February2, 2016 French Law creating new rights for the sick and people at the end of life: Analysis and comments

A new law creating news right in favour of sick persons and of persons at the end of life has been promulgated in February 2016, 2th in France. This law enhances the previous right and introduces a new one. The trustworthy person status is strengthening. Advance directives become binding but are not unenforceable: medical doctor has to respect them except three situations: a vital emergency, an unappropriated character or a redaction which is not conform to the patient's medical situation. Advance directives have no limited duration. They will be written in concordance with a model elaborated by the French high health authority. This model has to anticipate that the person knows or not if he (she) is affected by a serious disease when he (she) writes his (her) advance directives. Probably, medical doctor will be encouraged to help the patient in the writing of his advance directives. An ``advance directives national register'' planed by the law as a storage, accessibility and security reference should be the shared medical file. The law introduces the right to a deep and continuous sedation maintained until death in three specific situations: (1) at the patient's request when his vital prognosis is engaged in a short term, when he presents one or more symptoms or suffering impossible to control with no alternative than the use of sedation; (2) at the patient's request when he chooses to withdraw a treatment which artificially maintains him alive, this withdrawal would lead to his vital prognosis being engaged in a short time and susceptible to involve an unbearable suffering; (3) when the patient is unable to express his wishes and when the practitioner, after a collegiate procedure, withdraws a treatment which maintains the patient alive, resulting in the refusal of unreasonable obstinacy; the deep and continuous sedation is imperative when the patient presents signs of suffering or when the suffering cannot be evaluated because of the patient's cerebral or cognitive state. The law provides an a priori control to be applied. This control has to be realized by a new kind of collegiate procedure. The correct application of this new law will depend strongly on the implementing decrees. It will also depend on the implementation of the real development of a palliative care policy and of professional recommendations, which need to be realized. A few questions remain outstanding and further research and deepening are needed. (C) 2010 Elsevier Masson SAS. All rights reserved.