The intensivist at the heart of the end-of-life social debate, three years after the Claeys-Leonetti act

Abstract

The Claeys-Leonetti act has been voted three years ago. It introduces “deep continuous sedation until death” in specific conditions, gives patients’ advance directives a compelling status for medical doctors, and institutes an official mutual trust between the patient and his/her designated representative. This act remains partially ignored and therefore low quality of the end of life is still reported. Particularly, the decision to define short-term vital prognosis to few hours or days has been perceived as too restrictive for some patients who suffer from chronic or acute diseases with longer but ineluctable prognosis. Also, nutrition/hydration termination as part of the end of life process remains diversely interpreted. As a whole, these limits fuel a persisting call for a new law in which euthanasia and medically assisted suicide could be included. This was also expected since autonomy which now represents a central ethical value that can be viewed as a response to the rapid progress of modern medicine. This call for a new act must however be weighed against potential consequences of a societal utilitarian turn. Indeed, although both euthanasia and assisted suicide have been instituted in Benelux for the last 20 years, this is still debated there. The priorities are to inform about the potential of the current law as well as to develop a global policy to decrease sensations of disgraceful end of life. Intensive care teams must remain central in the construction of this new policy, as their decision in the end of life process impact patients’ short and long-term prognosis.