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Institutionalized form for withholding or withdrawing life-sustaining treatment in paediatrics: Feedback from Robert Debré Hospital (Paris) Volume 24, issue 1, January-February-March 2022

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Authors
1 Hôpital Universitaire Robert Debré, Équipe mobile d’accompagnement et de soins palliatifs pédiatriques, Bd Sérurier, 75019 Paris
2 Hôpital Universitaire Robert Debré, Service de néphrologie pédiatrique, Bd Sérurier, 75019 Paris
3 Hôpital Universitaire Robert Debré, Service de néonatologie et réanimation néonatale, Bd Sérurier, 75019 Paris
4 Hôpital Universitaire Robert Debré, Service de neurologie pédiatrique, Bd Sérurier, 75019 Paris
5 Hôpital Universitaire Robert Debré, Service de réanimation et surveillance continue pédiatriques, Bd Sérurier, 75019 Paris
6 Hôpital Universitaire Robert Debré, Service mobile d’urgence et de réanimation (SMUR Paris), Bd Sérurier, 75019 Paris
7 Groupe de travail « décisions concertées » Membres du Groupe de travail « décisions concertées » : S. Abruzzese, S. Aizenfish, A. Baruchel, O. Baud, B. Benier, C. Beyler, C. Borie, A. Bourrillon, B. Brethon, J-H. Dalle, C. Farnoux, A. Faye, M. Gabolde, S. Guilmin-Crépon, J-P. Hugo, A. Kempf, L. Lacour, B. Lescoeur, V. Monier, A. Munck, J. Naudin, S. Pichard, D. Poisson, S. Pontone, F. Renaldo, S. Soudee, D. Vernier, J. Viala.
* Correspondance : A. Nicolas-Robin

Since 2005, performing acts or administering treatments when they appear to be useless, disproportionate or having no other effect than the artificial prolongation of life, defining the unreasonableness of a curative treatment, is prohibited by the French law. In the case of nonemancipated underage patients, the physician in charge is required to respect a collegial procedure before deciding to withhold or withdraw treatments. A preformatted sheet, to be filled during the deliberation, makes it possible, to recall the legal elements that the procedure must include, and the medical and non-medical arguments that must be considered to guarantee the quality of the discussion before the physician makes his or her decision. It thus ensures the tracing of the justification of this medical decision, and establishes a framework for the information given to holders of parental authority. Through formalization it, it constitutes an undeniable educational tool for the ethical and palliative acculturation of caregivers who are less experienced in this process. Finally, it can facilitate research work by providing easier access to systematized data. The institutionalization of such a sheet, authorizing all caregivers in the same hospital to share the same document, facilitates the appropriation of the tool by everyone. The computerization of the sheet, within the shared medical file, should allow the optimization of the sharing of the information to all the caregivers who require it, and the essential updating of the decision, after a maximum period of three months.