End-of-life patients, intensive care and consent: difficulties facing French intensivists.
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.


METHODS
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.


CONCLUSIONS
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.
Franchitto
N
N
Rangueil University Hospital, Department of Anesthesiology and Intensive Care, Toulouse, France. franchitto@club-internet.fr
Vinour
H
H
Gavarri
L
L
Telmon
N
N
Rouge
D
D
D016223:Advance Directives; D003422:Critical Care; D003657:Decision Making; D005602:France; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D016743:Mental Competency; D010166:Palliative Care / Q000331:legislation & jurisprudence; D028701:Patient Rights / Q000331:legislation & jurisprudence*; D013727:Terminal Care / Q000331:legislation & jurisprudence*; D016312:Treatment Refusal; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence*