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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: franchitto@club-internet.fr; Tel: +33 5 61 32 29 54; Fax: +33 5 61 32 21 77
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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

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