France’s lower chamber of parliament has approved a controversial assisted dying bill that would allow some seriously ill adults to request a lethal injection. The legislation has been backed by French President Emmanuel Macron but has met strong opposition from conservative parties and the Catholic clergy.

The National Assembly, which is dominated by left-leaning and progressive parties, approved the text on Tuesday by 295 votes to 232, with 35 abstentions. La France Insoumise, Socialists, Greens, and Communists largely backed it, while the right-wing National Rally and the Republican Right group voted mostly against; several other factions were split on the vote.

According to the bill, a patient must be at least 18, French or be a legal resident, have a serious and incurable life-threatening illness at an advanced or terminal stage, suffer in a way that is refractory to treatment or unbearable, and be able to express a free and informed wish. A doctor would consult another practitioner, a specialist and, if needed, a psychiatrist; the decision must come within 15 days, followed by at least two days for reflection.

The patient would normally self-administer the lethal substance prescribed by the doctor. If physically unable, a doctor or nurse could do it, though health professionals could invoke a conscience clause; psychological suffering on its own would not meet the test, as it should be linked to the illness.

In January, the bill was rejected by the right-leaning Senate. Now, the text will return to the upper chamber, and if the two bodies remain deadlocked, the Assembly can have the final word, with another vote already scheduled for July 15.

The assisted dying bill has enjoyed Macron’s support for years, who described it as a way to “reconcile the autonomy of the individual and the solidarity of the nation” and a measure to pave a “path of fraternity.”

Yael Braun-Pivet, president of the National Assembly, welcomed the adoption of the bill, touting it as “the culmination of several years of work and of a thorough public debate, conducted with seriousness, respect and dignity.”

Jonathan Denis, the president of the Association for the Right to Die with Dignity, called it an “incredible step forward for health democracy,” stressing that the ultimate decision will be made by the patient.

However, National Rally deputy Christophe Bentz called the safeguards “temporary” and “fictitious,” while Republican Right MP Justine Gruet argued that many vulnerable adults could opt for assisted dying simply because they are not being cared for by their loved ones.

Ahead of the vote, Catholic leaders urged MPs to vote in conscience rather than along party lines, warning that assisted dying would legalize euthanasia and assisted suicide and could lead to vulnerable people facing pressure. Cardinal Jean-Marc Aveline also said that “giving death” could not answer the duty to accompany life until the end.