Assisted dying: “Beyond distant advance directives, writing is necessary when you know you are doomed”

As the National Assembly examines the legalization of assisted dying, a seemingly technical detail threatens to undermine the ethical balance of the proposed law: the absence of an obligation for a written request from the patient, since they know they are destined to die in the short term – which is to be distinguished from an old directive possibly drawn up when they are in good health.

In Belgium, where I have been supporting patients at the end of their lives for over twenty years, the written request is at the heart of the process. It doesn't rigidify the approach: it guarantees its depth. It's a guidepost. A way of saying: this decision is mine, considered, and it engages my conscience. Words alone are not enough. They are, by nature, fleeting, subject to interpretation, sometimes ambivalent. They can twist under the weight of pain, emotions, or diffuse pressures, even involuntary ones. Writing, on the other hand, fixes the will. It leaves a trace. It allows us to reread, to connect. It protects. All parties.

Take the case of Clara [name has been changed] , a terminally ill cancer patient. For several weeks, she discussed with me, in a low voice, the idea of ​​dying. But it was the day she wrote her request, alone in her room, that her position became clear. The next day, she said to me, "I think I've figured out what I want. It's not to die. It's to no longer suffer like this." It wasn't a change of mind: it was a clarification born of the act of writing.

Writing transforms consciousness. Beyond distantly anticipated directives, it is necessary when one knows one is doomed. It imposes a relationship with oneself. It forces one to formulate the unspeakable. This confrontation, far from being an administrative formality, becomes a space for development. For many, it is even an act of relief: "Finally, I was able to say what I carry." For others, it is a revelation: it is not yet the time.

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