title: When Physicians Report Having Used Medical Drugs to Deliberately End a Patient's Life: Findings of the "End-of-Life in France" Survey.
abstract: BACKGROUND
  The debate on the decriminalization of active assistance in dying is still a topical issue in many countries where it is regarded as homicide. Despite the prohibition, some physicians say they have used drugs to intentionally end a patient's life.
  
  
  OBJECTIVE
  To provide some empirical grounding for the ongoing debate.
  
  
  METHODS
  Using data from the End-of-Life in France survey (a representative sample of 15,000 deaths that occurred in December 2009, questionnaires completed anonymously by the physicians who had certified the deaths), we selected all the cases where the physician had used one or more drugs to intentionally end a patient's life and compared the decisions and decision-making process with the conditions imposed by the French law for decisions to withhold or withdraw life-supporting treatments and by the Belgian law on euthanasia.
  
  
  RESULTS
  Of the 36 cases analyzed, four situations seemed to be deliberate acts after explicit requests from the patients, and only two seemed to fulfill the eligibility and due care conditions of the Belgian euthanasia law. Decisions made without any discussion with patients were quite common, and we observed inadequate labeling, frequent signs of ambivalence (artificial feeding and hydration not withdrawn, types of drug used), and little interprofessional consultation. Where the patient had requested euthanasia, the emotional burden on the physician was heavy.
  
  
  CONCLUSIONS
  These findings underscore the pressing need for a clarification of the concepts involved among health professionals, patients, and society at large, and better training and support for physicians.
authors.affiliation: CHU de Rennes-Hôpital Pontchaillou, Rennes, France. Electronic address: francoise.riou@chu-rennes.fr.
authors.forename: Françoise
authors.initials: F
authors.lastname: Riou
authors.affiliation: Inserm CIC1431, University Hospital of Besançon, Paris, France.
authors.forename: Régis
authors.initials: R
authors.lastname: Aubry
authors.affiliation: Institut National d'Etudes Démographiques, Paris, France.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pontone
authors.affiliation: Institut National d'Etudes Démographiques, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Pennec
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003657:Decision Making; D028601:Euthanasia, Active / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D017236:Suicide, Assisted / Q000523:psychology / Q000706:statistics & numerical data
keywords: End of life; France; physician-assisted deaths