France • June 29, 2026 • Erick Prometeo • 🌿 Progressive

The right to die: reclaiming autonomy from state paternalism

From the founding of the first euthanasia advocacy movements in the 1930s to the Belgian and Dutch laws of 2002, the trajectory of end-of-life rights has…

Daniel Borrillo, a bioethics jurist, published a tribune in Le Monde asserting that neither the State nor religious institutions hold the right to define what constitutes a "good death." His argument frames end-of-life decisions as a matter of individual sovereignty — a right that paternalistic governance has historically denied. 📅 The timeline: 3 key historical moments with exact dates explaining why this is happening now. **1936 — Founding of the Voluntary Euthanasia Society (United Kingdom):** One of the first organized movements to claim the individual's right to a self-determined death was established in London. This early advocacy demonstrated that the demand for autonomy at the end of life is not a modern invention, but a long-standing claim against institutional authority that has resisted recognition for nearly a century. **2002 — Netherlands and Belgium legalize euthanasia:** Both countries built regulated legal frameworks that recognized patient autonomy as a right enforceable under law. Critically, these frameworks were designed within robust welfare states — demonstrating that extending individual rights at the end of life is compatible with, not in tension with, strong social protection systems. **2005 — France's Leonetti Law:** French legislation moved partway toward recognizing patient agency by limiting therapeutic obstinacy and permitting sedation in terminal cases. But it maintained a prohibition on active euthanasia and assisted suicide — a line that critics, including Borrillo, argue reflects institutional deference to religious and conservative medical constituencies rather than the rights of patients. ↩️ The pattern: The history of rights over one's own body — from reproductive rights to marriage equality — consistently follows the same arc: institutional resistance, incremental compromise, and eventual recognition. What is different today is that the argument for end-of-life autonomy is being made from within the legal academy and published in one of France's most influential newspapers. The parallel with reproductive rights debates of the twentieth century is instructive: in both cases, the language of "protection" was used to deny individuals control over their own bodies. 🔄 Today: At EPM, we have documented how France's social crises — from climate inequality to failures in child protection — disproportionately affect those with the fewest resources to assert their rights. End-of-life autonomy is not exempt from this dynamic. Without a legal framework, access to dignified end-of-life options — quality palliative care, or legally recognized choices available in neighboring countries — remains contingent on economic means. Autonomy without equal access reproduces the very inequalities the welfare state was built to address. 📌 EPM Take: What Borrillo's argument reveals — and what mainstream coverage tends to smooth over — is that the refusal to legislate end-of-life autonomy is not a neutral position. It is a choice that has concrete victims: terminal patients who suffer without recourse, families who bear the weight of decisions the law will not allow them to make openly. France has taken decades to enact rights that other Western European democracies recognized in 2002. Each year of legislative inaction is not an absence of policy — it is a policy choice that falls hardest on those with the least power to navigate it. The question readers should ask is not whether France is ready for this debate, but who pays the cost of postponing it.

Daniel Borrillo, a jurist and bioethics specialist, published an opinion piece in Le Monde arguing that the State should not substitute its judgment for that of individuals on end-of-life decisions. He challenges what he describes as paternalistic frameworks — whether state or religious — that claim authority to define what a "good death" looks like. 📅 The timeline: 3 key historical moments with exact dates explaining why this is happening now. **1804 — The Napoleonic Code and the regulatory state:** France's foundational civil codification established the State as the legitimate regulator of major life decisions — marriage, property, inheritance — in service of social order and individual protection. This tradition of structured legal guardianship has, over two centuries, extended into domains including medicine and end-of-life care, reflecting a deep institutional habit of defining the boundaries of personal choice. **1999–2005 — The Kouchner and Leonetti Laws:** France built an internationally recognized legislative framework that balanced respect for life with protection from unnecessary suffering. These laws emerged from broad consultation among medical professionals, ethicists, religious communities, and civil society — a deliberative process that produced durable, if imperfect, consensus. They represent the institutional record France is now being asked to revise. **2002 — Netherlands and Belgium implement euthanasia laws:** More than two decades of experience in both countries offers substantive evidence on how regulated end-of-life frameworks function in practice. That record includes ongoing debates in both countries about the expansion of eligibility criteria — a development that informs the caution with which some legislators approach rapid reform. ↩️ The pattern: Western democratic history shows that institutions — state, church, and medicine — have served as counterweights to irreversible individual decisions, not merely as obstacles to freedom. What is different today is that the case against institutional involvement is being made by legal scholars within mainstream academic and media discourse. The relevant historical precedent is not only the Dutch or Belgian model, but any reform that, in removing institutional oversight, subsequently required constructing new safeguards to protect the most vulnerable from unintended consequences. 🔄 Today: Borrillo's argument is philosophically grounded in the liberal tradition, and it deserves serious engagement. But the historical record obliges a further question: when institutional tutelage is removed, what replaces it? At EPM, we have documented France's challenges in ensuring equitable access to social protection — from climate vulnerability to child welfare. Real autonomy at the end of life requires more than the absence of state prohibition; it requires that the decision be genuinely free, uncoerced by inadequate palliative care, financial pressure, or institutional abandonment. The strength of any new framework will be measured by how well it protects those conditions. 📌 EPM Take: The framing of this debate as paternalism versus autonomy, while philosophically useful, obscures a harder institutional question that conservative analysis is positioned to ask: autonomy for whom, and under what conditions? Borrillo is right that the State should not impose a definition of the good death. But history also shows that the removal of institutional frameworks without robust replacement structures tends to leave the most vulnerable — the poorest, the least socially connected, those with the least access to quality care — exposed to pressures that are anything but autonomous. The countries that have moved furthest in recognizing end-of-life rights have done so by strengthening, not weakening, their surrounding care infrastructure. That is the benchmark France should be measured against — not only whether it legislates, but whether it builds the conditions under which any such legislation can be genuinely protective.

El derecho a morir: autonomía frente al paternalismo del Estado

Desde las primeras organizaciones pro-eutanasia del siglo XX hasta las leyes belgas y neerlandesas de 2002, la historia muestra que reconocer la autonomía al…

El jurista Daniel Borrillo, especializado en bioética, publicó en Le Monde una tribuna en la que sostiene que el Estado no debe decidir en lugar de los individuos en materia de fin de vida. Borrillo cuestiona directamente las concepciones paternalistas —estatales y religiosas— que pretenden definir qué es una «buena muerte», reivindicando la soberanía del individuo sobre su propio cuerpo. 📅 La línea del tiempo: 3 momentos históricos clave con fechas exactas que explican por qué esto ocurre hoy. **1936 — El debate sobre la eutanasia en el contexto de los derechos civiles (Reino Unido):** La Voluntary Euthanasia Society fue fundada en Londres, constituyendo uno de los primeros movimientos organizados que reclamó para el individuo el derecho a decidir el momento de su muerte. Este antecedente demuestra que la reivindicación de autonomía frente al Estado en materia de muerte no es un fenómeno reciente. **2002 — Países Bajos y Bélgica legalizan la eutanasia:** Ambos países aprobaron marcos legales que reconocieron el derecho de ciertos pacientes a solicitar una muerte asistida bajo condiciones reguladas. Este hito mostró que legislar la autonomía al final de la vida es compatible con sistemas de bienestar social robustos y con el respeto a los derechos humanos. **2005 — Ley Leonetti en Francia:** La legislación francesa estableció límites a la «obstinación terapéutica» y abrió la posibilidad de sedación terminal, pero mantuvo prohibida la eutanasia activa. Desde entonces, el debate en Francia ha avanzado lentamente, marcado por la resistencia de sectores religiosos e instituciones médicas conservadoras. ↩️ El patrón: La historia muestra que los avances en derechos sobre el propio cuerpo —desde el aborto hasta las uniones civiles— siempre han enfrentado primero la resistencia del paternalismo estatal y religioso. Lo que cambia hoy es que el argumento liberal presentado por Borrillo ya no proviene solo de movimientos sociales, sino de la academia jurídica y del espacio editorial de referencia en Francia. El paralelo con el debate sobre el derecho al aborto en el siglo XX es claro: también entonces se invocó la «protección» del individuo para negarle su autonomía. 🔄 Hoy: Desde EPM hemos documentado cómo las crisis sociales en Francia —la desigualdad climática, la protección de menores vulnerables— afectan desproporcionadamente a quienes tienen menos recursos para ejercer sus derechos. El fin de vida no es ajeno a esa lógica: sin un marco legal claro, quienes pueden acceder a cuidados paliativos de calidad o a opciones legales en otros países son los que tienen medios económicos. La autonomía, sin garantías de acceso igualitario, reproduce desigualdad. 📌 Conclusión EPM: Lo que el debate francés sobre el fin de vida pone de manifiesto, y que pocas columnas señalan con claridad, es que el paternalismo no es neutral: tiene víctimas concretas. Cuando el Estado o la Iglesia definen la «buena muerte», lo hacen sobre los cuerpos de personas que ya sufren —enfermos terminales, pacientes sin voz pública—. Borrillo no está pidiendo un derecho abstracto; está señalando que la ausencia de ese derecho es una forma de violencia institucional silenciosa. En un país que ha tardado décadas en reconocer derechos reproductivos plenos y que sigue debatiendo leyes que otros países europeos aprobaron hace más de veinte años, la pregunta urgente no es si el Estado puede legislar sobre la muerte, sino a quién le cuesta más que no lo haga.

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