Une mort tres douce: end-of-life decisions in France; reflections from a Dutch perspective.
This study considers the range of thinking about end-of-life decisions (ELD) in France from a Dutch point of view, taking a small number of interviews with important French opinion-leaders as a basis. Until today, end-of-life care in France has been clouded with uncertainty pending the enactment of more specific definitions and regulations. French physicians could face a dilemma in treating a dying patient, caught between an official ban on ELD and a professional obligation to treat cases individually. The practical consequence of this climate is a lack of accountability of the French physician towards colleagues and patients. Rationalistic, paternalistic, and religious traditions have been obstructive to the adoption of regulatory reforms. In November 2004, Parliament accepted a law proposal by which the practice of the withholding and withdrawal of life-saving therapies would become more transparent, which would diminish the physician's fear of legal persecution. This proposal was then converted into law by the Senate. In the Netherlands, euthanasia - the active termination of life - is legal and regulated according to specific criteria. The Dutch approach has been shaped by an Anglo-Saxon emphasis on individual autonomy, and conforms to a broad preference in Dutch society to disclose and regulate controversial activities rather than to tolerate them sub rosa. As the Dutch regulations have been enacted, reporting rates - but not euthanasia cases - have risen. Compliance with the criteria and doctor-patient communication have been high. The French vigilance of professional autonomy provides a valuable example to the Dutch. The Dutch, in return, offer the French concrete examples for ELD policy.
Haverkamp
Margje H
MH
Leiden University Medical Center, Leiden, The Netherlands.
van Delden
Johannes J M
JJ
D001293:Attitude to Death / Q000208:ethnology*; D003431:Cross-Cultural Comparison; D003657:Decision Making; D028601:Euthanasia, Active / Q000331:legislation & jurisprudence; D005602:France; D006291:Health Policy / Q000331:legislation & jurisprudence*; D006801:Humans; D007407:Interviews as Topic; D009426:Netherlands; D010166:Palliative Care / Q000331:legislation & jurisprudence* / Q000639:trends; D010686:Philosophy, Medical; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012297:Right to Die / Q000331:legislation & jurisprudence; D012941:Social Responsibility; D013727:Terminal Care / Q000331:legislation & jurisprudence* / Q000639:trends; D014342:Truth Disclosure; D035501:Uncertainty