Search

Les patients en fin de vie dans de nombreux pays peuvent avoir accès légalement à une euthanasie, à une aide au suicide ou à un suicide assisté. La souffrance psychique intolérable, associée ou non à des pathologies incurables et/ou délabrantes, au-delà des possibilités thérapeutiques, est au cœur de leur demande. Celle-ci est cependant difficile à évaluer par tiers, toute souffrance étant par nature subjective. De plus, elle interpelle particulièrement le corps soignant lorsque le malade n'est pas dans une proximité de mort naturelle. Il est difficile d'affirmer l'incurabilité d'une maladie psychiatrique et d'une souffrance intolérable, critère subjectif à accueillir en tant que tel par les donneurs de soins. Les capacités de discernement et les prises de décisions d'un patient submergé par sa douleur morale sont altérées, et une personne âgée peut présenter des troubles cognitifs, ce qui doit être évalué dans sa demande d'aide active à mourir. Nous analysons dans cet article la complexité de l'approche de la souffrance psychique intolérable. Celle-ci relève de problématiques sociétales, des conséquences des maladies somatiques souvent invalidantes, de problèmes psychiatriques ou de difficultés psychologiques, en particulier existentielles. Nous insistons sur la nécessité de l'évaluation chez la personne âgée de ses capacités décisionnelles et sur l'importance de l'accompagnement des personnes en attente de cette aide active à mourir. L'approche du patient atteint de plusieurs pathologies chroniques passe par un dialogue loyal dans lequel il sera possible de clarifier précisément ses priorités et ses préférences. Ces priorités ne sont pas exclusivement médicales. L'approche des souffrances insupportables en fin de vie ou dans d'autres circonstances est nécessairement globale, holistique, bio-psycho-sociale. End-of-life patients in many countries have legal access to euthanasia, support for suicide, or assisted suicide. Intolerable psychological suffering, whether or not associated with incurable and/or debilitating pathologies, beyond the therapeutic possibilities, is at the very core of their request. It is, however, difficult for third parties to evaluate such suffering since all suffering is inherently subjective. Moreover, it is particularly challenging for caregivers and medical staff when the patient is not close to a natural death. It is difficult to ascertain the incurability of a psychiatric illness and intolerable suffering, which is a subjective criterion to be accepted as such by the nursing staff. The capacity for discernment and decision-making of a patient overwhelmed by his/her moral pain is impaired, and an elderly person may present cognitive disorders, which must be assessed in his/her request for active assistance in dying. In this article, we analyze the complexity of the approach to intolerable mental suffering. Such suffering is related to societal issues, the consequences of often incapacitating psychiatric problems and psychological difficulties, particularly existential ones. We insist on the necessity of evaluating the cognitive capacity of elderly persons to make such a decision and on the importance of the accompaniment of those awaiting active assistance in dying. Decision-making and care for seniors with multiple chronic conditions must focus on the seniors' priorities and on their quality of life. These priorities are not exclusively medical. The general approach to unbearable suffering at the end of life or in other circumstances is necessarily global, holistic, and bio-psycho-social. [ABSTRACT FROM AUTHOR]

Copyright of Summa, Animali da Compagnia is the property of Point Veterinaire Italie s.r.l. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Derecho y Genoma Humano is the property of Dykinson SL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

French end-of-life law aims at protecting patients from unreasonable treatments, but has been used to force caregivers to prolong treatments deemed unreasonable. We describe six cases (five intensive care unit patients including two children) where families disagreed with a decision to withdraw treatments and sued medical teams. An emergent inquiry was instigated by the families. In two cases, the court rejected the families' inquiries. In two cases, the families appealed the decision, and in both the first jurisdiction decision was confirmed, compelling caregivers to pursue treatments, even though they deemed them unreasonable. We discuss how this law may be perverted. Legal procedures may result in the units' disorganisation and give rise to caregivers' stress. Families' requests may be subtended by religious beliefs. French end-of-life law has benefits in theoretically constraining physicians to withhold or withdraw disproportionate therapies. These cases underline some caveats and the perverse effects of its literal reading. [ABSTRACT FROM AUTHOR]

Especially in oncology and in critical care, the provision of medical care can require therapeutic choices that could go beyond the patient's will or intentions of the protection of his health, with the possible adoption of medical behaviors interpreted as unreasonable obstinacy or, at the opposite extreme, as euthanasia. In some cases, the demand for obstinate therapeutic services could come from the patient or from his relatives, in which case the dilemma arises for the health professional between rejecting such a request, in respect of their professional autonomy, or abiding by it for fear of a professional care responsibility for therapeutic abandonment. We analyzed and commented on emblematic clinical cases brought to court for alleged wrong medical conduct due to breach of the prohibition of unreasonable obstinacy. In healthcare it is impossible to fix a general rule defining any therapeutic act as appropriate, because on one hand there are technical assessments of medical competence, and on the other the perception of the patient and of his family members of the usefulness of the health care provided, which may be in contrast. The medical act cannot make treatments that are inappropriate for the needs of care or even be unreasonable; conversely, before the request by the patient or by his family members for disproportionate health services in relation to the results they may give in practice, in compliance with the legislative and deontological provisions, the doctor can refuse them, thus safeguarding both his decision-making autonomy and, therefore, his professional dignity. [ABSTRACT FROM AUTHOR]

Résumé Dans l’incontournable « affaire Vincent L. », de nombreuses juridictions ont eu à se prononcer. Dernière en date, la décision du tribunal administratif de Châlons-en-Champagne est passée presque inaperçue. Pourtant le jugement se révèle d’une réelle importance. Il permet de rappeler que le principe de l’indépendance du médecin est incontournable. Le praticien en charge du patient ne saurait être considéré comme un simple exécutant d’une décision médicale antérieure prise par un confrère. In the must-known “Vincent Lambert case”, many jurisdictions have had to adjudicate on what was submitted to them. The latest decision from Châlons-en-Champagne's administrative court almost went unnoticed. However, the judgment turns out to be truly significant. It reminds that the principles of medical doctor's independence and freedom of action are simply fundamentals and unavoidable. The patient management practitioner shall not be regarded as a mere executor of an earlier decision taken by a medical colleague. [ABSTRACT FROM AUTHOR]

Abstract: On 2 June 2009, the Nîmes administrative court condemned the Hospital of Orange (France) for unreasonable obstinacy after neonatal resuscitation. On 14 December 2002, an apparently stillborn child was resuscitated after approximately 30minutes of fetal distress. Cardiac activity was recovered, but the child has since suffered from severe disabilities. The court did not find any fault committed by the hospital regarding maternal care. However, the hospital was sentenced to compensate for the injuries caused by unreasonable obstinacy. According to the court, the medical team should have taken into account the harmful neurological consequences of prolonged fetal distress. The court does not condemn the resuscitation effort itself, but its excessive length. The judge said that resuscitation was initiated “rightfully (…) from the child''s birth”. This court ruling serves as a basis for reflection regarding the limits by which unreasonable obstinacy should be set. Current and past recommendations from the time of the incident advocate temporary intensive care, giving time to neonatal care teams to assess neurological status, and to eventually stop therapeutic efforts in case of a very pejorative prognosis. Decisions to not resuscitate cannot be taken in a neonatal emergency setting. [Copyright &y& Elsevier]

On 2 June 2009, the Nîmes administrative court condemned the Hospital of Orange (France) for unreasonable obstinacy after neonatal resuscitation. On 14 December 2002, an apparently stillborn child was resuscitated after approximately 30 minutes of foetal distress. Cardiac activity was recovered, but the child has since suffered from severe disabilities. The court did not find any fault committed by the hospital regarding maternal care. However, the hospital was sentenced to compensate for the injuries caused by unreasonable obstinacy. According to the court, the medical team should have taken into account the harmful neurological consequences of prolonged foetal distress. The court did not condemn the act of resuscitation itself, but its excessive length. This court ruling serves as a basis for reflection regarding the limits by which unreasonable obstinacy should be set. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Decision-making bringing to an admission or not in intensive care is complex. The aim of this study is to analyze with an ethical point of view the making decision process leading to the refusal and its consequences. It is proposed a setting in prospect through the principles of beneficence, non-maleficience, respect for autonomy, justice, and the Leonetti law. Patients and methods: Prospective study in surgical reanimation at the University Hospital of Rouen over 9 months (November 2007–September 2008). Systematic collection for each non-admitted patient of the general characters, the methods of decision making, immediate becoming and within 48h Constitution of two groups: patients for whom an admission in intensive care could be an unreasonable situation of obstinacy, and patients for whom an admission in reanimation would not be about unreasonable if it occurred. Results: One hundred and fifty situations were analyzed. The potentially unreasonable character of an admission does not involve necessarily a refusal of care in intensive care. The question of the lack of place and equity in the access to the care is real but relative according to the typology of the patients. The research of the respect of the autonomy of the patient is difficult but could be facilitated. The Leonetti law does not appear to be able to be a framework with the situation of refusal of care in intensive care. Conclusion: It is not a question of going towards a systematic admission in intensive care of any patient proposed, but to make sure that so if there is a refusal, it is carried out according to a step ethically acceptable. [Copyright &y& Elsevier]

The management of oncology patients, especially hospitalized patients, can lead to almost daily discussions regarding therapeutic limitations. Here, we review the history and propose a summary of the texts framing the notion of "withholding and withdrawing life-sustaining treatment" in oncology practice in France. This decision is regulated by the Claeys-Léonetti Law of February 2, 2016 recommending a collegial discussion and its documentation in the medical record. The decision to withhold or withdraw life-sustaining treatments is the subject of discussion between the patient, his physicians and his family and may take place at any time during his management. The work of intensive-care physicians provides many useful recommendations for acute oncology situations, however articles specific for oncology practice are scarce; this is a topic that oncologists must take up., (Copyright © 2021 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Ethics question our values and the principles which govern our decisions. In the specific context of the home, where the family is alone most of the time with the sick family member, and where the team of health professionals is more fragmented, day-to-day care, notably in the palliative phase, requires almost constant ethical questioning., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)