2023-09-19 09:06:49
Context
Numerous debates accompanied the vote on the Clayes-Léonetti law (February 2016) legalizing deep and continuous sedation for end-of-life patients. This included deciding whether euthanasia and assisted suicide might be authorized under certain conditions. These debates are not closed and are often relaunched by opinion surveys. A team from the Assistance Publique Hôpitaux de Marseille noted that in France, none of them had taken an interest in the primary concerns, patients in palliative care. To remedy this, they conducted a national, prospective and multicenter study 1, conducted between 2016 and 2020.
Methodology
The patient selection criterion was to have advanced or metastatic localized cancer requiring palliative care provided in a dedicated hospital department or by a specialized team at the hospital or at home. Of the 410 patients contacted, 331 responded positively. Among the latter, the average age was 66 years (range 21 to 94 years) and 51.4% (n=170) were women.
Results
The vast majority (89.7%; n=297) approved the legalization of deep and continuous sedation in cases of uncontrollable pain, 65.6% (n=217) in cases of psychological suffering without physical pain and 82.2% (n=274) in the event of a request from a patient who has decided to stop life-sustaining care. In addition, 73% (n=244) approved the possible medical decision of this sedation in patients who are not able to express their wishes and whose life support care has been stopped.
Regarding the legalization of assisted suicide (by a doctor), 48.6% (n=161) of respondents approved it, 27.2% (n=90) opposed it and 21.5% (n =80) had no opinions. Finally, 52% (n=172) were in favor of legalizing euthanasia and 22% (n=73) had no opinion on the subject. If this legalization were passed, 42% of patients surveyed said they would consider it for themselves.
Remarkably, only one factor influenced patients’ opinions in this study: those who believe in God were less likely to approve of assisted suicide and euthanasia. The other factors studied (pain intensity, anxiety, location of cancer, treatments administered, general condition, education level and duration of illness) were not significant. However, the authors recognize that “belief in God” is a vague notion, which needs to be explored in other studies.
Limits
They highlight some limitations to their work. The patients interviewed suffered from cancer, it is possible that the results differ for other pathologies. Worsening health can also change results. The survey did not involve patients not receiving palliative care. Finally, the wording of the questions may have influenced the responses of the respondents.
Conclusions
In any case, by comparing their work with other surveys carried out on the subject among other audiences, the authors note that end-of-life patients are mostly less favorable to euthanasia and assisted suicide than the general population. general, but more favorable than palliative care specialists. The first author of the study, Sébastien Salas, adds 2 that “when quality care is put in place and provided, requests for assisted suicide or euthanasia are much less frequent in oncology”. Finally, the general conclusion of this work is that “overall, the Claeys-Leonetti law adequately responds to the expectations and wishes of patients”.
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