[The project of a law concerning patients' rights at the end of life].
A bill about Patients' rights and the end of life was adopted unanimously by the National Assembly on November 30, 2004. Article 1 provides that the physician is not obligated to continue treatment "when the latter appears futile, disproportional and has no effect other than artificially maintaining the patient's life". Article 2 recognizes that painkillers administered at high doses to terminally ill patients may as a side effect "shorten the patient's life". Conscious patients and the families of unconscious patients must be so informed, and the discussion must be mentioned in the patient's file. Physicians must respect their patients' refusal of treatment, even in life-threatening situations. On the other hand, patients who are not terminally ill must await the expiration of a mandatory waiting period before the physicians must comply with their wishes to refuse care. Article 3 specifies that any treatment can be withheld or withdrawn, including artificial nutrition. The law specifies that it is applicable in 4 different sets of situations: for patients who are or are not terminally and for those who are or are not conscious. Article 9 makes clear that futile treatment of unconscious patients can be withheld or withdrawn. Article 7 specifies that adults may draw up advance directives to indicate their wishes for their end of life and their desires regarding the withholding or withdrawal of treatment. Withholding or withdrawing active treatment is authorized under 3 conditions: the consent from the patient, or if he or she is unconscious, the approval of the health-care proxy, or a family member or close friend if the patient is unconscious; the inclusion of the decision in the patient's medical file, and a group decision-making process.
Lemaire
F
F
Service de reanimation médicale, Hôpital Henri Mondor (AP-HP), Université Paris XII, 51 av du Mal de Lattre de Tassigny, 94010 Creteil Cedex. francois.lemaire@hnm.ap-hop-paris.fr
D016223:Advance Directives; D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D003657:Decision Making; D005602:France; D006291:Health Policy; D006801:Humans; D016743:Mental Competency; D028701:Patient Rights / Q000331:legislation & jurisprudence*; D013727:Terminal Care; D016312:Treatment Refusal; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence*
D000700:Analgesics