End-of-life in the intensive care unit: is Leonetti’s law sufficient?

Abstract

For a long time, there have been concerns with patients’ end-of-life in the intensive care unit (ICU), leading to the publication of French guidelines updated in 2009, taking into account the insights given by Leonetti’s law in regarding patients’ rights at end-of-life. Following the mission given to Professor Didier Sicard by the French president about end-of-life, the French society of intensive care (SRLF) wished to know the feelings of their members (physicians and nurses) about various aspects of end-of-life in the ICU. SRLF members were invited to respond to a questionnaire, directly sent by e-mail, in order to assess their knowledge about Leonetti’s law and to show how many caregivers agree with the authorization of lethal drug administration in selected situations of end-of-life. Out of 2700 requests, 616 answers were analyzed. A majority (82.5%) had a good knowledge of Leonetti’s law and most of them (88%) said they have often applied the law. They reported to have received a “help dying” request from a patient (one-third of respondents) and patient’s relatives (more than 50%). A quarter of the respondents agreed to give lethal drugs to end-of-life patients. Assuming that palliative cares in the ICU are wellconducted, 25.7% of the respondents would approve though a law authorizing euthanasia exception, while 26.5% did not. Answers were influenced by the fear of a possible risk of abuse. Doctors and nurses answered differently. In conclusion, Leonetti’s law appears well-known by ICU caregivers. Nevertheless, in selected clinical situations with adapted palliative care, a quarter of the respondents would be in favor of a law authorizing lethal drugs administration to patients.