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

Abstract

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.

High‐intensity end‐of‐life care among children, adolescents, and young adults with cancer who die in the hospital: A population‐based study from the French national hospital database

“…We cannot exclude an overestimation of this proportion due to “upcoding,” which can take place in all prospective payment systems that are based on diagnosis‐related groups . Future studies should further explore barriers to palliative care in France, with a specific focus on the “reluctance” of some physicians and the understanding of patients and families of palliative care and EOL issues (eg, the fear of the absence of a therapeutic project), and more generally to question and clarify the positioning of palliative care and EOL issues in a biomedical curative model . To date, the majority of studies have been performed on adults, and those on children were performed in the United States and the United Kingdom .…”

“…42,43 Future studies should further explore barriers to palliative care in France, with a specific focus on the "reluctance" of some physicians and the understanding of patients and families of palliative care and EOL issues (eg, the fear of the absence of a therapeutic project), and more generally to question and clarify the positioning of palliative care and EOL issues in a biomedical curative model. 44,45 To date, the majority of studies have been performed on adults, and those on children were performed in the United States 46 and the United Kingdom. 47 The most commonly cited barriers were uncertainties in prognosis and discrepancies in treatment goals between staff and family members.…”

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

“…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.…”