One month ago last night, Marie Humbert sat at her son Vincent's bedside in a clinic by the sea in northern France. It was three years to the day since the car crash in which he lost the use of his four limbs, his sight, speech and senses of smell and taste.
Vincent Humbert, 21, a former fireman, did not want to live. "The life I am forced to lead is a shit life. It is not a life, it is not my life. I can lead it no longer; I will lead it no longer," he wrote in a book, I Ask For the Right to Die, that was published the day after his death.
To write it, he indicated what he wanted to say, letter by letter, by squeezing a journalist's palm with his right thumb - the only part of his body he could move - while the man repeatedly recited the alphabet. It has since sold 300,000 copies, and is at number two on the French non-fiction bestseller list.
That evening, mother and son put into action their plan C. Plan A, in which Vincent wrote to Jacques Chirac begging the president to allow him to die, had come to nothing, even after a tearful visit by his mother to the Elysée palace.
Plan B - flying to a country where euthanasia had been legalised - was impossible. So Marie Humbert, 48, injected a poison, apparently barbiturates, into the drip that fed her son. He fell into a deep coma. At 9pm a nurse realised something was wrong and rushed Vincent into intensive care. His mother was arrested and spent the night in the police station.
And in the final ethical twist to this tragedy, it was the head of the clinic's reanimation unit, Frederic Chaussoy, who decided to switch off Vincent's artificial respirator two days later. "It was my decision and my responsibility," Dr Chaussoy said. "I ended his life. Let there be no doubt about that."
Euthanasia is, of course, illegal in France, as it is in almost all of Europe. If Marie Humbert and Dr Chaussoy are pursued (a decision that a prudent public prosecutor has yet to take), she could be charged with poisoning and attempted assassination; he with anything from failure to assist a person in danger to premeditated murder. From Barcelona to Berlin, the crime would be the same.
The case has reignited the mercy killing debate across Europe, in part because that was the Humberts' intention. He wrote a bestselling book about his suffering; she went on television to explain what she planned to do. Eighty-eight percent of the French, at least, now believe the laws must be changed.
The day of Vincent Humbert's funeral, the government appointed a parliamentary commission on the issue. Every political party agreed on the desirability, in due course, of changing the law. All acknowledged that there had to be a way for such painful dilemmas to be avoided.
But French politicians remain deeply divided over the advisability of legalising - or even decriminalising - one of the west's most sensitive taboos. And despite the thoroughly unsatisfactory legal situation in most European countries, where euthanasia is generally treated as homicide, those same doubts are reflected across much of the rest of the continent.
The Council of Europe was forced to postpone a debate on harmonising legislation last month when it proved almost impossible to arrive even at an agreed definition of the terms involved.
In Germany, for example, mercy killing is illegal, largely because the country is still haunted by the legacy of the Nazis. Under Hitler's euthanasia programme, more than 100,000 people, many of them mentally or physically handicapped, were killed during the Third Reich.
Some 60 years later, "active" mercy killing remains a criminal offence. But what is known as indirect mercy killing - when a doctor stops treatment to someone who is already dying, known elsewhere as passive euthanasia - is permissible if the patient clearly expresses a wish to die or writes a statement in advance.
The euthanasia debate in Germany has been reignited by the case of a 53-year-old cancer doctor, Mechthild Bach, accused of killing 76 of her patients. Dr Bach, a cancer specialist at an exclusive clinic in Hanover, has been suspended. According to investigators, she killed her patients by giving them excessive doses of morphine.
She denies any wrongdoing, saying her treatment was merely to relieve pain for the dying. "Of course there's always something I can do to prolong life," she said. "But is that the honest way to do things?" It is the type of case anti-euthanasia campaigners jump on as evidence of what a tolerant regime can lead to.
Lenient
In Roman Catholic Spain and Italy, the church's teachings on the value of life have instilled in legislators a deep-seated reluctance even to discuss the hastening of death - despite a cautious public trend towards acceptance of the practice.
Italian judges, at least, have become more lenient: last April, a man was acquitted of killing his wife, even though he admitted unplugging her life support. The national bioethics committee is considering whether to recommend legislation that would allow patients to release doctors from the requirement to do "everything possible" to keep them alive.
It is impossible in Italy to gauge how many mercy killings are carried out without anyone, except perhaps relatives, knowing. Two recent reports suggest doctors there may be particularly wary of interfering: one found only 23% of deaths involved "end-of-life decisions" by medical staff - the lowest in the six European countries studied. Another report found that withdrawing and withholding life support were less common in the south than the north of Europe.
Euthanasia is also illegal in Spain, but one in six doctors privately recognise that they have helped people die, and 60% want the law changed. One said: "We all know what is really going on. Normally it only happens in cases which are very clear, but it would be better for both us and for our patients if it were regulated".
Fernando Marín, a doctor with the organisation Die at Home, which helps people end their lives by, for example, refusing to be drip-fed or treated for infections, said: "For many patients it is not just a question of putting up with pain, it is a question of dignity at the end of their lives. They do not want a nappy put on them and someone changing them."
Ten percent of Spain's terminally ill - around 10,000 people a year - express an interest in euthanasia, although only around 25 turn to groups such as Die at Home. The conservative government of José Maria Aznar has, however, turned down pleas for a debate by the opposition socialists, despite evidence that two out of three Spaniards are in favour of controlled euthanasia. Spain's bishops are also virulently opposed to change.
Assisting euthanasia is a serious offence in Spain, carrying a prison sentence of up to 10 years. So when the country's best-known euthanasia campaigner, the tetraplegic Ramon Sampedro, lost patience with a five-year court battle to be allowed to kill himself, he made sure there was no evidence implicating those who helped him end his life.
Sampedro filmed himself sipping potassium cyanide with a straw from a glass beside his bed. "When I have drunk this I will have renounced one of the worst types of slavery, that of being a living head glued to a dead body," he said in a videotape later shown on television.
"You can punish [the person helping me] if you want. But you know that what you will simply be doing is seeking revenge when, in fact, I am the only person responsible for my actions." Spanish police tried to find out who was behind the camera and who helped prepare the cyanide, but eventually gave up.
Only two countries in Europe have dared tackle the question explicitly. The ever-liberal Netherlands became the first state to formally sanction mercy killing, under strict conditions, in April last year, although the practice had been tolerated for years. The official number of cases is now about 3,800 a year, although experts say the real figure is twice as high.
But while 90% of the population supported the legalisation, the Dutch experience continues to solicit controversy - especially among Christian groups. A UN committee has warned that mercy killing in the Netherlands risks becoming routine, and has questioned the rationale of letting children as young as 12 opt for euthanasia with parental backing.
Abuse
Several high-profile abuses have fuelled fears that the law is creating a conveyor-belt culture of death where medical professionals and pseudo-doctors have, and sometimes abuse, wide-ranging powers. Earlier this year a court convicted Willem Muns, a medically unqualified "suicide consultant", of illegally helping an 81-year-old woman to kill herself.
The conviction of Lucy de Berk, a Dutch nurse, for killing her patients - three babies and an elderly woman - has also raised fears about the implications of the law. A dozen Dutch doctors have been found guilty of not following euthanasia procedures in the past four years, but none has received a custodial sentence.
There have been several TV documentaries claiming that the practice of flouting the regulations is widespread.
Belgium also legalised euthanasia in September last year, under similarly strict conditions and on a wave of public support. Doctors have registered some 200 cases in the law's first year, although the real figure is put at 600 or more. The bill's passage into law has otherwise been undramatic - with one notable exception.
The first person to die under the legislation, 39-year-old multiple sclerosis sufferer Mario Verstraete, seemed to deliberately flout the rules: his death was broadcast live on television and his illness was not terminal. He was a passionate advocate of euthanasia. "I love life," he said. "But when it's finished, I want to be able to say it's finished, and leave."
Despite such controversial incidents, proponents of euthanasia say that where the Netherlands and Belgium have led, others will eventually have to follow. "Doctors are more confident now that they will not be prosecuted," said Rob Jonquiere of the Netherlands' main pro-euthanasia lobby. "And nor has the new law brought about the enormous rise in euthanasia cases everyone expected."
According to Dr Jonquiere, the momentum for pan-European legalisation is growing. "Our example already gave a boost to other countries. Belgium has followed suit, Luxembourg has been busy and only missed legalisation by one or two votes. We know they are busy in France and in the UK there is a bill in the House of Lords."
For the Dutch activist, the case of Vincent and Marie Humbert is "a tragic example of what happens when you don't legalise, and people are forced to help someone they love die on their own, and illegally, when it should all be subject to transparency and proper medical advice".
But many, including the French health minister, Jean-François Mattei, remain unconvinced. He fears that no amount of legislation can resolve what will always remain "a problem of conscience". Pro-legalisation campaigners may, however, take some heart from Mr Mattei's remark that a "code of good conduct" for euthanasia may be useful: Which is exactly what the Dutch government decided, more than 15 years ago.
When is killing not a crime?
Britain In principle, active euthanasia and assisted suicide are counted as murder
France Euthanasia - active and passive - is strictly outlawed. Active euthanasia is treated as assassination, passive as failing to help a person in danger. Prison terms of up to 10 years
Germany Topic taboo since Nazi era. Active euthanasia is illegal, passive euthanasia is permissible under certain conditions - doctors have defined criteria for "accompanying people at the end of their lives"
Netherlands First country in the world to have sanctioned euthanasia. Conditions under which doctors are allowed to help people die are strict: patients must be in a state of continuous, unbearable and incurable suffering. A second medical opinion is required, and the patient must be of sound mind. Finally, their request must be made voluntarily, independently and persistently. According to a survey in the Lancet in August, 44% of deaths in the Netherlands follow an "end-of-life decision" by doctors
Belgium Adopted law in 2002 partially authorising euthanasia. Patients must make specific, voluntary and repeated requests, a second opinion must be obtained and a month must pass between a written request to die and the mercy killing. Some 38% of deaths stem from an "end-of-life decision"
Switzerland Euthanasia is outlawed but assisted suicide carried out "for non-egotistical motives" is expressly permitted. Some 51% of deaths stem from an "end-of-life decision"
· Additional reporting by Andrew Osborn in Brussels, Giles Tremlett in Madrid, John Hooper in Rome, Luke Harding in Berlin
