Issues and applications in neurological pathologies of the French "Leonetti law" relative to the patients' rights and the end-of-life practices Volume 2, issue 7, septembre 2010

Centre SLA-MMN, neurologie, Hôpital Roger-Salengro, Lille Cedex

The Leonetti law outlaws excessive professional practice leading to prolongation of life by medical means. Any treatment, including artificial nutrition may be withheld or withdrawn. The law defines 3 situations, in which : the patient is conscious and at end of life, conscious and not at end of life, and unconscious (whether or not at end of life). In the case of a conscious end of life patient who requests a limitation of care, the doctor is obliged to respect the patient’s request and inform the patient of the consequences. For a person who is not end of life the doctor must respect the patient’s request, inform him/her of the consequences and do all in his/her power to convince the patient, and the patient must repeat his/her request after a reasonable period of time. If a patient is unable to express his/her own will the law requires that the patient’s will and collegiate discussion, which must reach a consensus, be respected. The will of the unconscious patient should be investigated by the practitioner through advanced instructions which the patient may have written within 3 years, or failing this from reportage by the trusted person and those close to the patient. The law stipulates that the decision of the trusted person will prevail over any other non-medical opinion. The collegiate procedure indicates consultation with the care team and with a doctor other than the doctor in charge of the patient and not within that doctor’s line management. In all situations, the patient’s will, the medical decision and its justifications and medical actions will be recorded in the patient dossier for the purposes of transparency and the sick person will receive palliative care.