• R Aubry.
• Axe « Éthique et progrès médical », Inserm CIC 1431/neurosciences intégratives et cliniques, EA 481, university Bourgogne Franche-Comté, 2, place Saint-Jacques, 25000 Besançon, France; CHRU de Besançon, 2, boulevard Fleming, 25030 Besançon, France. Electronic address: raubry@chu-besancon.fr.
• Rev Neurol France. 2016 Dec 1; 172 (12): 719-724.

AbstractOn February 2, 2016, the French parliament adopted legislation creating new rights for the terminally ill. The text modifies and reinforces the rights of patients to end-of-life care and strengthens the status of surrogate decision makers. Under the new regulations, advance directives become legally binding though not unenforceable. Two types of advance directives are distinguished depending on whether the person is suffering or not from a serious illness when drafting them. The attending physician must abide by the patient's advance directives except in three situations: there is a life-threatening emergency; the directives are manifestly inappropriate; the directives are not compatible with the patient's medical condition. There is no time limit on the validity of advance directives. They are to be written in concordance with a model elaborated by the French superior health authority. This model takes into account the person's knowledge (or not) of having a serious illness when drafting his/her advance directives. In all likelihood, physicians will be called upon to help patients elaborate their advance directives. The law also has a provision for a national registry - potentially the shared medical file - to be designed as a reference source to facilitate storage, accessibility and safety of advance directives. The law introduces the right to continuous deep sedation until death in three specific situations: (i) at the patient's request when the short-term prognosis is death and continuous deep sedation is the only alternative for relieving the patient's suffering or one or more otherwise uncontrollable symptoms; (ii) at the patient's request when the patient chooses to withdraw artificial life-sustaining treatment and such withdrawal would be rapidly life-shortening and susceptible to cause unbearable suffering; (iii) when the patient is unable to express his/her wishes and the collegiate medical decision is to withdraw aggressive futile life-sustaining treatment; continuous deep sedation is mandatory when the patient presents signs of suffering or when the patient's suffering cannot be evaluated due to the patient's cerebral or cognitive state. The law stipulates prior control of such practices, implying the development of a new type of collegiate procedure for medical decision-making. Satisfactory application of this new law will depend greatly on the implementing decrees. It will also depend on the implementation of a genuine policy for the development of palliative care. Professional guidelines will be needed. Several issues relevant to the field of neurology remain unresolved or are introduced by the new regulations. Further in-depth reflection and research are need.Copyright © 2016 Elsevier Masson SAS. All rights reserved.

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