The French National Assembly has advanced two end-of-life bills in a second reading: one expanding palliative care and another creating a right to assisted dying, with the latter approved by a vote of 299 to 226.

Despite objections from medical groups and critics who say safeguards are inadequate, the reform is moving forward, though some deputies warn it has evolved beyond its original scope.

The default is self-administration, with doctors or nurses stepping in only if the patient cannot physically administer the substance, a point refined in the latest vote.

The legislation adds a criminal framework including a conscience clause for healthcare workers, a collegial review process, and new penalties for obstructing access or incitement to seek assisted dying.

A government figure referenced earlier opposition to the reform and stressed its lasting political impact.

Both texts will be referred to the Senate for a second review, though the Senate previously rejected the assisted-dying bill when it last sat, where opposition blocs hold a majority.

Safeguards for physicians include verifying voluntary, unpressured wishes and promptly reporting any coercion to authorities.

A key next step is a February 25 vote in the Assembly on the assisted-dying bill after hours of debate and thousands of amendments, with ongoing contention over administration method and procedural details.

Administration rules require the patient to be accompanied by a physician or nurse, with the patient choosing the location and timing, and self-administration is standard unless the patient cannot physically do it.

Key debates include who administers the substance and whether psychological suffering alone can justify access, with a consensus that mental distress must be part of a broader criteria.

There is a sharp division among lawmakers over caregiver administration versus strict self-administration, framed as balancing ultimate freedom for the patient with safeguards.

Amendments continue to debate who may administer the lethal substance and what constitutes sufficient suffering, with a shift toward allowing caregiver administration to honor patient autonomy.