An Interprofessional Process for the Limitation of Life-Sustaining Treatments at the End of Life in France

Jacob A Blythe; Nancy Kentish-Barnes; Anne-Sophie Debue; Daniel Dohan; Elie Azoulay; Ken Covinsky; Thea Matthews; J Randall Curtis; Elizabeth Dzeng

doi:10.1016/j.jpainsymman.2021.06.016

An Interprofessional Process for the Limitation of Life-Sustaining Treatments at the End of Life in France

J Pain Symptom Manage. 2022 Jan;63(1):160-170. doi: 10.1016/j.jpainsymman.2021.06.016. Epub 2021 Jun 19.

Authors

Jacob A Blythe¹, Nancy Kentish-Barnes², Anne-Sophie Debue³, Daniel Dohan⁴, Elie Azoulay⁵, Ken Covinsky⁶, Thea Matthews⁴, J Randall Curtis⁷, Elizabeth Dzeng⁸

Affiliations

¹ Stanford University School of Medicine (J.A.B.), Stanford, California, USA.
² Assistance Publique Hôpitaux de Paris (APHP) (N.K.-B.), Hôpital Saint Louis, Famiréa Research Group, Paris, France.
³ Assistance Publique Hôpitaux de Paris (APHP) (A.-S.D.), Hôpitaux Universitaires Paris Centre (HUPC), Hôpital Cochin, Medical Intensive Care Unit, Paris, France; UVSQ, INSERM, Équipe Recherches en éthique et épistémologie (A.-S.D.), CESP, Université Paris-Saclay, Paris, France.
⁴ Philip R. Lee Institute of Health Policy Studies (D.D., T.M., E.D.), University of California, San Francisco, California, USA.
⁵ Médecine Intensive et Réanimation (E.A.), Hôpital Saint-Louis, APHP, Paris, France; Université de Paris (E.A), Paris, France.
⁶ University of California (K.C.), San Francisco, California, USA.
⁷ Division of Pulmonary (R.C.), Department of Medicine, Division of Geriatrics, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence (R.C.), University of Washington, Seattle, Washington, USA.
⁸ Philip R. Lee Institute of Health Policy Studies (D.D., T.M., E.D.), University of California, San Francisco, California, USA; Division of Hospital Medicine (E.D.), Department of Medicine, University of California, San Francisco, California, USA. Electronic address: liz.dzeng@ucsf.edu.

PMID: 34157398
DOI: 10.1016/j.jpainsymman.2021.06.016

Abstract

Context: The provision of potentially non-beneficial life-sustaining treatments (LSTs) remains a challenging problem. In 2005, legislation in France established an interprofessional process by which non-beneficial LSTs could be withheld or withdrawn, permitting exploration of the effects of such a legally-protected process and its implementation.

Objectives: To characterize intensive care unit (ICU) interprofessional team decision-making and consensus-building practices regarding withholding and withdrawing of LSTs in two Parisian hospitals and to explore physician and nurse perceptions of and experiences with these practices.

Methods: This was an exploratory qualitative study utilizing thematic analysis of semi-structured, in-depth interviews of physicians and nurses purposively sampled based on level of training and experience from two hospitals in Paris, France.

Results: A total of 25 participants were interviewed. Participants reported that the two Parisian hospitals in this study have each created an interprofessional process for withholding or withdrawing non-beneficial LSTs, providing insight into how norms of decision-making respond to systems-level legal changes. Participants reported that these processes tended to be consistent across several domains: maintaining unified messaging with patients, empowering nurses to participate in end-of-life decision-making, reducing moral distress provoked by end-of-life decisions, and shaping the ethical milieu within which end-of-life decision-making takes place.

Conclusions: The architecture of the interprofessional process created at two Parisian hospitals and its perceived benefits may be useful to clinicians and policy-makers attempting to establish processes, policies, or legislation directed at withholding or withdrawing potentially non-beneficial LSTs in the United States and elsewhere.

Keywords: Care intensity; decision-making; life-sustaining treatments; multidisciplinary team; qualitative research; withholding treatment.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Death
Decision Making
France
Humans
Intensive Care Units
Terminal Care*
Withholding Treatment