Yale scholar helps steer French citizens’ assembly on euthanasia

Last December, Yale political theorist Hélène Landemore traveled to her native France to help guide an assembly of French citizens charged with reconsidering the country’s laws on euthanasia and assisted dying.

Over the next few months, the assembly of 184 randomly selected citizens produced a report that, among other things, endorsed some form of euthanasia for those who want it, and proposed increasing investment in palliative care to ease the process of dying.

In April, the group presented its policy recommendations in a final report to French President Emmanuel Macron, who pledged to submit a bill on end-of-life issues to parliament by the end of summer.

Perhaps just as important, though, was that the process successfully allowed ordinary people to guide policymaking, said Landemore, who served on the assembly’s 13-member governance committee.

“We accomplished our mission, which was to render credible the use of citizens’ assemblies to deliberate on fraught political issues and to normalize the assemblies’ status in France’s political landscape,” said Landemore, whose scholarship examines alternatives to electoral democracy that empower randomly selected citizens, rather than professional politicians, to define laws and set legislative agendas.

The convention’s 184 members were selected using a series of criteria, including age, gender, education, place of residence, and occupation, to ensure that they accurately reflected the country’s population. Their deliberations stretched over nine sessions in Paris from Dec. 9 through March. In the end, 76% of its members voted in favor of allowing, with exceptions, some form of euthanasia or assisted dying.

Its 170-page final report — which included nuanced descriptions of the views of those members opposed to euthanasia and assisted dying — gained the support of 92% of the assembly’s members. France’s current law allows medical personnel to sedate individuals who are dying and in intolerable pain but forbids ending life. Some form of assisted dying or euthanasia is legal in several European countries.

Other Western democracies have experimented with similar citizens’ assemblies in recent years. In Ireland, assemblies helped set the stage for nationwide referenda that legalized same-sex marriage and abortion. Belgium has held mixed commissions — two-thirds of which were citizens and one-third members of parliament — to consider various policy matters. And from 2019 to 2020, France held a citizens’ assembly to evaluate the country’s climate policy.

For the new assembly on end-of-life issues, the governance committee setting procedures was composed of six members of the CESE (Le Conseil Économique Social et Environnemental), the consultative legislative body that traditionally represents organized civil society and is in charge of convening citizen’s assemblies; five individuals with expertise relevant to the convention, including academics and medical ethicists; and two citizens who had previously participated in the assembly on climate change.

Landemore, who attended five of the assembly’s nine sessions while also teaching a lecture course at Yale this semester, said the committee took several steps that helped this assembly succeed.

“We gained the trust of the citizens by being transparent and owning up to our mistakes,” she said. “We used our trust in the citizens and the process as the basis of all of our decisions, which really helped.”

Once the citizen members of the assembly were familiar with the process and each other, the governance committee began finding ways to increase co-responsibility with them over the convention’s procedures. For example, it allowed assembly members to choose representatives to speak with the press and draft the manifesto that introduced their final report. The committee held debriefing sessions and office hours with members to hear their concerns and suggestions, Landemore said.

The committee was flexible and experimental, she said. For example, when members who opposed euthanasia and assisted dying complained of not being heard, the committee formed opinion groups in which participants could consult with like-minded colleagues.

“This wasn’t an obvious solution because randomly selected assemblies are precisely meant to reshuffle groups so that they don’t create factions based on the logic of political parties,” Landemore said. “But factions didn’t form. Instead, people who had been feeling ignored and isolated found a support group.”

Members also started visiting with opposing groups, forging an atmosphere of mutual respect.

“They found that they could talk about the things that divided them profoundly in ways that were respectful and based on friendship and solidarity,” Landemore said. “That was absolutely amazing to watch.”

It was the second citizen’s assembly convened during Macron’s presidency. In 2020, the Citizen’s Convention for Climate, which included 150 randomly selected individuals, devised a list of 149 policy recommendations for reducing the country’s carbon emissions by 40%. In the end, few of the assembly’s proposals were included in legislation voted on by Parliament, which created a sense that it was pointless, Landemore said, and Macron’s critics accused him of using the convention as cover for his authoritarianism. 

“That didn’t happen this time,” she said. “Even people critical of Macron or the use of citizens’ conventions didn’t think there was manipulation happening inside the convention or that this was a meaningless exercise.”

In accepting the citizens’ recommendations, Macron promised to pursue a 10-year plan to improve end-of-life care in France, embracing the assembly’s proposal to boost investment in palliative care, indicating that the citizens’ effort can have an impact.

“The convention’s decision carries with it a requirement and an expectation for a French model for the end of life,” Macron said at the time. “We will respond to it.”

It helped, Landemore said, that the assembly’s conclusions aligned with those of an ethics committee convened by Macron to study the same issues and with the views of the French public. (Polling shows overwhelming support for liberalizing laws on euthanasia and assisted dying.)

There is momentum within the French government to convene a third citizens’ assembly to consider ways to improve democracy, she said, adding that the there is plenty of room to further democratize the legislative process. 

She would prefer that the recent citizen’s assembly’s proposals be the subject of a national referendum so that French voters, not their elected representatives, can decide whether to implement them. However, France’s constitution prohibits euthanasia and other social issues from being open to referenda. Landemore hopes the next exercise in deliberative democracy gives the French people ultimate authority over the issues under consideration.

“I would hope that a third convention manages to more successfully tie the micro public to the macro public in the sense of holding a national referendum on the recommendations it produces,” she said. “I think our success this time around shows that we can trust the people to deliberate respectfully and offer proposals for their fellow citizens to consider.”