Five lessons from the College of Guarantors of the French Citizens’ Convention on the End of Life

From December 2022 until April 2023, 184 randomly selected French citizens met over nine weekends for the Citizens’ Convention on the End of Life (Convention Citoyenne sur la fin de vie, or the CCFV). The deliberation was organised by and at the Economic, Social and Environmental Council (CESE) in Paris. The College of Guarantors (Collège des Garants) was appointed by the President of the CESE with the broad mission to ensure the quality of participation and deliberation, independently of the Governance Committee set up to oversee the entire process. In this article, we offer five practical lessons from our unique perspective as Guarantors of the Convention.

Participants are not all equally committed to deliberation.

Citizens’ Conventions may include participants who are not committed to deliberation and procedures are needed to manage these difficulties. Whilst the overwhelming majority of Convention members embodied a spirit of citizenship that commands respect and reinvigorates democratic debate, a small minority used strategies that did not meet these standards and reached out to media that was sceptical of these kinds of democratic innovations, seeking to undermine the process. While this is to be deplored, these attempts are evidence, on the one hand, of a form of representativeness of the random selection, since, like society as a whole, not all its members are always well disposed towards the demands of pluralism and, on the other hand, that the process stood up against manipulation, fomented by Convention members who were often quick to say that they were being manipulated themselves, or at least were not being heard.

Future conventions – and their aftermath – must be closely monitored for potential abuses to ensure that they do not bring the hard and collective work of a convention into disrepute. A related question is how long a Convention should last after it has ended its work, since the longer the processes, the more potential for associations to form that undermine the deliberation. This is aligned with the spirit of a democratic lottery, which is about not monopolising power.

Final reports must balance complexity and clarity.

Final reports must tread a fine balance between communicating the complexity of the issues at stake, the nuances in opinions, and clarity. The Convention’s Final Report proposes three types of guidelines for access to assisted dying and 19 models which provide food for thought about the conditions and pathways for such assistance. In addition, behind a majority position in favour of active assisted dying combining assisted suicide and euthanasia, the Convention proposed a range of opinions structured into three major groups and eight sets of opinions. For each set of opinions, the report indicates the arguments in favour of a particular model, the points on which there is disagreement within the group, and the safeguards proposed.

This Final Report reflects the complexity of the debate. The Report sets out many of the factors to be considered under different scenarios if end-of-life support were to be envisaged, as well as arguments and counter-arguments, making it highly comprehensive. However, this complexity, even with weighted votes, sometimes impacts the clarity of the proposals, and this might obscure a clear path for decision-making as well as broader public engagement with the Convention’s work. There is still some way to go to take the outcomes of the Convention further towards decision-making. This is certainly understandable, as these decisions are not their responsibility.

Voting procedures during deliberations need to be carefully considered.

When and why votes are held during a deliberation matters and these implications must be thought through. The CCFV demonstrated that it is possible to vote early in the process to give visibility to opinion groups, which then had to continue the work of argumentation and counter-argumentation. This early revelation of preferences and positions encouraged further discussions. An understandable choice was made to then allow those opposed to active assisted dying to vote on its many conditions of access. In addition, opponents sometimes had the choice of not voting, abstaining or voting “opposed to assisted dying” in later votes. Whilst this ensured respect for the different views amongst Convention members, interpreting such different votes was challenging, if not impossible, and at the very least problematic. The timing of a vote to open the debate up to active assisted dying, and the timing of its terms and conditions – once this opening has been accepted – are not the same. Those opposed to assisted dying may have never asked themselves this question: “the law has been passed, so I accept it, but what are the best ways of accessing assisted dying?”.

The wording of votes during the process should also be subject to deliberation. The Convention experimented with different kinds of votes throughout the process. The advantages of voting over deliberation include allowing everyone to express their individual opinions and aggregating opinions without members having to justify their positions. From the start of the Convention, its members voted many times.
These votes, whatever they may be, must be more clearly worded in future citizens’ conventions. In the interest of transparency, their objectives and consequences must be made clear. The wording of questions and the methods of answering them, as well as their coherence, must not be left solely to organisers. It is better to vote less and take the time to arrive at the right wording and consistency of questions and response options. The precise wording of questions for voting, and their deployment, could be subject to deliberation amongst members to ensure shared understanding and consistency.

Division of responsibility across organisers must be planned mindfully.

There should be a clear division of labour and responsibility across organising parties. The day-to-day operations team of the Convention was a mix of private facilitation companies and CESE staff. On the positive side, it provided a useful mix of complementary skills and knowledge. However, major design choices should be led by the Governance Committee, supported by the organising authority (in this case, CESE), so that strategic decisions are further removed from the teams on the ground. These strategic decisions should not be left to the facilitation team in charge of delivery, especially since the time needed to make many decisions is limited. Adequate resourcing is required to support organisers and the Governance Committee to carry out this responsibility.

Finally, alongside our more practical insights, we discovered that our work raised further open questions about deliberations that tackle fundamental ethical issues like active assisted dying. One such open question is whether it would be better to call on more experts, in particular moral philosophers and legal experts, who have an in-depth understanding of these issues and debates, rather than people with general knowledge. One could hope that seeing and listening to experts producing arguments in a setting that encouraged adversarial debate would enable participants to take their ethical reasoning further, go through the counter-arguments and weigh them up. The seriousness of the issue warrants nothing less. But the path of more advanced ethical reasoning is cluttered with hurdles. For example, why should randomly selected citizens go any further in this respect than elected representatives or voters? How can the need for a political decision be reconciled with the need for an ethical quest, especially concerning private issues or even metaphysical and religious ones, in a secular context?

These questions are so important for society that they should not be limited to a Convention of 184 citizens. Yet, a Convention can be a springboard for broader public deliberation. Thus above all, we call for more contact and greater connection with the broader public. This requires attention and imagination. It concerns different government agencies, other democratic institutions as well as the public at large, which should be more aware of and possibly more involved with the Convention and, as a result, honour the Convention members’ commitment and the value of their reflections, the fruit of collective and pluralist deliberation that should ideally be translated into the society as a whole.

Authors’ note
In France, the term ‘active assisted dying’ covers both euthanasia and assisted suicide. This was the relevant term for the Convention which is why we use it here. However, terminology varies across different countries and languages.

About the Authors
Min Reuchamps is a Professor of Political Science at the Université catholique de Louvain (UCLouvain), Belgium. Since 2011 and the organisation of the G1000 citizens’ summit, he has been regularly involved in the design and evaluation of democratic processes in the perspective of their institutionalisation in Belgium and abroad.

Bernard Reber is a Franco-Swiss moral and political philosopher, Director of Research at the CNRS, in Centre de recherches politiques de Sciences Po (Cevipof), Paris. For over 20 years, he has been involved in international works on ethical and political deliberation, pluralism, responsibility and argumentation both from a theoretical point of view and by conducting research on experiences as varied as the États généraux de la bioéthique, the Citizens’ Climate Convention, and the Conference on the Future of Europe.

Marjan H. Ehsassi is a Future of Democracy Fellow at the Berggruen Institute and a Senior Innovations Fellow at the Institute for Democratic Engagement and Accountability (IDEA). She is based in Washington and is completing her first book on the transformative potential of Citizens’ Assemblies (published Summer 2024).

Agnese Bertello is a facilitator, expert in participatory planning, deliberative processes and conflict management. In addition to her work as a member of Ascolto Attivo, an organisation based in Milan that has designed several participatory processes in Italy, she also teaches and disseminates participatory practices in Italy and abroad.