“How to ensure that the patient’s decision is free and informed? »

Hello Jerome,

First of all, it is necessary to specify what type of decision it is in a country where active assistance in dying is illegal. “Making a decision relating to the end of life”, in France, this can be: either ask for treatment to be stopped at the risk of hastening deaththat is request deep and continuous sedation until death.

► In the first case, the healthcare team responds to this request when it considers that to continue the treatments would be unreasonable obstinacywhat was previously called therapeutic relentlessness.

► In the second case, deep and continuous sedation can be performed on three conditions: the patient is suffering from an incurable condition, he presents refractory suffering (i.e. resistant to treatments) and his vital prognosis is engaged in the short term.

In both cases, “the patient’s capacity for discernment is an essential parameter for judging the admissibility of the request”, explains Giovanna Marsico, director of the National Center for Palliative and End-of-Life Care (CNSPFV), a public body. affiliated with the Ministry of Health. By capacity for discernment, we mean the capacity to obtain information, to assess the situation and its consequences, and to make a free choice..

In France, any request to stop treatment is subject to a collegial procedure. This brings together the reference doctor, the therapeutic team, as well as a third-party doctor with no hierarchical link to the said team. During this procedure, healthcare professionals share information about the patient, exchange their points of view and assess, among other things, their capacity for discernment.

When the patient is unable to decide

In some cases, especially for people with a neurodegenerative disease, the patient is not able to make such a decision. The caregivers then consult the person of trust, as well as the advance directives, if the patient has written one. “The quest for the will of the person is first, fundamental”, insists Giovanna Marsico.

If the patient seems to be in the grip of psychic disorders at the time of formulating his request, a psychiatrist can also be called upon.

At the end of the collegial procedure, it is up to the referring doctor to decide. “If he refuses to accede to his patient’s request, he must justify his refusal in writing, in the medical file, explains Giovanna Marsico. The patient can, if he wishes, repeat his request, but it will then be with another health professional. »

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🟠📽️#FinDeVie : comment @The cross will deal with the debate, @jchapuis
“We are among those who wonder and even worry about the risks of abuse. But we are above all committed to helping everyone, whatever their convictions, to enter into the complexity of the subject.” pic.twitter.com/vRLTTW8R0u

— The Cross (@LaCroix) December 8, 2022

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