Nutrition et hydratation en fin de vie : une mise en œuvre pas toujours bientraitante

Devalois, Bernard; Broucke, Marion

doi:10.1016/j.lpm.2015.02.007

Cited by 10 publications

(2 citation statements)

References 17 publications

(14 reference statements)

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“…Yet when nutrition and hydration is dispensed by injection to compensate a deficient vital function, the widespread feeling in the public is that this constitutes treatment. This is especially so since they do not necessarily provide the comfort and well-being desired and can induce gastric or intestinal distension [16, 17]. In fact, the Claeys-Leonetti law stipulates that nutrition and artificial hydration are forms of treatment [6].…”

Section: Discussionmentioning

confidence: 99%

Opinions about the new law on end-of-life issues in a sample of french patients receiving palliative care

et al. 2017

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BackgroundIn February 2nd 2016, the French government enacted the Claeys-Leonetti law that forbade euthanasia and established the right to deep and continuous sedation for end-of-life patients. Moreover, the law also obliges clinicians to abide by any advance directives regarding treatment and investigation, except in cases where they are “obviously inappropriate” in a given medical situation, or in cases of emergency, in order to allow medical staff to take time to assess the patient’s situation. Artificial feeding and hydration are considered as treatment. The aim of this report is to investigate individuals receiving palliative care about their opinion about euthanasia, about advance directives, about the right to deep and continuous sedation, and the right to stopping artificial feeding and hydration.MethodsThe study was an opinion survey conducted among patients treated in two different palliative care institutions: a palliative care unit at the University Hospital (Timone, Marseille, France) and a non-profit association palliative care home (“La Maison”, Gardanne, France). Face-to-face interviews were performed by two investigators. The survey included sociodemographics, clinical data, and opinions about euthanasia, deep and continuous sedation, stopping artificial feeding and hydration, and advance directives.ResultsForty patients were interviewed. The mean age was 59.8 years (standard deviation 12). Fifty three percent reported opposition to legalized euthanasia. Eighty three percent were in favour of the right to deep and continuous sedation in patients with refractory pain, 75% when it concerns a patient unable to express their wishes, and 68% when the patient decides to stop vital treatment. Fifty eight percent reported that artificial nutrition and hydration should be considered as care. Fifty eight percent of the patients interviewed would like to see doctors follow the express wishes contained in advance care directives and 53% that advance directives should be subject to a validity period.ConclusionsThis work demonstrates the feasibility of discussing sensitive issues such as euthanasia, continuous and deep sedation and cessation of care with patients receiving palliative care. These preliminary results point to the need to perform a larger study in order to find determinant factors in this specific situation and to incorporate them into thinking about end-of-life laws.Electronic supplementary materialThe online version of this article (doi:10.1186/s12904-016-0174-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Opinions about the new law on end-of-life issues in a sample of french patients receiving palliative care

et al. 2017

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“…52 However, despite guidelines generally erring against CANH in the last days and hours of life, in several studies, the majority of patients and families were in favor of CANH, 55 many feeling that CANH reduces dehydration and pain and prolongs life. 56 Families may feel that by pushing for CANH, they are benefiting their loved one. Media portrayal of ''starvation to death by the NHS'' or ''back-door euthanasia'' may further fuel feelings that care is inferior if CANH is not offered.…”

Section: Patient Family and Media Perceptionsmentioning

confidence: 99%

To What Extent Does Clinically Assisted Nutrition and Hydration Have a Role in the Care of Dying People?

Carter

2020

J Palliat Care

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The question over whether to administer clinically assisted nutrition and hydration (CANH) to a dying patient is controversial, with much debate concerning this sensitive issue. The administration of CANH poses clinical and ethical dilemmas, with supporting and opposing views. Proposed positive effects of CANH include preventing thirst, delirium, hypercalcemia, and opioid toxicity. However, CANH has been shown to increase the risk of aspiration, pressure ulcers, infections, and hospital admissions as well as potentially causing discomfort to the patient. Guidance from several national bodies generally advises that the risks and burdens of CANH outweigh the benefits in the dying patient. However, an individualized approach is needed, and the patient’s wishes regarding CANH need consideration if they have capacity and can communicate. Otherwise, sensitive discussions are required with the family, enquiring about the patient’s prior wishes if there is no advanced care plan and acting in the patient’s best interests. The ethical principles of autonomy, beneficence, non-maleficence, and justice need to be applied being mindful of any cultural and religious beliefs and potential misperceptions.

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Annoncer une mauvaise nouvelle en fin de vie, la bientraitance comme boussole

Devalois

Broucke

2016

L'Aide-Soignante

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Nutrition et hydratation en fin de vie : une mise en œuvre pas toujours bientraitante

Cited by 10 publications

References 17 publications

Opinions about the new law on end-of-life issues in a sample of french patients receiving palliative care

Opinions about the new law on end-of-life issues in a sample of french patients receiving palliative care

To What Extent Does Clinically Assisted Nutrition and Hydration Have a Role in the Care of Dying People?

Annoncer une mauvaise nouvelle en fin de vie, la bientraitance comme boussole

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