The trustworthy person designated to speak for the patient

To ensure that his wish will be respected even if it finds unable to express it, a hospitalized patient may designate a spokesperson substitution: the confidential
Moral and legal obligations
The state of a patient with cancer may degrade to the point of preventing caregivers to express their will and the decisions he wants to take his health.

The Law of 4 March 2002 allows him to designate in writing, for the duration of hospitalization (or longer if desired), a "person of trust" single, which can be a parent, relative, or doctor contractor.

Unlike the "one to avoid" that caregivers should contact in case of need but has no responsibility for the medical care, the "person of trust" when she accepts his mission, obligations, moral and legal, vis-à-vis the patient.

Exception to confidentiality, it is still required to comply, it may be allowed to attend medical appointments and procedures.

Indeed, it has a mission to accompany the patient and the support throughout treatment. It must be close to both neutral and bring the word of the patient when it is no longer able to do so.

Thus, when the patient's condition does not allow him to express an informed, the trusted person is consulted by the health care team for all important decisions (continuation or discontinuation of treatment, ...) and its opinion prevail over the other.

However, the responsibility for the final decision rests with the medical team, probably because the legislature did not want to burden the conscience of the person of trust "the risk of excessive sense of responsibility or a guilt, "analyzes Dr. Régis Aubry, national coordinator of the development plan for palliative care and support.

Difficulties of implementation
"The person of trust: legal fiction or real action," questioned Dr. Aubry, also responsible douleurins palliative department at the University Hospital of Besançon, at the 8th National Congress of Grasspho (Reflection Group on the care and support support for patients in hematology and oncology), held in Tours.

Joined by the APM, Dr. Aubry slice: "This is a legal reality, but difficult to implement."

Indeed, "designate a trusted person requires the patient to project themselves into a situation worse than it lives gravity, to imagine unable to express their will. This is necessarily difficult and can do violence to the person, "he says.

This anticipation can be very hard living, unless there is a real skill of the caregiver who speaks. This requires it to a culture and ethics of discussion with the patient, he said.

In addition, "there is a kind of procedural application of the concept of trusted person: as it is written in the law, we now tend to ask who is the person trusted too quickly from my point of view "says Dr. Aubry.

"In theory, it is proposed to appoint a trusted person in any hospital. I tend to say 'when a disease worsens when a disease has all the signs of an incurable" considers Does there.

A source of tension designation
Besides this designation may be a source of tension, especially among relatives of the patient who has not been selected.

The term "person of trust" is perhaps not well chosen because it may suggest that others are not trustworthy, "suddenly it can cause disagreements," says Dr. Régis Aubry.

Moreover, the important thing is not to have a name, but to ensure that the person understands the mission entrusted to it (...) it takes time, requires several parties, and is appeal to a kind of relational competence, it would perhaps develop, the doctor suggests.

Moreover, in case of brain tumors, for example, "not everything is all white or all black" people have "periods of lucidity and confounding periods", it is then not "inappropriate to the opinion of the trusted person in the presence of maladei person, "he says.