Shift?

Over the years, French public opinion has moved decisively towards legalising end-of-life options. This sustained, and broad support has given successive governments political cover to keep pushing the bill despite the Senate’s resistance. The shift in societal attitudes towards death and autonomy reflects a broader move away from paternalistic medicine, in which doctors largely determine the course of a patient’s care, towards a model of shared decision-making that places greater emphasis on patient autonomy in their own treatment. Though this shift transgresses from the idea of sanctity of life, it restores the dignity of a patient and extends autonomy over how one must be treated when one dies. 

President Macron made the current law possible through a deliberate exercise of participatory democracy in France. Following his re-election in 2022, he pushed for nationwide reflection on end-of-life issues through the Citizen’s Convention on End-of-Life Care. The Convention was hailed as a landmark democratic exercise comprising 184 French citizens who, over several months, deliberated with medical experts, legal scholars and patient groups before recommending that France must open access to assisted dying while simultaneously strengthening palliative care. The participants of this Convention were selected through sortition (selected by lot) and comprised a representative sampling of France across six criteria. In doing so, France has chosen to redefine the norms of freedom at the end of life. The reform reflects a broader societal choice that extends beyond the ability to choose the manner of one’s death to recognising one’s bodily autonomy and the right to die with dignity.

Another important aspect is France’s current demographic profile. The average life expectancy in France rose from 78.91 in 2000 to 83.51 in 2026. The country has one of the highest life expectancies amongst other European Union (EU) countries. However, this longevity comes with a burden of chronic and terminal illnesses. The estimated incidence of cancer in France is slightly above the EU average. Cancer and cardiovascular diseases remain the leading causes of death in France. As a higher number of people live longer with chronic and incurable conditions, the political conversation has gradually shifted from simply prolonging life to a more pertinent question: what does it mean to ensure a good and dignified life towards its end?

India’s Own Reckoning

The question France has just settled is far from resolved in India. Indian law allows passive euthanasia, which involves withdrawing or withholding life-sustaining treatment, recognised by the Supreme Court in Aruna Shanbaug (2011) and Common Cause (2018) under Article 21 (right to life and personal liberty). Active euthanasia, requiring deliberate administration of a lethal substance to end a patient’s life, remains illegal under the Indian Penal Code. More recently, in Harish Rana v. Union of India (2026), the Supreme Court reiterated the need for comprehensive legislation on end-of-life care, including measures to expand palliative and comfort care. The Kota episode, therefore, is less a legal issue than a public health challenge. It exposes systemic gaps in access to organ transplantation, affordable treatment, maternal healthcare and psycho-social support. More often than not, requests for euthanasia reflect not a desire to die, but the absence of meaningful alternatives.

This is where France’s own debate offers an important lesson. By pairing assisted dying legislation with a parallel commitment to expand palliative care, it acknowledges that the right to choose death cannot exist without the right to compassionate care and effective relief from pain. The French debate reminds us that dignity at the end of life is shaped as much by the quality of healthcare as by the legal rights available, long before they are even invoked. Dignity and bodily autonomy are thus at the heart of both debates, but for India, the more pressing need is to ensure that no patient at the end of their life feels that death is their only dignified option.

Image: Unsplash/ Annie Spratt

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