Maintien artificiel de la vie, comment limiter ou arrêter le traitement

FlickR - Pattenburg Tunnel - Owls Flight PhotographyLe législateur a souhaité, par décret n°2010-107 du 29 janvier 2010, davantage associer à la douloureuse décision de limiter ou d’arrêter un traitement « inutile, disproportionné ou n’ayant d’autre objet que la prolongation artificielle de la vie », la famille et les proches d’un patient hors d’état d’exprimer sa volonté, soit par suite d’une affection grave et incurable – on pense notamment au cancer -, soit par suite d’une complication, ou d’un accident ayant plongé ledit patient dans le coma.

Désormais, le médecin peut, de sa propre initiative (le décret le précise expressément), engager la procédure collégiale visant à prendre la décision de limiter ou d’arrêter le traitement dont un patient, plongé dans un coma a priori sans retour, fait l’objet.

Contrairement à l’ancienne réglementation, les détenteurs des directives anticipées du patient, la personne de confiance, la famille, ou le cas échéant l’un des proches, sont dorénavant informés, dès qu’elle a été prise, de la décision de mettre en oeuvre la procédure collégiale.

Cette décision doit obligatoirement :

  • soit se conformer à la teneur des directives anticipées émises, le cas échéant, par le patient et détenues par les personnes mentionnées à l’article R.1111-19 du code de la santé publique ;
  • soit faire suite à une demande en ce sens de la personne de confiance, de la famille ou, à défaut de l’un de l’un des proches.

Traçabilité oblige, cette décision est inscrite dans le dossier médical (article L.1111-4, 5ème alinéa et article L.1111-13, 1er alinéa du code de la santé publique).

La personne de confiance, si elle a été désignée, la famille ou, à défaut, l’un des proches du patient sont informés de la nature et des motifs de la décision de limitation ou d’arrêt de traitement.

Le décret ajoute enfin un nouveau paragraphe à l’article R.4127-37 ainsi rédigé :

« III. – Lorsqu’une limitation ou un arrêt de traitement a été décidé en application de l’article L. 1110-5 et des articles L. 1111-4 ou L. 1111-13, dans les conditions prévues aux I et II du présent article, le médecin, même si la souffrance du patient ne peut pas être évaluée du fait de son état cérébral, met en œuvre les traitements, notamment antalgiques et sédatifs, permettant d’accompagner la personne selon les principes et dans les conditions énoncés à l’article R. 4127-38. Il veille également à ce que l’entourage du patient soit informé de la situation et reçoive le soutien nécessaire. »

L’article R.4127-38 du code de la santé publique renvoie au code de déontologie médicale prescrivant aux praticiens d’assurer par des soins et mesures appropriés la qualité d’une vie qui prend fin, sauvegarder la dignité du malade et réconforter son entourage.

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