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3. Dying as a Subject: The True Stakes of Palliative Care and Assisted Dying

As France debates assisted dying, psychoanalysis reveals a fundamental truth: dying is not simply the end of life, but a profound risk of losing one’s voice, connection to others and personal dignity. When confronted with palliative care and requests for death, the issue is not about being for or against, but about listening deeply – right up to the very end.

In France, the debate over palliative care and assisted dying challenges the very foundations of how we relate to life and death, to pain and, more profoundly, to the dignity of the human subject. What does it truly mean to die? Is it simply the end of life, or the loss of one’s voice, one’s place within social bonds and the capacity for desire? At a time when the right to “die with dignity” is widely invoked, psychoanalysis reminds us that dignity is not a physical state but a matter of voice, connection and – above all – active listening.

Palliative care was originally conceived not as a prelude to death, but as a space where death can unfold differently – free from abandonment and dehumanization. Its purpose is not merely to ease physical pain, but to allow a human being to remain, until the very end, a subject: someone capable of speaking, of desiring, even faintly, even when silence prevails.

Pain is not solely biological; it is also psychological. Freud recognized this early on: “The psyche is extended but does not know it,” he wrote. In other words, suffering can manifest in the body, and conversely, the body can express unconscious distress. The symptom marks the intersection where body and unconscious meet. Thus, the suffering of the dying is not always communicated through words but often through gestures, refusals or glances. The role of palliative care is to remain attentive to these expressions – to hear a voice, even a desire.

Palliative care is not just a “final treatment.” It is a means to preserve a person’s sense of self, even when everything around them seems designed to erase it – the hospital bed, medical interventions, loss of independence and infantilizing attitudes. Many incurable patients feel reduced to objects – objects of care, pity, or even discomfort. When grounded in a human-centered approach, palliative care can and must help restore their identity as speaking individuals who deserve to be truly heard.

There is no room for idealization. The reality of dying is often harsh, chaotic and undignified from the perspective of others. Yet psychoanalysis has never shied away from this truth. Instead, it urges us to stand alongside those facing death, without trying to soften or sugarcoat their experience. The dying do not always seek consolation; they want their reality acknowledged. Silence, abandonment, loneliness and a hurried, neglected death often cause more pain than the suffering itself. In palliative care, even the smallest word can become an act of life.

This brings us to the other, even more complex side of the debate: assisted dying. Psychoanalysis neither prescribes nor condemns; rather, it seeks to understand the meaning behind such a request. A request to die is never purely biological – it is a form of communication, and every expression carries its own shadow, its own mystery.

In some cases, the request to die can be a way to reclaim control over a life that has become passive and unbearable – an “I choose” spoken in the face of the unspeakable. But is this choice truly free? Could it stem from profound loneliness, a sense of being a burden or a distorted self-perception? These are questions no law, however well-intentioned, can answer on behalf of the individual.

Lacan famously said, “Suicide is an address.” This phrase must be understood in its full depth: even the most irreversible act remains a form of language. Sometimes, the wish to die is a way to speak – to cry out, to plead, to give voice to an unspeakable suffering. When someone asks to die, aren’t they first asking to be truly heard in their unbearable distress? Assisted dying can thus be understood not as a right to death, but as an acknowledgment of an absolute subjective impasse. It becomes an ethical act – not because it ends life, but because it refuses to deny the subject’s ultimate demand.

However, caution is crucial: a wish to die does not always reflect a genuine choice. Sometimes, it is a call for someone to stay – to listen and not to leave. Psychoanalysis does not seek to preserve life at all costs but to carefully unravel the meaning behind the request, avoiding any rushed response.

Euthanasia should neither be viewed as an automatic act of compassion nor dismissed outright on moral grounds. It demands time – time for attentive listening and a careful process of meaning-making. The question is not simply whether someone has the right to die, but whether they can still, until the very end, remain a speaking subject. This time – however brief or uncertain – is the ethical foundation of assisted dying, one that honors rather than betrays the subjectivity of the person making the request.

Public debate often frames individual freedom – “I want to choose my death” – against the protection of life – “Society must prevent voluntary death.” Psychoanalysis, however, takes a different stance: it recognizes that the subject is never fully free nor entirely alienated.

There is no such thing as an absolutely autonomous subject. Every desire, every request, is embedded within a complex web of addresses, symbols and gazes. The real question is not merely whether to respect a choice, but to whom that choice is addressed, what it seeks to communicate, and what it reveals about a person’s history. Psychoanalysis does not replace lawmakers, but issues an important warning: a society that responds too hastily to a request for death, without exploring its unconscious meaning, risks conflating compassion with objectification.

What a person sometimes truly seeks is not death itself, but for someone to fully acknowledge their solitude, fear and loss of future. If assisted dying becomes merely a social reflex for relief, it ceases to honor the individual and instead reduces them to a symptom that society tries to erase.

Conversely, dismissing all requests to die based on an abstract principle of preserving life overlooks the profound intensity of certain sufferings and the sometimes genuine demand for a chosen death. The role of psychoanalysis is to hold this tension in awareness – without forcing a resolution.

Neither for nor against. Psychoanalysis does not take sides; it listens. This is not a withdrawal or avoidance, but an ethical commitment: to give each individual the space to express what living or dying means to them. When palliative care and assisted dying operate within this space where speech remains possible, they should be seen not as opposites, but as two ways to honor subjectivity in the face of mortality.

What if, right up until the end, we dared to hold space for that speech – even when faltering, even when filled with pain? Perhaps this is what it truly means to accompany someone who is dying: not to speak on their behalf, but to create a space where they can still, if they choose, voice something of themselves. And in that expression – even the faintest – the subject remains alive.

Louis Bouffard’s moving testimony on CNews clearly highlights the issues we’ve been discussing. At just 24 years old and living with an incurable degenerative neuromuscular disease, he knows his time is limited. Yet he firmly expresses his will to live: “Even at the end of life, there is still life.” In today’s French debate, he feels a “social pressure to be eliminated,” as if he were a burden – “unworthy of living.” Despite this great tragedy, he insists on his love for life. He shows the deep struggle between the desire to live and the pull of death, choosing to stand strong when everything pushes him to give up. His words, “I want,” are a powerful act of resistance, proving to those who hear him that he remains a speaking, feeling, thinking and loving desire.