Article

On February 2, 2016, the French parliament adopted legislation creating new
rights for the terminally ill.
The text modifies and reinforces the rights of
patients to end-of-life care and strengthens the status of surrogate decision
makers. Under the new regulations, advance directives become legally binding
though not unenforceable.
Two types of advance directives are distinguished
depending on whether the person is suffering or not from a serious illness when
drafting them. The attending physician must abide by the patient's advance
directives except in three situations: there is a life-threatening emergency; the
directives are manifestly inappropriate; the directives are not compatible with
the patient's medical condition. There is no time limit on the validity of
advance directives. They are to be written in concordance with a model elaborated
by the French superior health authority. This model takes into account the
person's knowledge (or not) of having a serious illness when drafting his/her
advance directives. In all likelihood, physicians will be called upon to help
patients elaborate their advance directives. The law also has a provision for a
national registry - potentially the shared medical file - to be designed as a
reference source to facilitate storage, accessibility and safety of advance
directives. The law introduces the right to continuous deep sedation until death
in three specific situations: (i) at the patient's request when the short-term
prognosis is death and continuous deep sedation is the only alternative for
relieving the patient's suffering or one or more otherwise uncontrollable
symptoms; (ii) at the patient's request when the patient chooses to withdraw
artificial life-sustaining treatment and such withdrawal would be rapidly
life-shortening and susceptible to cause unbearable suffering; (iii) when the
patient is unable to express his/her wishes and the collegiate medical decision
is to withdraw aggressive futile life-sustaining treatment; continuous deep
sedation is mandatory when the patient presents signs of suffering or when the
patient's suffering cannot be evaluated due to the patient's cerebral or
cognitive state. The law stipulates prior control of such practices, implying the
development of a new type of collegiate procedure for medical decision-making.
Satisfactory application of this new law will depend greatly on the implementing
decrees. It will also depend on the implementation of a genuine policy for the
development of palliative care. Professional guidelines will be needed. Several
issues relevant to the field of neurology remain unresolved or are introduced by
the new regulations. Further in-depth reflection and research are need.
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