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We are pleased to announce that Ruth Horn, from the Ethox Centre, has had a short report published in the Journal of Medical Ethics this month. Read her summary and full report here

Report summary

In February 2016, a law was adopted in France granting terminally-ill patients who refuse life-sustaining treatment (LST) the right to continuous deep sedation (CDS), an extreme form of sedation, which renders patients unconscious until death. Also, physicians are now required to provide CDS when withdrawing LST for terminally-ill patients that have lost capacity. The right to CDS was presented as the ‘French exception’, or the ‘French response’ to euthanasia. The bill sought to ensure that patients can refuse LST ‘without having to suffer’, highlighted the concern that French physicians could refuse to manage patients’ symptoms when LST is withdrawn. For many years, French physicians were reluctant to use sedation and opiates at the end-of-life which, in turn, led to an extreme fear of terminal suffering among patients, healthcare professionals and the public. The proposed ‘French exception’ expresses the lack of trust in French physicians to effectively control pain at the end-of-life. Making CDS an end-of-life practice that can be requested by a patient in every case of withdrawal of LST, transforms its character of being a last resort medical response to intractable terminal suffering. The potential disproportionality of providing CDS, where there may be no medical need for such an intervention with possible life-shortening effect, blurs the boundaries between CDS as a means to respond to refractory pain and CDS as a means to hasten death. In the particular French context, such a blur could 1) increase physicians’ reluctance to use CDS, and therefore, physicians could avoid accepting patients’ wishes to withdraw LST; 2) lead some physicians to use CDS as a means of hastening death, but without any institutional monitoring. Given these possible scenarios, French legislation should have aimed for improved pain management training, rather than granting terminally-ill patients the right to request CDS and requiring doctors to accompany the withdrawal of LST for incompetent patients by CDS.

Read the full report here