Determinants of favorable or unfavorable opinion about euthanasia in a sample of French cancer patients receiving palliative care.

BACKGROUND: Opinion about euthanasia has been explored among the general population and recently in patients receiving palliative care. 96% of the French population declared themselves in favor of euthanasia while less of 50% of palliative care patients are. The aim of the present study was to explore and identify potential determinant factors associated with favorable or unfavorable opinion about euthanasia in a French population of cancer patients receiving palliative care. METHODS: We performed a cross-sectional study among patients in two palliative care units. Eligible patients were identified by the medical staff. Face-to-face interviews were performed by two investigators. Two groups were defined as favorable or unfavorable about euthanasia according to the answer on the specific question about patient opinion on euthanasia. A multivariate analysis including age, belief in God, chemotherapy and gender was built. RESULTS: Seventy-eight patients were interviewed. Median age was 60.5 years (range: 31-87.2). In univariate analysis, patients with a favorable opinion were most often under 60 years old (62 versus 38% unfavorable; p = 0.035), in couple (64 versus 35%; p = 0.032), didn't believe in God (72 versus 28% were non-believers; p < 0.001) and had more frequently an history of chemotherapy treatment (58 versus 42% received at least one cycle of chemotherapy; p = 0.005). In a multivariate analysis, age <  60 years, absence of belief in God and an antecedent of chemotherapy were independently associated with a favorable opinion about euthanasia (OR = 0.237 [0.076-0.746]; p = 0.014, OR = 0.143 [0.044-0.469]; p = 0.001, and OR = 10.418 [2.093-51.853]; p = 0.004, respectively). CONCLUSION: We report here determinants of opinion about euthanasia in palliative care cancer patients. Thus, young patients who do not believe in God and have a history of chemotherapy treatment are more likely to request the discontinuation or restriction of their treatment. A better understanding of these determinants is essential for the development of information and/or interventions tailored to the palliative context.

Opinions about the new law on end-of-life issues in a sample of french patients receiving palliative care.

BACKGROUND: In February 2nd 2016, the French government enacted the Claeys-Leonetti law that forbade euthanasia and established the right to deep and continuous sedation for end-of-life patients. Moreover, the law also obliges clinicians to abide by any advance directives regarding treatment and investigation, except in cases where they are "obviously inappropriate" in a given medical situation, or in cases of emergency, in order to allow medical staff to take time to assess the patient's situation. Artificial feeding and hydration are considered as treatment. The aim of this report is to investigate individuals receiving palliative care about their opinion about euthanasia, about advance directives, about the right to deep and continuous sedation, and the right to stopping artificial feeding and hydration. METHODS: The study was an opinion survey conducted among patients treated in two different palliative care institutions: a palliative care unit at the University Hospital (Timone, Marseille, France) and a non-profit association palliative care home ("La Maison", Gardanne, France). Face-to-face interviews were performed by two investigators. The survey included sociodemographics, clinical data, and opinions about euthanasia, deep and continuous sedation, stopping artificial feeding and hydration, and advance directives. RESULTS: Forty patients were interviewed. The mean age was 59.8 years (standard deviation 12). Fifty three percent reported opposition to legalized euthanasia. Eighty three percent were in favour of the right to deep and continuous sedation in patients with refractory pain, 75% when it concerns a patient unable to express their wishes, and 68% when the patient decides to stop vital treatment. Fifty eight percent reported that artificial nutrition and hydration should be considered as care. Fifty eight percent of the patients interviewed would like to see doctors follow the express wishes contained in advance care directives and 53% that advance directives should be subject to a validity period. CONCLUSIONS: This work demonstrates the feasibility of discussing sensitive issues such as euthanasia, continuous and deep sedation and cessation of care with patients receiving palliative care. These preliminary results point to the need to perform a larger study in order to find determinant factors in this specific situation and to incorporate them into thinking about end-of-life laws.

[Palliative care and legislation]. / Soins palliatifs et législation.

PALLIATIVE CARE AND LEGISLATION. Defined by the circular of August 26, 1986, palliative care is provided to people at the end of life, helping to relieve their suffering. Since the law of June 9, 1999, access to palliative care has been a right of all patients. With a view to alleviating suffering, human resources are mobilized to support the sick person. While human relationships play a central role, technology is also called. Caregivers have a responsibility to provide palliative care, as they are bound by professional ethics. Doctors and nurses have a duty to accompany the dying person to his final moments, ensuring the quality of a life that is coming to an end through appropriate care and measures. They are liable for any breach.

SOINS PALLIATIFS ET LÉGISLATION. Définis par la circulaire du 26 août 1986, les soins palliatifs sont dispensés à des personnes en fin de vie et contribuent au soulagement des souffrances. Depuis la loi du 9 juin 1999, l'accès aux soins palliatifs est un droit des personnes malades. Dans une optique de conjuration de la souffrance, des moyens humains sont mobilisés à travers l'accompagnement de la personne malade. Si les relations humaines occupent une place centrale, la technique est également sollicitée. Les soignants ont une responsabilité dans la délivrance des soins palliatifs, puisque la déontologie les y oblige. Le médecin et l'infirmier ont notamment le devoir d'accompagner le mourant jusqu'à ses derniers moments en assurant, par des soins et mesures appropriés, la qualité d'une vie qui prend fin. Leur responsabilité est engagée en cas de manquement.