Les directives anticipées et le désir de maîtrise de sa fin de vie

Boulanger, Augustin

doi:10.1016/j.meddro.2017.09.006

Cited by 6 publications

(2 citation statements)

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“…The Claeys-Leonetti law, that always forbade euthanasia or slaw-euthanasia (described as occurring “when clinicians sedate patients approaching the end of life with the primary goal of hastening the patient’s death” [4]), maintains terminal sedation, but also increased patients’ autonomy by strengthening the value of advance directives and extending the spectrum of unreasonable obstinacy to the sustainment of vital treatments [5]. Claeys-Leonetti law improved end-of-life conditions by establishing, under certain conditions, the right to deep and continuous sedation at the request of palliative patients, consisting of sedative treatment, and analgesic treatment if needed, leading to a profound and continuous change of vigilance to death, associated with the cessation of all life-sustaining treatments including artificial nutrition and hydration [6].…”

Section: Introductionmentioning

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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Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…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 ]. The law also confirmed the ban on euthanasia per se [ 5 ].…”

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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