End-of-Life Practices in France under the Claeys-Leonetti Law: Report of Three Cases in the Oncology Unit

Nonneville, Alexandre de; Marín, Anthony García; Chabal, Théo; Tuzzolino, Véronique; Fichaux, Marie; Salas, Sébastien

doi:10.1159/000450940

Cited by 11 publications

(7 citation statements)

References 5 publications

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“…Since 2016, in France, mainly case reports are available about CDSUD practices and health care professionals' feelings (De Nonneville et al, 2016; Boulanger et al, 2017; Plançon et al, 2018; Vitale et al, 2019). Larger studies, including multicentric surveys (Serey et al, 2019) should be developed in the future to better understand indications and consequences on clinical practices.…”

Section: Resultsmentioning

confidence: 99%

Refractory psycho-existential distress and continuous deep sedation until death in palliative care: The French perspective

et al. 2019

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ObjectiveSince February 2016, French Claeys-Leonetti law has recognized patients' right to confront incurable diseases with short-term prognosis and refractory physical or psychological or existential symptoms by requesting continuous deep sedation until death (CDSUD). Determining when psychological or existential distress is refractory and unbearable remains complex and controversial.This review provides a comprehensive thought on CDSUD for advanced incurable patients with refractory psychological and/or existential distress in palliative care settings. It offers guidance on psychiatric or psychological diagnosis for explaining patients' requests for CDSUD.MethodA narrative literature review (2000–2019) was conducted on the MedLine search about the use of palliative sedation in cases of refractory psychological and/or existential distress.Results(1) Definitions of “refractory symptom,” “refractory psychological distress,” and “refractory existential distress” are inconsistent; (2) alternative diagnoses might obscure or be obscured by psycho-existential distress; and (3) criteria on meanings, reasons for requests, decision-making processes, and functions are evolving in practice.Significance of resultsBefore implementing CDSUD, palliative healthcare professionals should seek input from psycho-oncologists in palliative care. Mental health professionals should analyze and assess the reasons for psychological and/or existential distress, consider the intentionality processes of requests, and explore alternative diagnoses, such as depressive or adjustment disorders, demoralization syndrome, desire to hasten death, and desire for euthanasia. Therapeutic responses (e.g., pharmacological and psychotherapeutic) should be implemented before deciding that psycho-existential distress is refractory.

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Section: Resultsmentioning

confidence: 99%

Refractory psycho-existential distress and continuous deep sedation until death in palliative care: The French perspective

et al. 2019

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“…The Claeys-Leonetti law created the right to deep and continuous sedation. In a recent publication [7], we pointed that this right was eagerly awaited by palliative care patients. An opinion survey conducted among patients treated in different palliative care institutions showed that up to 83% palliative care patients were in favor of the right to deep and continuous sedation.…”

Section: Discussionmentioning

confidence: 99%

Medical staff opposition to a deep and continuous palliative sedation request under Claeys-Leonetti law

et al. 2019

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BackgroundFor the year 2018, the French government plans a revision of bioethics laws, including certainly the recent Claeys-Leonetti law introducing the right to deep and continuous sedation at the request of palliative patients and prohibiting euthanasia for end-of-life patients. Because there is no published data on medical staff opposition to a deep and continuous palliative sedation request under Claeys-Leonetti law, we believe this report may give insight into physicians’ decision making, into the role of criteria for prudent practice, and thus contribute to the bioethical debate.Case presentationWe report a 70-year-old patient with squamous cell carcinoma of the hypopharyngeal region, who categorically refused any treatment since one year and asked for deep and continuous palliative sedation until death after attempting suicide. The patient’s request was examined and denied by palliative multidisciplinary board, in accordance with by the French Oncology Coordination Centre guidelines. This situation did not fulfil the criteria requested by Claeys-Leonetti law.ConclusionsAs highlighted by the present case-report, patient’s expectation regarding palliative sedation can be ambivalent with properly so called euthanasia or assisted suicide. This ambivalent perception was part of the controversy surrounding the parliamentary debate, which is still relevant. This case report supports that deep and continuous sedation under Claeys-Leonetti law need to meet specific criteria defined by the law and documented in the medical files as a safeguard against inappropriate practice. In fact, one of the shortcomings of the current arrangements of Claeys-Leonetti law is a lack of objective medical-based criteria. So it is necessary that scientific peer-reviews papers be published quickly in order to deepen the bioethical debate on the end of life.

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“…Inclusion criteria were as follows: age ≥ 18 years old; locally advanced or metastatic cancer; patient with palliative care (as defined by the French Society of Palliative and Support Care, SFAP, as active care in a global approach to persons with progressive or terminal illness) [ 6 ] in a palliative care unit or in specific palliative care beds in non-palliative care units; without sleepiness (Epworth scale: score > 16) [ 11 ]; without anxiety and/or mood disorder (HAD scale: score < 7) [ 12 ]; and providing written informed consent for participation. Patients already sedated or those unable to communicate or to understand the purpose and conditions of the study (based on the clinician’s judgment) were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…After the re-examination by a parliamentary commission of questions related to the accompaniment of patients at the end of life and euthanasia, the French Government voted a new law in February 2016 called the Claeys-Leonetti Law [ 5 ], which introduce various significant amendments to the existing Leonetti’s law. This law establishes the right to deep and continuous sedation, consisting of sedative and analgesic treatment leading to a profound and continuous change of vigilance to death if the patient is likely to suffer pain, associated with the cessation of all life-sustaining treatments including artificial nutrition and hydration [ 6 ]. Claeys-Leonetti law increased patients’ autonomy by strengthening the value of advance directives and extending the spectrum of unreasonable obstinacy to the sustainment of vital treatments [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Determinants of favorable or unfavorable opinion about euthanasia in a sample of French cancer patients receiving palliative care

Nonneville¹,

Chabal²,

Marín³

et al. 2018

BMC Palliat Care

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BackgroundOpinion about euthanasia has been explored among the general population and recently in patients receiving palliative care. 96% of the French population declared themselves in favor of euthanasia while less of 50% of palliative care patients are. The aim of the present study was to explore and identify potential determinant factors associated with favorable or unfavorable opinion about euthanasia in a French population of cancer patients receiving palliative care.MethodsWe performed a cross-sectional study among patients in two palliative care units. Eligible patients were identified by the medical staff. Face-to-face interviews were performed by two investigators. Two groups were defined as favorable or unfavorable about euthanasia according to the answer on the specific question about patient opinion on euthanasia. A multivariate analysis including age, belief in God, chemotherapy and gender was built.ResultsSeventy-eight patients were interviewed. Median age was 60.5 years (range: 31–87.2). In univariate analysis, patients with a favorable opinion were most often under 60 years old (62 versus 38% unfavorable; p = 0.035), in couple (64 versus 35%; p = 0.032), didn’t believe in God (72 versus 28% were non-believers; p < 0.001) and had more frequently an history of chemotherapy treatment (58 versus 42% received at least one cycle of chemotherapy; p = 0.005). In a multivariate analysis, age < 60 years, absence of belief in God and an antecedent of chemotherapy were independently associated with a favorable opinion about euthanasia (OR = 0.237 [0.076–0.746]; p = 0.014, OR = 0.143 [0.044–0.469]; p = 0.001, and OR = 10.418 [2.093–51.853]; p = 0.004, respectively).ConclusionWe report here determinants of opinion about euthanasia in palliative care cancer patients. Thus, young patients who do not believe in God and have a history of chemotherapy treatment are more likely to request the discontinuation or restriction of their treatment. A better understanding of these determinants is essential for the development of information and/or interventions tailored to the palliative context.Electronic supplementary materialThe online version of this article (10.1186/s12904-018-0357-6) contains supplementary material, which is available to authorized users.

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End-of-Life Practices in France under the Claeys-Leonetti Law: Report of Three Cases in the Oncology Unit

Cited by 11 publications

References 5 publications

Refractory psycho-existential distress and continuous deep sedation until death in palliative care: The French perspective

Refractory psycho-existential distress and continuous deep sedation until death in palliative care: The French perspective

Medical staff opposition to a deep and continuous palliative sedation request under Claeys-Leonetti law

Determinants of favorable or unfavorable opinion about euthanasia in a sample of French cancer patients receiving palliative care

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