What is the prohibition against unreasonable obstinacy.?

The law states that medical acts “must not be pursued by unreasonable obstinacy“, in other words, it opposes “

therapeutic relentlessness”. It thus justifies decisions to stop or limit treatments that have become “useless or disproportionate, or having as effect only

the artificial maintenance of life”. It specifies at the same time that the doctor must always safeguard the dignity of his patient, ensure his

The principles adopted reinforce the Code of medical ethics which specifies:

provide appropriate care and measures for the quality of life that is coming to an end, safeguard the patient’s dignity and comfort those around him” (article

The difficulty of any medical decision at the end of life is due to the concern to ensure the balance between the protection of life and the right of the person to an end of life

Can a person who is ill at the end of their life ask for their treatments to be stopped or limited?

The principle laid down by the law is that the sick person, conscious and able to express his will, can refuse any investigation or any treatment even if this refusal puts his life in danger. On the other hand, if the person is not at the end of life, the doctor has the obligation to make every effort to try to convince him to accept the essential care, including by calling on another doctor and does not give following his will only after a reasonable period allowing him to reiterate his wish, at the end of life; the doctor must then, without delay, respect the will thus expressed by the patient, after having informed him of the consequences of his choice.

In all cases, the procedure followed, like the decision, is recorded in the patient’s medical file and pain management and palliative care must always be provided.

What happens if the sick person is no longer able to express their wishes?

In anticipation of such a situation, each adult can appoint a trusted person who will be consulted in the event that he or she is no longer in a position to decide. She can also write advance directives in order to express, in advance, her wishes regarding the organization of her end of life. These can be entrusted to the trusted person.

Indeed, if, following a serious accident or taking into account the evolution of the disease, a person is in a coma or in a persistent vegetative state, he no longer has the means to participate in the decisions concerning and to express his will. In this case, it is the doctor who can take the decision to interrupt or not to undertake treatments deemed “useless, disproportionate or having no other effect than the artificial maintenance of life” at the end of the treatment. a collegial procedure.

Collegial procedure means consultation with the care team and the reasoned opinion of at least one doctor outside the service. This procedure does not exempt the doctor from researching and taking into account the will previously expressed by the sick person (advance directives, testimony from the person of trust), he will also take the opinion of the family and relatives. The collegial procedure can be requested by the doctor, the medical team but also by the family and the relatives on the basis of the advance directives of which they would be depositaries. The final decision belongs to the doctor who must justify it and record it in the patient’s medical file.

What is the role of family and friends?

Their role is complex because they are intimately linked to the patient and their integration into the decision-making process for limiting or stopping care is particularly delicate. A feeling of guilt is often felt, especially since the family does not always express a unity of views on the best decision to take for their loved one. In practice, several interviews with them are planned. In the event of a divergence of points of view, the

Does the law of April 22, 2005 authorize doctors to help their patients die?

The 2005 legislator authorizes the doctor not to undertake unnecessary or disproportionate care and obliges him to respect the refusal of treatment expressed by his patient. He must listen to her and her complaint and seek her relief.

If the only way to relieve the suffering is to administer a powerful sedative treatment which could have the side effect of shortening life (we speak of a “double effect”), the doctor must inform the patient, the person of and/or family; he must, in complete transparency, register his approach in the medical file. The law, on the other hand, does not lift the ban on the doctor not to deliberately cause death.