Limitation therapeutic oncology: What the law says

When "life becomes too painful and that all hope is vain," the issue of withdrawal of potentially aggressive care arises, within a legal framework to protect the patient thought the end of life.
End of life
While "the development of scientific knowledge showed a therapeutic arsenal (...), at the individual level, however, caregivers are faced with treatment failure, exhaustion of sick or refractory disease progression," note Cécile Laude Hospices Civils de Lyon and the lawyer Serge Deygas Deygas, Perrachon and Associates (Lyon) firm, in a review published in the Bulletin du Cancer.

Sometimes it becomes "essential question current treatments or those technically possible, leaving the patient care who bring an immediate benefit." It is then to decide, in conjunction with the patient or not, to establish a "therapeutic limitation."

"What are the ways to deploy in practice to build this decision and how to formalize it is not legally binding?" Questioned the authors.

Article L1110-5 of the Public Health Code (CSP) provides that a medical procedure should not run to the patient "risk disproportionate to the expected benefit" and thus raises the principles of therapeutic limitation.

"These actions should not be pursued by an unreasonable obstinacy. When they appear unnecessary, disproportionate or having no effect other than the only artificial life support, they may be suspended or may not be undertaken," explains the section of law.

Palliative care and support can provide quality end of life for the patient. These treatments, which are "active and continuous (...) aims to relieve pain, ease mental suffering, to safeguard the dignity of the patient and to support his entourage," say the authors.

"Everyone patient whose condition requires a right of access to palliative care and coaching," said Article L1110-9 CSP.

And "if necessary to relieve the patient themselves at risk of shortening life care, they can be made, provided they are accompanied by a patient information" indicate Cécile Laude and Serge Deygas.

However, the law does not allow euthanasia, which remains voluntary manslaughter under Article L221-1 of the Criminal Code.

A split decision between doctor and patient
"Since March 2002, the French law makes it clear that the patient is co-player of care, it is able to do," explains Cécile Laude and Serge Deygas. Treatment decisions must be taken bilaterally.

Article 35 of the Code of Medical Ethics states that the physician owes to his patient "a clear and appropriate fair information on his condition, investigations and treatment he offers."

It is also recommended that the physician record in the medical record information it delivers to the patient, the nature of the questions that he asked him the answers he brings, and the date of decision limiting care, and supportive care as planned. "It's also a way to legally prove that the decision to limit treatment was discussed and decided in conscience," the authors write.

Article 35 also provides that "in the interest of the patient and for the legitimate practitioner appreciates conscience reasons, a patient may be kept in ignorance of a serious diagnosis or prognosis" (cases with risk of contamination of a third party are excluded from this provision).

The physician must then ask the family or someone you trust. The decision will be taken "in a collegial manner, the mode of consensus."

"This should be the exception to avoid the exclusion of patient care and allow it to remain an actor of his care," the authors warn.

Moreover, the demand for therapeutic limitation expressed by a patient at the end of life must be repeated to be taken into account.

And when this desire comes from a patient who is not in a position to end of life, the law on the enforcement of the sick and dying does not apply. The situation is then similar to a denial of care and is managed accordingly to the will of the patient and the severity, the authors say.

"The politicians, the law on therapeutic limitation, permits the establishment of a framework for the protection of patients at end of life and decision support for practitioners," the authors suggest in their conclusion.

"Medicine is a social science, and history of each patient can not be reduced to a law," they point out.