On August 5, 2016, the Official Journal published two decrees and a decision dated August 3 which provide clarification regarding “deep and continuous sedation until death” and on the advance directives, such as those provided for by the February 2, 2016 law on the end of life.
> The first decree n°2016-1066 primarily concerns doctors and health professionals. The French Code of Medical Deontology Code has been modified to include this new form of sedation, with different modalities according to whether or not the patient can express his will. A thorough analysis of its content, and especially the practices to be implemented on its basis, will be needed to assess the actual scope of this text.
In order to put an end to cases which a doctor considers as unreasonable obstinacy, for example, it is specified that the doctor can practice this form of terminal sedation, when the patient can no longer express his will, “even if the patient’s suffering cannot be evaluated given his cerebral condition”. Isn’t it paradoxical to use sedation, whose primary objective is to relieve refractory pain, when we aren’t even sure the individual is suffering?
It will also be necessary to learn to differentiate between two collegial procedures which appear to be only slightly different, according to whether the doctor wishes to curb or discontinue treatment (procedure in article L.1110-5-1) or if he wishes to overlook the advance directives that he esteems are obviously inappropriate or inconsistent with the medical condition (procedure in article L.1111-11).
> The second decree n°2016-1067 concerns the entire French population, since it modernizes the terms of drafting and conserving advance directives that each individual can establish to make his will known in the event where he can no longer express himself. This decree describes the content of the template requested by the End of Life law and the various ways of storing this document.
There are two distinct scenarios, resuming the suggestions made by the French National Authority for Health a few months earlier: one whereby the individual is at the End of Life and realizes that he has a serious and life-threatening condition, and one whereby the individual is not believed to have a serious condition (with a lesser number of sections proposed). Furthermore, a specific section addresses deep and continuous sedation until death. The naming of a person of confidence is also provided for. All of these aspects, as well as other ancillary details are contained in the annex of the Health Minister’s decision for implementing this decree.
> As for the different means of conserving this document, the decree recommends the Shared Medical Record, the computerized tool containing all the medical data for the same individual and which is planned to be available for the entire population by 2017. This choice was suggested in report by the French General Inspection for social Affairs (IGAS)1 last October 2015, and the government decided that this means could be considered as the national register provided for by Article 8 of the end of life law. In addition, the advance directives could be kept, for example, by the family physician, in medical records in the event of a hospitalization, or in the health care records for individuals in nursing homes, in addition to either conserving the document at home or giving it to a chosen individual.
1 IGAS: « Inspection Générale des Affaires Sociales »: French government audit, evaluation and inspection office for health, social security, social cohesion, employment and labor policies and organizations.
For further information: VITA Decoder n°45 on the End of Life law, February 4, 2016