Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-23T11:33:08.877Z Has data issue: false hasContentIssue false
  • English
  • Français

End-of-life patients, intensive care and consent: difficulties facing French intensivists

Published online by Cambridge University Press:  01 August 2007

N. Franchitto ,
H. Vinour ,
L. Gavarri ,
N. Telmon  and
D. Rouge
N. Franchitto*
Affiliation:
Rangueil University Hospital, Department of Anesthesiology and Intensive Care, Toulouse, France
H. Vinour
Affiliation:
Rangueil University Hospital, Department of Anesthesiology and Intensive Care, Toulouse, France
L. Gavarri
Affiliation:
Faculty of Law, Toulon, France
N. Telmon
Affiliation:
Rangueil University Hospital, Department of Legal Medicine, Toulouse, France
D. Rouge
Affiliation:
Rangueil University Hospital, Department of Legal Medicine, Toulouse, France
*
Correspondence to: Nicolas Franchitto, Service de Medecine Légale, CHU Rangueil, Avenue Jean Poulhès, TSA 50032, F-31059 Toulouse, Cedex 9, France. E-mail: [email protected]; Tel: +33 5 61 32 29 54; Fax: +33 5 61 32 21 77
Get access

Summary

Background

The French legislature passed a law in 2005 that assigns a new role to the physician and redefines his liability in end-of-life decisions.

Method

This law is presented and discussed in context with current French legal practice.

Results

This law emphasizes patient autonomy, advocating that the patient be fully informed before treatment, and creates specific procedures to be followed according to whether the patient is conscious or unconscious. In the latter situation, the law reinforces the role of both the patient’s surrogate and the patient’s advance directives in establishing consent. In these extreme situations, doctors have the option to request a second medical opinion. This joint decision-making procedure is laid down by law and becomes obligatory in the interests of transparency.

Conclusion

Respect for patients’ consent implies the possibility that they may refuse medical care, creating an ethical and legal dilemma of providing medical care or respecting the patients’ wishes. The key issue concerning end-of-life patients rests in the decisions taken concerning the continuation or withdrawal of life support and the administration of palliative care.

Keywords

ETHICSCLINICALFRANCEINFORMED CONSENTMENTAL COMPETENCYINTENSIVE CARE UNITS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 8 , August 2007 , pp. 709 - 713
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. French Society of Critical Care: Les limitations et arrêt de thérapeutique(s) active(s) en réanimation adulte. Recommandations de la Société de Réanimation en Langue Franȱaise 2002. http://www.srlf.org/societe/infoethique/thera.active.html.Google Scholar
2.Council on Ethical and Judicial Affairs, American Medical Associations. Decisions near the end of life. JAMA 1992; 267: 2229–2233.CrossRefGoogle Scholar
3. Comité Consultatif National d’Ethique pour les Sciences de la Vie et de la Santé: Refus de traitement et autonomie de la personne: Avis no. 87; avril 2005: available on line at: http//www.ccne-ethique.fr/francais/avis/a_087.htm.Google Scholar
4.Task Force of the American College of Critical Care Medicine, Society of critical care medicine. Guidelines for intensive care unit admission, discharge and triage. Crit Care Med 1999; 27: 633–638.CrossRefGoogle Scholar
5.Luce, JM. Ethical principles in critical care. JAMA 1990; 263: 696–703.CrossRefGoogle ScholarPubMed
6.Lanken, P. American thoracic society position statement on withholding and withdrawing life sustaining therapy. Ann Intern Med 1992; 115: 478–485.Google Scholar
7. Loi n° 2005-370 du 22 avril 2005, relative aux droits des malades et à la fin de vie. Journal Officiel 23 avril 2005.Google Scholar
8. Loi n° 2002-303 du 4 mars 2002, relative aux droits des malades et à la qualité du système de santé. Journal Officiel 05 mars 2002.Google Scholar
9.Luce, JM, Alpers, A. End-of-life care: what do the American courts say? Crit Care Med 2001; 29 (Suppl): N40–N45.CrossRefGoogle ScholarPubMed
10. Loi n° 99-477 du 9 juin 1999, Journal Officiel 10 juin 1999.Google Scholar
11. Article 226-3 du Code Pénal: «Quiconque pouvant empêcher par son action immédiate, sans risque pour lui ou pour les tiers, soit un crime, soit un délit contre l’intégrité corporelle de la personne s’abstient volontairement de le faire est puni de cinq ans d’emprisonnement et de 75000 euros d’amende…». Ordonnance n° 2000-916 du 19 septembre 2000 art. 3 Journal Officiel du 22 septembre 2000.Google Scholar
12.Turner, JS, Michell, WL, Morgan, CJ et al. . Withdrawal of life support. Frequency and practice in a London and Cape Town intensive care unit. Intensive Care Med 1996; 22: 1020–1025.CrossRefGoogle Scholar
13.Vincent, JL. Forgoing life support in western European intensive care units: the results of an ethical questionnaire. Crit Care Med 1999; 27: 1626–1633.CrossRefGoogle ScholarPubMed
14.Ferrand, E, Robert, R, Ingrand, P, Lemaire, F, French LATAREA Group. Withholding and withdrawal of life support in intensive care units in France: a prospective survey. Lancet 2001; 357: 9–14.CrossRefGoogle ScholarPubMed
15.Prendergast, TJ, Luce, JM. Increasing incidence of withholding and withdrawal of life support from the critically ill. Am J Respir Crit Care Med 1997; 155: 15–20.CrossRefGoogle ScholarPubMed
16.Carlet, J, Lambertus, G Thijs, Antonelli, M et al. . Challenges in end-of-life care in the ICU. Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003. Intensive Care Med 2004; 30: 770–784.CrossRefGoogle ScholarPubMed
17.SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatment (SUPPORT). JAMA 1995; 274: 1591–1598.CrossRefGoogle Scholar
18.Hanson, LC, Tulsky, JA, Danis, M. Can clinical interventions change care at the end of life? Ann Intern Med 1997; 126: 381–388.CrossRefGoogle ScholarPubMed
19. Code de Déontologie Médicale, Article 37: «…la décision est prise par le médecin en charge du patient, après concertation avec l’équipe de soins si elle existe et sur l’avis motivé d’au moins un médecin, appelé en qualité de consultant…».Google Scholar
20.Le Conte, P, Baron, D, Trewick, D et al. . Withholding and withdrawal life-support therapy in an Emergency Department: prospective survey. Intensive Care Med 2004; 30: 2216–2221.CrossRefGoogle Scholar
21.Fischer, GS, Tulsky, JA, Rose, MR et al. . Patient knowledge and physicians predictions of treatment preferences after discussion and advance directives. J Gen Intern Med 1998; 13: 447–454.CrossRefGoogle ScholarPubMed
22.Seckler, AB, Meier, DE, Mulvihill, M, Cammer Paris, BE. Substitute judgment: how accurate are proxy predictions? Ann Intern Med 1991; 115: 92–98.CrossRefGoogle ScholarPubMed
23.Azoulay, E, Chevret, S, Leleu, G et al. . Half the families of intensive care unit patients experience inadequate communication with physicians. Crit Care Med 2000; 28: 3044–3049.CrossRefGoogle ScholarPubMed
24.Pochard, F, Azoulay, E, Chevret, S et al. . Anxiety and depression in families of ICU patients: ethical considerations for decision making capacities. Am J Respir Crit Care Med 2000; 159: A923.Google Scholar
25. Article 7 de la loi du 22 avril 2005, Article L. 1111-11 du Code de Santé Publique.Google Scholar
26. Décret n° 2006-119 du 06 février 2006, Article 1 Journal Officiel du 07 février 2006.Google Scholar
27.Teno, J, Lynn, J, Wenger, N et al. . Advance directives for seriously ill hospitalized patients: effectiveness with the patient self-determination act and the SUPPORT intervention. SUPPORT investigators. Study to understand prognoses and preferences for outcomes and risks of treatment. J Am Geriatr Soc 1997; 47: 500–507.CrossRefGoogle Scholar
28.Hofmann, JC, Wenger, NS, Davis, RB et al. . Patients preferences for communication with physicians about end-of-life decisions. Ann Intern Med 1997; 127: 1–12.CrossRefGoogle ScholarPubMed
29.Roupie, E, Santin, A, Boulme, R et al. . Patients’preferences concerning medical information and surrogacy: result of a prospective study in a French emergency department. Intensive Care Med 2000; 26: 52–56.CrossRefGoogle Scholar
30.Fournier, V, Trarieux, S. Les directives anticipées en France. Med and Droit 2005; 74–75: 146–148.CrossRefGoogle Scholar
31.Manthous, CA. Are living wills useful? In search of a new paradigm. Conn Med 2003; 67: 283–290.Google ScholarPubMed
32.Thorevska, N, Tilluckdharry, L, Tickoo, S et al. . Patient’s understanding of advances directives and cardiopulmonary resuscitation. J Crit Care 2005; 20: 26–34.CrossRefGoogle ScholarPubMed
33.Ferrand, E, Lemaire, F, Regnier, B et al. . Discrepancies between perceptions by physicians and nursing staff of intensive care unit end-of-life decisions. Am J Respir Crit Care Med 2003; 163: 1310–1315.CrossRefGoogle Scholar