Continuous Deep Sedation Until Death: First National Survey in France after the 2016 Law Promulgating It

• Published in: Journal of pain and symptom management 2021-10, Vol.62 (4), p.e13-e19
• Main Authors: Bretonniere, Sandrine, Fournier, Veronique
• Format: Article
• Language: English
• Subjects: Continuous deep sedation; general practitioners; hospital settings; patients’ rights; qualitative research, end-of-life care; surveys
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2021.03.009

The French parliament passed a groundbreaking law in 2016, opening a right for patients to access continuous and deep sedation until death (CDS) at the end of life, under conditions. Parliamentarians’ goal was to consolidate patients’ rights whilst avoiding legislating on medical aid in dying. To conduct a first national retrospective survey on CDS to evaluate the number of CDS requested, proposed and performed in 2017 and to elicit qualitative data from physicians on the practice and on the terms used by patients to refer to CDS. Early 2018, an online survey was sent to all French hospitals, nursing homes, hospital at homes services and general practitioners (GPs). Descriptive statistics and qualitative inductive content analysis were used to analyze the data and comments of respondents. The qualitative data show that respondents generally approve the law on CDS as it sets a legal framework; nonetheless, there is a persistent controversy about CDS vs. euthanasia for some physicians in all settings. GPs reported limited access to midazolam and the difficulty in organizing multidisciplinary procedures as major constraints. In hospital settings in particular, differentiating CDS from other sedation practices is uneasy. All physicians reported patients use multiple elements of language to request CDS. After the law was passed in France, CDS were requested, proposed and performed in all medical settings, in nursing homes, at home. The qualitative data presented here show the relevance of exploring physicians’ reflexive stances on this practice in different settings and within the context of a patient-physician relationship marked by a new patient's right. The study highlights the wide range of elements of language used by patients at the end of life, as understood by respondent physicians to mean a request for CDS and underscores the polymorphous meaning of CDS.