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An institutionalized form for withholding or withdrawing life-sustaining treatment in pediatrics: Feedback from Robert Debré Hospital (Paris)

Par : Contributeur(s) : Type de matériel : TexteTexteLangue : français Détails de publication : 2022. Ressources en ligne : Abrégé : Since 2005, performing acts or administering treatments when they appear to be useless, disproportionate, or having no other effect than the artificial prolongation of life (the definition of unreasonable medical care) has been prohibited by French law. In the case of non-emancipated underage patients, the physician in charge is required to respect a collegial procedure before deciding to withhold or withdraw treatments. A preformatted form, to be filled in during the deliberation, serves as a reminder of the legal elements that the procedure must respect and the medical and non-medical arguments that must be considered, guaranteeing the quality of the deliberation before the physician makes their decision. It thus ensures a record of the justification of this medical decision and establishes a framework for the information given to holders of parental authority. Through formalization, it constitutes an essential educational tool for the ethical and palliative acculturation of caregivers who are less experienced in this process. Finally, it can facilitate research work by providing easier access to systematized data. The institutionalization of such a form, authorizing all caregivers in the same hospital to share the same document, facilitates the appropriation of the tool by everyone. The computerization of the form, within the shared medical file, should help to optimize the transmission of the information to all the caregivers who require it, and to optimize the essential review of the decision, after a maximum period of three months.
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Since 2005, performing acts or administering treatments when they appear to be useless, disproportionate, or having no other effect than the artificial prolongation of life (the definition of unreasonable medical care) has been prohibited by French law. In the case of non-emancipated underage patients, the physician in charge is required to respect a collegial procedure before deciding to withhold or withdraw treatments. A preformatted form, to be filled in during the deliberation, serves as a reminder of the legal elements that the procedure must respect and the medical and non-medical arguments that must be considered, guaranteeing the quality of the deliberation before the physician makes their decision. It thus ensures a record of the justification of this medical decision and establishes a framework for the information given to holders of parental authority. Through formalization, it constitutes an essential educational tool for the ethical and palliative acculturation of caregivers who are less experienced in this process. Finally, it can facilitate research work by providing easier access to systematized data. The institutionalization of such a form, authorizing all caregivers in the same hospital to share the same document, facilitates the appropriation of the tool by everyone. The computerization of the form, within the shared medical file, should help to optimize the transmission of the information to all the caregivers who require it, and to optimize the essential review of the decision, after a maximum period of three months.

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