“What is the point of making advance directives known if they are not respected? »

“What is the point of making advance directives known if they are not respected?  »

Pn a decision of November 10, 2022, the Constitutional Council ruled on the compliance with the Constitution of the provisions of the Public Health Code relating to “advance directives”. These, which every citizen can write, are binding on the doctor for any care decision except, in particular, when they appear “manifestly inappropriate or not consistent with the medical situation ».

In a painful case, the high court is seized of a priority question of constitutionality (QPC) by the Council of State. On May 18, 2022, Mr. D was the victim of a terrible accident, run over by a vehicle. He presents an extreme medical picture with in particular an absence of cerebral activity.

The continuation of invasive therapies constitutes an unreasonable obstinacy for the medical team. The person concerned had written a letter for his attending physician on June 5, 2020, indicating the wish, in the event that he would no longer be able to express himself, to be kept alive, even artificially, in the event of a coma. prolonged considered irreversible.

Hope for therapeutic progress

Given the negative outlook for the evolution of the situation, a decision to stop treatment was taken on July 15, 2022 after a collegial procedure, dismissing the advance directives as manifestly inappropriate or not in accordance with the medical situation.

Read also: Article reserved for our subscribers End of life: in a decision that will set precedent, the Constitutional Council rules on the respect of advance directives by doctors

Relatives challenge it and initiate proceedings. On August 19, 2022, the Council of State refers the question to the Constitutional Council, in order to say whether the legislative provisions concerned are in conformity with the Constitution or not.

The second French law on the end of life, known as the Claeys-Léonetti law, of February 2, 2016, reinforced the weight of advance directives, emphasizing the will of the person. The doctor must respect them.

But two hypotheses make it possible to transgress them: vital urgency on the one hand; the acknowledgment of the manifestly inappropriate or non-compliant nature of the directives with the medical situation on the other hand.

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This law of 2016 obviously focused on the hypothesis where the person, wishing a dignified and painless outcome, expresses his will to end his life. The reverse happens here. The patient wishes to live. He writes it, probably hoping for therapeutic progress. But his medical situation is such that no improvement can be expected.

Unreasonable stubbornness

What should be done ? To keep him alive at all costs, in a vegetative state, by conforming to his will? Or retain the character ” inappropriate “ advance directives, and consider that the wish for life must be transgressed because it does not conform to medical reality?

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