Alain Monnier

While the places and causes of death are the subject of abundant literature, the circumstances surrounding the end of life, the ultimate phase of existence, remain largely not explored in France. The pathways through different living places taken by people aged 80 and over during the last month of existence and the factors associated with them are described thanks to the unique information and data collected by the "End of Life in France" survey.

The “Patients’ Rights and End of Life Care” Act came into force in France in 2005. It allows withholding/withdrawal of life-support treatment, and intensified use of medications that may hasten death through a double effect, as long as hastening death is not the purpose of the decision. It also specifies the requirements of the decision-making process. This study assesses the situation by examining the frequency of end-of-life decisions by patients’ and physicians’ characteristics, and describes the decision-making processes.

In France, almost half of deaths (48% in 2010) are preceded by a medical decision that may hasten death. But only in 1% of cases are drugs administered to deliberately end life. The large majority of decisions taken are based on the provisions of the Leonetti Act, which enables physicians, under specific circumstances,to withhold or withdraw treatment or to administer drugs in order to alleviate pain or symptoms that may have the effect of hastening death. However, the legal provisions governing these decisions are still not always fully known or complied with: end-of-life decisions are not always discussed with the patients and medical teams, and very few patients draw up advance directives, as recommended in the Leonetti Act, to express their wishes to the physicians responsible for their care.

En France, près de la moitié des décès (48 % en 2010) a été précédée d'une décision médicale ayant pu hâter la mort du patient. Mais des médicaments ont été donnés pour mettre délibérément fin à la vie dans seulement moins de 1 % des cas. Les décisions prises s'appuient dans leur grande majorité sur les dispositions de la loi Leonetti qui permet sous certaines conditions de limiter ou d'arrêter un traitement, ou d'administrer des médicaments afin de soulager les souffrances du patient, qui peuvent avoir pour effet d'avancer la survenue de la mort. Toutefois, les prescriptions légales encadrant ces décisions ne sont pas encore totalement connues ou respectées : les décisions de fin de vie ne sont pas toujours discutées avec les patients et les équipes soignantes ; la rédaction par les patients de directives anticipées, proposée par la loi Leonetti pour que les soignants prennent en compte leurs souhaits, reste en pratique très rare.