Medmoune v France: To Live and Let Die
5 March 2026
By Kian Leong Tan
INTRODUCTION
In Medmoune v France App no 55026/22 (ECHR, 5 February 2026), the Fifth Section of the European Court of Human Rights considered the extent of a Member State’s obligation under Art. 2 ECHR (the right to life) when deciding to withdraw life support, in circumstances where the patient had explicitly asked for it to be continued.[1] The judgment helpfully illustrates the contentious boundary at which informed patient consent must give way to the expert opinion of medical professionals.
THE LAW
The French Code of Public Health (Code de la santé publique) makes provision for patients’ rights and healthcare providers’ obligations in relation to end-of-life care. Thus, amongst other things, Art. L. 1110-2 provides that patients have the right to respect for their dignity; similarly, Art. L. 1110-5 requires that patients must receive the most appropriate treatment and care, taking into account the state of their health and the urgency of the medical intervention they require.
The right to receive such treatment, however, is not absolute: Art. L. 1110-5-1 caveats that where the treatment results from ‘unreasonable obstinacy’, or appears to be “unnecessary, disproportionate or when they have no other effect than the artificial maintenance of life”, it may be suspended (or withheld), in accordance with the will of the patient or, if the patient’s will is unknown, through a defined collective procedure.
The Code also anticipates the possibility of a patient being rendered unable to communicate with healthcare providers. Patients are entitled to draw up ‘advance directives’ setting out their wishes on the circumstances around, inter alia, the continuation or cessation of medical treatment at the end of their lives: Art. L. 1111-11. Doctors are required to (i) ascertain a patient’s wishes where they are unable to communicate them (Art. L. 1111-12), and (ii) respect their will as expressed in an advance directive (Art. R. 4127-37-1), save where following the directive would be manifestly inappropriate or was not compatible with their medical prognosis. In such a circumstance, the physician in charge of the patient must apply the collective procedure, which involves collecting the opinion of the members of the patient’s healthcare team (if one exists) and of at least one independent physician. At this stage, they may also consider input from the patient’s relatives as to their wishes. Any departure from an advance directive must be justified with reasons and recorded in the patient’s file.
BACKGROUND FACTS
AM was the brother of the first two Applicants and the husband of the third Applicant. In June 2020, he prepared a handwritten advance directive setting out his request to continue to be kept alive artificially, even where he had permanently lost consciousness. On 18 May 2022, AM was run over by a vehicle that he had been repairing. He subsequently suffered severe polytrauma, cardiorespiratory arrest, and oxygen deprivation to his brain for seven minutes. Upon admission to hospital, he was found not to have any brain activity and severe anoxic injuries.
On 31 May 2022, AM’s healthcare team initiated the collective procedure and sought the Applicants’ input as to his wishes (it being unknown to them at the time that he had drafted an advance directive). The following day, they communicated their unanimous decision to discontinue AM’s life support to the Applicants, citing their duty to refrain from ‘unreasonable obstinacy’. The decision document also noted – wrongly – that AM had not prepared any advance directives. The Applicants applied for urgent interim relief to the Lille Administrative Court, which suspended the decision to withdraw life support on 8 June 2022 on the basis that the healthcare team had failed to consider AM’s advance directive.
AM’s healthcare team then undertook anew the collective procedure. On 15 July 2022, the head of the hospital’s intensive care unit decided that AM’s treatment would be discontinued on 22 July. The new decision was signed by 10 physicians, including two independent ones; their unanimous conclusion was that to continue treatment would amount to (and indeed, already amounted to) unreasonable obstinacy such that AM’s advance directive did not apply. It noted that the existing treatment was both disproportionate and had no effect other than the artificial maintenance of AM’s life. AM’s advance directive was both manifestly inappropriate and was not compatible with his medical prognosis.
The Applicants unsuccessfully applied again to the Lille Administrative Court for urgent interim relief, citing a breach of AM’s Art. 2 ECHR rights. The Lille court’s decision refusing interim relief was upheld on appeal by the French appellate courts. AM’s treatment was eventually discontinued on 26 December 2022, and he passed that same day.
DECISION
Dissatisfied, the Applicants lodged a complaint with the ECtHR, alleging breaches of AM’s Arts. 2, 8 (right to private life) and 9 (freedom of thought, conscience and religion) ECHR rights. The ECtHR, however, considered that the complaints under the latter two rights were subsumed by the Art. 2 complaint, and therefore did not need to be considered separately: para. 71.
The Court affirmed (citing Lambert and Others v France (2016) 62 EHRR 2)that in withdrawal of treatment cases, a State’s Art. 2 positive obligations would be satisfied where (i) there existed a domestic legislative framework which was compatible with the requirements of the provision; (ii) the decision-making process by the health authorities had taken into account the patient’s wishes (and of their relatives), and the opinions of other medical professionals; and (iii) legal recourse where any doubt arose as to the proper decision in the patient’s best interests: paras. 39-40. States are also afforded a margin of appreciation in determining how to strike a fair balance between protecting the patient’s right to life, and respect for their private life and personal autonomy, versus other competing interests – including, crucially, preserving the patient’s dignity and alleviating their suffering.
Here, the Applicants’ complaint that Art. L. 1111-11 of the Code afforded doctors an imprecise and arbitrary power to override a patient’s advance directives on the basis that they appeared ‘manifestly inappropriate’ was unsustainable: para. 49. The general framework set out by the Code, and the collective procedure applied by AM’s healthcare team, plainly showed that (i) his wishes (and that of his relatives) had been considered, but also (ii) advance directives, although important, had not been accorded an overriding/binding status: paras. 45-46; 53-54. Although Art. 8 ECHR (which was also engaged in withdrawal of treatment cases) guaranteed a right to personal autonomy, that did not extend to requiring advance directives to have such effect; nor did it imply a patient’s right to receive any treatment which they requested: para. 48.
The decision-making process undertaken by AM’s healthcare team – which had properly taken into account his advance directive, and the views of his relatives – was unimpeachable: para. 58. Similarly, the French courts had considered at length the Applicants’ complaints and concluded, with reasons, that the Code was neither unconstitutional nor contrary to Art. 2 ECHR. The Applicants had therefore both been afforded access to, and indeed had obtained, a judicial remedy as required under the ECHR: paras. 59-68.
COMMENTARY
Medmoune marks the first instance in which the ECtHR has directly examined the issue of withdrawal of treatment in circumstances where a patient has explicitly requested for it to be continued. Echoing its earlier case law, it treats the right to personal autonomy (including to make informed decisions about one’s healthcare) under Art. 8 ECHR as being an important component of the Art. 2 ECHR analysis, rather than existing as a standalone complaint.
The decision will doubtless be of interest to those practising in the Court of Protection, which routinely deals with withdrawal of treatment issues. It also remains to be seen how the principles reiterated therein will map onto the distinct issue of assisted dying, which similarly raises a conflict between a person’s autonomy and medical practitioners’ duty of care.
Elsewhere, Alex Ruck-Keene KC (writing in his Mental Capacity Law and Policy blog on Medmoune) also helpfully cautions CoP practitioners to remain mindful of the nuanced distinction between cases where a treatment is said to be clinically inappropriate (where, he suggests, the appropriate forum would be to seek a declaration from the King’s Bench Division of the High Court), versus a treatment which is not in the patient’s best interests (which the Court of Protection is well-equipped to address).
Kian Leong Tan is a future pupil barrister at 5 Essex Chambers.
[1] The judgment is currently only available on the ECtHR website in French. For the purposes of this case comment, the author has relied upon an unofficial English translation.
