title: [French law related to patient's rights and end of life: pediatric intensive care unit's health professionals' opinions].
abstract: OBJECTIVE
  To identify the knowledge of caregivers of pediatric intensive care units (PICUs) on the French law related to patients' rights and end of life, their views on withholding/withdrawing life-sustaining treatment (WWLST) decisions, and their feelings about how these decisions were made and implemented.
  
  
  METHODS
  A multicenter survey in 24 French PICUs during the fourth trimester 2010.
  
  
  RESULTS
  One thousand three hundred and thirty-nine professional healthcare workers (1005 paramedics and 334 physicians) responded. Over 85% of caregivers had good knowledge of the WWLST decision-making processes required by law. More than 80% of caregivers accepted mechanical ventilation, hemodiafiltration, or hemodynamic support withdrawal or withholding. Nevertheless, the withdrawal of artificial nutrition and hydration generated reluctance or opposition for the majority of respondents. While paramedics' participation in the decision-making process was deemed necessary by all caregivers, paramedics found more often than physicians that they were insufficiently involved. The quality of end-of-life care was judged very positively by caregivers. The answers on how WWLST was applied suggest very different interpretations of the law. Some caregivers respect the principles of palliative care as stated in the public health code and 40% of doctors and 64% of caregivers consider it "acceptable" to hasten death if resulting from a collaborative decision-making process.
  
  
  CONCLUSIONS
  This study is the first to show that caregivers of French PICUs have good knowledge of the French law concerning the end of life. Yet, there is still confusion about the limits of practice during the end-of-life period.
authors: Service de réanimation, CHU Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France. Electronic address: laure.desaintblanquat@nck.aphp.fr.
authors: L
authors: L
authors: de Saint Blanquat
authors: Service de réanimation pédiatrique et espace éthique hospitalier et universitaire, hôpital Jeanne-de-Flandre, centre hospitalier régional universitaire de Lille, 59037 Lille, France.
authors: R
authors: R
authors: Cremer
authors: Département biostatistique et informatique médicale, centre hospitalier universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
authors: C
authors: C
authors: Elie
authors: Service de réanimation, CHU Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
authors: F
authors: F
authors: Lesage
authors: Service de réanimation, CHU Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
authors: L
authors: L
authors: Dupic
authors: Service de réanimation pédiatrique, université Paris V Descartes, chu Necker-Enfants-Malades, 149, rue de Sèvres, 75743 Paris cedex 15, France.
authors: P
authors: P
authors: Hubert
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D034723:Double Effect Principle; D005602:France; D006306:Health Surveys; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000331:legislation & jurisprudence*; D010166:Palliative Care / Q000331:legislation & jurisprudence; D010348:Patient Care Team / Q000331:legislation & jurisprudence; D028701:Patient Rights / Q000331:legislation & jurisprudence*; D011785:Quality Assurance, Health Care / Q000331:legislation & jurisprudence; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence*; D017236:Suicide, Assisted / Q000331:legislation & jurisprudence; D013727:Terminal Care / Q000331:legislation & jurisprudence*; D028761:Withholding Treatment / Q000331:legislation & jurisprudence*