France’s National Assembly has approved a controversial bill to legalize assisted dying for adults suffering from terminal illnesses, a move supporters call historic and critics warn could endanger vulnerable citizens. The bill, championed by President Emmanuel Macron, passed by a vote of 305 to 199 and now heads to the Senate for further consideration. Lawmakers aim to see it enacted by 2027.

Currently, France allows passive euthanasia, such as ending life support or using deep sedation before death. The new legislation would permit patients to request a lethal dose of medication—either self-administered or delivered by a medical professional if the patient is physically unable to do so.

To qualify, individuals must be over 18, hold French citizenship or residency, and be diagnosed with an incurable, advanced, or terminal illness that causes constant, untreatable suffering. Those with severe psychiatric disorders or neurodegenerative conditions like Alzheimer’s would not be eligible. A medical team would evaluate each case, and after a period of reflection, the patient could receive the medication at home, in a hospital, or in a care facility.

The government described the bill as a measured, ethical solution to support those facing unbearable suffering. Macron called the vote “an important step” in creating a more compassionate end-of-life system. A separate, unanimously supported bill to expand access to palliative care was also passed.

France’s proposal is more limited than laws in countries like Belgium and the Netherlands, where euthanasia has been legal for decades and includes provisions for minors. Other nations with similar laws include Canada, Spain, Australia, Portugal, Colombia, and parts of the U.S. and Switzerland.

While right-to-die advocates applauded the decision, calling it long overdue, critics argue the bill’s language is too vague and could lead to unintended consequences. Concerns include weakening medical ethics, eroding standards of care, and pressuring people—especially the elderly, disabled, or socially isolated—to end their lives.

“It would be like a loaded pistol left on my bedside table,” said a 44-year-old woman with Parkinson’s disease during a protest, according to the BBC.

France’s religious leaders released a rare joint statement condemning what they called an “anthropological rupture,” while Interior Minister Bruno Retailleau posted on social media that the measure is “not a bill of fraternity but a bill of abandonment.”