The role of the intensive care physician in the process of reflection on advance directives

Médecin intensiviste et aide à la réflexion à propos des directives anticipées

Abstract

Advance directives (AD), which have been part of French legislation since 22 April 2005, have been binding on doctors since the law of 02 February 2016. They are now an expression of the patient's wishes, rather than their own. It is therefore reasonable to imagine that ADs can be considered and drafted at any point in the patient's care, and that they can also address all the potential developments in the disease and, in particular, the possibility of admission to intensive care. In this article, the authors discuss the role of the intensive care physician as a privileged interlocutor in the patient's care pathway and his or her potential role in the early development of therapeutic objectives, which may include the drafting of ADs. The question of useful tools and strategies for meeting these objectives is addressed, including the question of the appropriateness of admission to intensive care. Ideas were also discussed, such as improving communication and anticipating discussions, which could be traced in the internet space developed by the Assurance Maladie: "Mon Espace Santé", section "Entourage et Volontés".