Euthanasia: Who decides when life should end?

France has taken a major step into one of the world's most difficult ethical debates as the country on 19 August formally enacted a law allowing assisted dying after the European country's Constitutional Council approved it.

The law allows eligible adults suffering from incurable conditions and unbearable pain to seek a lethal substance, which they must normally administer themselves; a healthcare worker may administer it if the patient is physically unable to do so.

The French move raises an old question that goes far beyond France: should a person have the right to decide when and how their life ends if suffering has become unbearable?

Which countries allow it?

There is no simple global number because "euthanasia" and "assisted dying" are not legally identical. In euthanasia, a doctor or other authorised healthcare professional administers the life-ending substance at the patient's request. In physician-assisted suicide or assisted dying, the patient generally takes the substance themselves.

On the strict definition of physician-administered euthanasia, countries including the Netherlands, Belgium and Spain have nationwide laws allowing it in certain circumstances. Switzerland, meanwhile, permits assisted suicide under certain conditions but does not allow active euthanasia. In the US, medical aid in dying, also known as physician-assisted dying, is legal in 10 states — California, Colorado, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont and Washington — as well as the District of Columbia. Oregon was the first US state to legalise it, with its law taking effect in 1997. France is now part of the broader group permitting assisted dying, although its model is primarily patient-administered rather than conventional euthanasia.

Why do supporters say yes?

The strongest argument is autonomy. If competent adults have the right to decide what medical treatment they accept or refuse, supporters ask why that autonomy should disappear when the disease becomes terminal and suffering unbearable.

For them, assisted dying is not about choosing death over life in general. It is about allowing someone facing an irreversible and intolerable end to exercise control over the final stage of life.

There is also the argument of compassion. Modern medicine can keep a body alive for months or years while being unable to eliminate all physical or psychological suffering. Supporters argue that forcing a person to endure such suffering simply because society is uncomfortable with assisted death can itself become cruel.

France's law reflects this approach. It requires medical assessment, a review panel, a waiting period and confirmation of consent on the day of the procedure. The patient can withdraw the request at any time.

Another argument is that regulation is safer than prohibition. If people are determined to end unbearable suffering, supporters argue, a transparent medical process with eligibility criteria and oversight is preferable to desperate, secretive or potentially violent methods.

Why do opponents say no?

The central objection is equally powerful: human beings should not deliberately kill another human being. The World Medical Association remains firmly opposed to both euthanasia and physician-assisted suicide. Its position is that doctors should not deliberately participate in ending a patient's life, while recognising that patients have the right to refuse unwanted medical treatment.

Opponents also worry about the vulnerable. A terminally ill person may technically request death voluntarily but still feel pressure from family, financial hardship, disability, loneliness or the fear of becoming a burden. During Britain's assisted-dying debate, opponents made precisely this argument: vulnerable patients might feel that they ought to die rather than impose costs or emotional burdens on others.

There is also the slippery-slope argument. The concern is where the line would ultimately be drawn. If the deliberate ending of life is justified to relieve unbearable suffering in terminal cases, critics ask whether the same reasoning could eventually be applied to chronic illness, psychological distress or other forms of suffering. For these reasons, opponents argue that governments should invest more in palliative care, pain management and psychological support rather than creating a legal route to death.

But what about the death penalty?

This is perhaps the most uncomfortable question for countries where deaths penalties are legal. The argument that "humans are not authorised to take human life" becomes difficult to defend consistently when the same legal system allows the state to execute people.

Yet the two cases are not morally identical. The death penalty is imposed by the state as punishment for a crime; euthanasia, in principle, involves a competent person's voluntary request to end unbearable suffering. One is intended as punishment, the other as relief from suffering.

But the comparison exposes an important inconsistency: if society accepts that the state may deliberately end a person's life under certain circumstances, then the absolute claim that "no human being has the moral authority to end another human life" cannot by itself settle the euthanasia debate.

The real question becomes more difficult: who should have that authority, under what circumstances, and with what safeguards?

Ultimately, the euthanasia debate is not simply life versus death. It is a clash between two ideas of human dignity: the dignity of preserving life at almost any cost, and the dignity of allowing a suffering person, under exceptionally strict safeguards, some control over how life ends. The difficult part is deciding where compassion ends—and where the irreversible power to kill begins.