“Advance directives, let’s talk about it! » In the conference room of the geriatrics center of the University Hospital of Poitiers, representatives of around twenty nursing homes in Vienne were present. This Thursday, November 17, they are invited by Estelle Amiot, nurse, and Laurent Montaz, head of the palliative care department, kingpins of the Information and Advance Directives Collection Unit (Cirda).
Objectives of the day: to present this system introduced by the laws of 2005 and 2016 on the end of life, which makes it possible to collect the wishes of a patient in the event that he could no longer express himself, because he is not well known to the French – 40% have heard of advance directives, but only 19% know what it is, according to a 2019 survey by the National Center for Palliative and End-of-Life Care (CNSPFV). Then discuss how it is implemented in their establishment.
“Legally, we know that we must inform the resident about the possibility of writing advance directives. But it’s hard to find the time and the way to talk about it. So, we are often content to distribute a notice and a form”admits a participant. “The problem is that we are increasingly dealing with people suffering from cognitive disorders, even under guardianship, or on whom the weight of families weighs”drops another. “Besides, are we really sure that the wishes of the patients are respected by the doctors? »worries a third.
A unique unit in France
What are advance directives? What are they for ? How to accompany the patients so that they can write them in the best possible way? It was to answer questions from health professionals that the unit led by Estelle Amiot and Doctor Laurent Montaz was created last February, the first and only of its kind in France.
“During the Covid crisis, a visit from the High Authority for Health, which came to certify the safety and quality of the care provided at the CHU, led us to the conclusion that we were not good on this point and that we had to react.says Laurette Blommaert, Director of Legal Affairs. The idea of setting up a pair dedicated to the subject – referring nurse and doctor – quickly took hold. » The project was quickly validated by the Nouvelle-Aquitaine Regional Health Agency, which agreed to finance Estelle Amiot’s position and the 20% of time devoted to it by Laurent Montaz, with the CHU bearing the cost of the training operations. .
Raising awareness of all medico-social structures
“Initially, we thought of going to the bedside of patients to help them write their directivesrecalls Doctor Montaz. But how to respond, together, to all the requests? »
To circumvent the obstacle, the adopted strategy consists in sensitizing all the personnel of the hospital – that is to say nearly 9,000 people -, but also all the medico-social structures which counts the department, of the Ehpad to the associations of caregivers. A task that does not frighten Estelle Amiot more than that, after fifteen years spent in oncology and palliative care services. “Ideally everyone should have heard of advance directives before arriving at the hospital”she dreams aloud.
“On paper, this device is a great step forward because it allows everyone to assert their will. But it remains to make it liveinsisted Laurent Montaz. To do this, we must realize that advance directives are much more than a form with choices to tick. Talking about it with someone, whether they are healthy or sick, is to walk with them on how they see their end. And talking about death is not easy for anyone, neither for the patient nor for the doctor. »
This is probably why, beyond the lack of information from the general public, so few French people – barely 18%, according to an assessment by the CNSPFV – have already written their advance directives. Will the pilot experiment carried out in Poitiers serve as a school for increasing the ratio? “From February to November, we have already trained more than 900 peoplewelcomes Estelle Amiot. And that’s just the beginning ! »
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Advance directives, instructions for use
Any adult, sick or healthy, can write advance directives who express their wishes on the medical acts they are ready to accept, or to refuse, in the event that they are no longer able to express themselves.
These advance directives take precedence over any other opinion of relatives and are binding on doctors, except in cases of emergency and if the will expressed seems “inappropriate” or “not medically compliant”.
They can be written on plain paper or on a dedicated form, dated and signed. Their duration is unlimited but they can be revised at any time by their author.