Ethics review: End of life legislation – the French model

Abstract

French law 2005-370 of April 22, 2005 (Leonetti's law) brings new rights to patients and clarifies medical practices regarding end of life care. This new law prohibits unreasonable obstinacy in investigations or therapeutics and authorizes the withholding or withdrawal of treatments when they appear "useless, disproportionate or having no other effect than solely the artificial preservation of life". Relief from pain is a fundamental right of patients. With regard to pain control, the law also allows doctors to dispense to patients "in an advanced or final phase of a serious and incurable affliction" anti-pain treatments as needed, even if these treatments, as a side effect, hasten their death. The drafting of advance directives regarding end of life constitutes a new right of patients. The decision to withdraw or withhold a treatment from a patient unable to express their will has to take into account the wishes they might have expressed through advance directives, and/or the wishes of a trusted person or, lastly, of the family. Before making any decision, physicians should respect a collegial medical procedure. Euthanasia defined as the act of terminating one's life on a patient's explicit request remains illegal.

Impact of an intensive communication strategy on end-of-life practices in the intensive care unit

“…In France, this process of reflection led to new legislation, dating from 22 April 2005, relative to patient rights at the end-of-life, the so-called Leonetti law [12,13]. Briefly, this law gives new rights to patients and clarifies medical practices regarding end-of-life care.…”

Limitación de tratamiento de soporte vital en una Unidad de Cuidado Intensivo pediátrica chilena: 2004-2014

“…Ello lleva a una esperable gran variabilidad de acción en el mundo 12,23,24,25 . La discusión sobre alternativas del curso a seguir frente a patologías limitantes de la vida va en aumento 7,8,18,26,27 . Factores como el concepto individual de calidad de vida, cultura, religión, pronóstico, opinión de la familia, disponibilidad local de cuidado crítico, costos sanitarios en alza, uso racional de recursos siempre escasos, etc., pueden influir en la indicación o restricción de ingreso/egreso de UCI en diferentes realidades alrededor del mundo.…”

Classic cases revisited: Mrs Janet Tracey, resuscitation and the importance of good communication

“…For instance, introduced in France on 22 April 2005, so-called Leonetti's Law (Law 2005-370) authorises the withholding and withdrawal of treatment when it appears to be 'useless'. 25 The law sanctions the principle of double effect and makes pain relief a fundamental patient right. The law focuses on preservation of dignity and avoidance of unnecessary treatments.…”

“…The motives for the opinion shall be made explicit'. 25 In the United States, Federal Law includes Patient Self-Determination Act, which was introduced in 1990. The Act serves to affirm patient rights including the right to facilitate their own health care decisions, the right to accept or refuse medical treatment and the right to make advance health care directives.…”