Open Letter to the Members of the Constitutional Council: Medical Aid in Dying in France—Contrary to the Constitution, Hope, and Dignity
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| Dr Paul Saba |
By Dr Paul Saba, a family physician in Lachine Quebec.
You only need to walk through the halls of a hospital long enough to discover the reality that lies behind the numbers. Patients aren’t just medical records; they’re people. The difference between hope and despair often comes down to a door that opens… or remains closed. The new laws on assisted suicide claim to be about choice, but anyone who has worked in the medical field knows how quickly that “choice” crumbles under pressure. There’s the cancer patient living in a cramped, noisy apartment; the woman with a disability who can’t afford to go grocery shopping; the elderly man living alone who fears for his future. They’re told they have the right to die with dignity, but what they really need is the right to live with dignity.
Canada’s experience should give us pause for thought. Since 2016, when the law was first enacted, 100,000 Canadians have died by medical assistance in dying, many of whom still had years, even decades, left to live. What was initially presented as an option reserved for terminally ill patients has expanded to include people with chronic illnesses and mental health conditions. Quebec alone accounts for 8% of the total deaths by assisted dying, the highest rate in Canada and worldwide. These numbers are rising every year.
Initially, the system was based on strict criteria, but the boundaries have quietly shifted. We are hearing more and more stories of people requesting assisted dying because they are unable to access home care, accessible housing, or adequate food. “Dignity” is becoming a code word for cost-cutting, while the most vulnerable find themselves facing a maze with no way out. Consent is not a box to check. It is a conversation, a process, and, above all, a reflection of the options available to the individual.
When a person is sick, frightened, and overwhelmed by bills, to what extent is their freedom of choice truly real? Loneliness and poverty influence decisions just as much as physical distress or a diagnosis. Advocates for this cause believe that safeguards will hold firm, but in practice, the boundaries are shifting. The line between compassion and abandonment is blurring, especially when budgets are tight and beds are scarce. I have seen families exhausted by the burden of care, patients who would rather disappear than ask for help, and medical staff powerless in the face of bureaucracy.
France, just like Canada, lacks adequate health care, particularly when it comes to general practitioners, emergency room doctors, and timely access to specialists. Legalizing assisted suicide without fixing our failing health care systems is tantamount to telling people that some lives are too complicated to be supported. It is easier to pass a law than to put a safety net in place. True dignity comes from community, commitment, and the refusal to abandon anyone. Until every patient has a comfortable bed, quality care, and a sympathetic ear, we will not have the right to offer a way out.
Beyond these practical and moral concerns, the French bill also contradicts the country’s Constitution.
First, unlike in France, where the protection of health enjoys constitutional recognition (Preamble to the Constitution of October 27, 1946, para. 11, incorporated into the constitutional framework; see, in particular, the case law of the Constitutional Council), the Canadian Constitution contains no provision expressly guaranteeing such a right. The constitutional mandate of the French state is to protect life and health by guaranteeing access to care, treatment, and palliative care, rather than by establishing a medical aid in dying program.
Furthermore, the law on medical assistance in dying disproportionately affects vulnerable groups, particularly people with disabilities, chronic illnesses, or associated mental health conditions who, in the absence of adequate care and social support, may feel pressured to end their lives prematurely. This constitutes a direct violation of the constitutional right not only to health and life but also to equality, as it creates a situation where certain citizens are effectively encouraged to die because their needs are not being met.
Similarly, the principle of liberty requires that consent be free and informed. However, when a person is experiencing physical or associated psychological distress, is isolated, and lacks support, their ability to make a clear and not coerced decision is compromised. The law’s failure to guarantee truly voluntary consent risks undermining this fundamental constitutional liberty.
Let me tell you a story. Eight years ago, John (a pseudonym), a highly knowledgeable engineer, came to see me for a cough. A chest X-ray suggested lung cancer. He could have given up at that point, since Canadian law allows patients to refuse tests and seek assisted dying prematurely. But I convinced him to undergo further testing. It turned out to be Hodgkin’s lymphoma, It is entirely treatable. Today, John is alive and in good health.
Unfortunately, a recent study revealed that 13% of patients who died by assisted suicide after a diagnosis of lung cancer had never undergone a biopsy to confirm the diagnosis and were less likely to consult oncologists or receive treatment.
Another patient, Rachel (also a pseudonym), in her 50s, was diagnosed with breast cancer. After surgery, tumor cells remained and grew rapidly. At first, frightened and desperate, she refused chemotherapy and immunotherapy, even going so far as to stop eating. Eventually, she agreed to treatment and made a full recovery. Rachel said that cancer can drive a person crazy and cloud their judgment. It was hope that saved her.
These are not isolated cases. As a physician responsible for reviewing cases of assisted dying, I find that most involve people suffering from medical conditions or disabilities exacerbated by social isolation, feelings of being a burden, loss of autonomy, and psychological distress. Physical pain, which could be relieved, is often the least common reason.
A recent study estimated that making assisted dying available to vulnerable groups in Canada—including, but not limited to, the homeless, people with substance use disorders, retirees, the elderly, and Indigenous communities—could save 1,273 billion CAD (791 billion EUR) by 2047, resulting in 2.6 million deaths. This scenario could easily apply to France if it were to follow the same path.
This raises a frightening question: Are we broadening eligibility criteria to eliminate citizens for financial gain rather than to care for and support them? This approach devalues human life and fosters a dangerous mindset, according to which the easy solution to complex health and social problems is to eliminate vulnerable individuals rather than invest in care. It creates a conflict of interest in which governments profit, directly or indirectly, from the deaths of their citizens. It also raises profound ethical questions for healthcare professionals.
France has the opportunity to prevent this. Do not be fooled by rhetoric about autonomy and dignity when basic needs are not being met. Assisted dying destroys hope. It pushes people to give up before their time. Hope is the greatest strength of quality care—the conviction that every step forward counts. Assisted dying prematurely puts an end to that hope.
I urge you to protect the most vulnerable, to invest in care, and to reject laws that offer shortcuts instead of safety nets and options for extended care. Until every patient has access to the care, support, and dignity they deserve, no law authorizing assisted dying can be considered, much less regarded as an act of compassion.
Respectfully,
Dr. Paul Saba
Maître Natalia Manole
Dr.
Paul Saba is a Canadian physician who has practiced medicine around
the world. He currently practices family medicine in Montreal. He is a
co-founder of the Physicians' Alliance against Euthanasia (https://collectifmedecins.org/en/about/) and author of the book *Made to Live* (madetolive.com) +1 514-886-3447
We knew that the language of Bill C-218 would have prevented euthanasia for mental illness, as a sole criteria, but we have not seen the language of the upcoming government bill. 
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