Tension between continuous and deep sedation and assistance in dying: a national survey of intensive care professionals' perceptions.

The situation in France is unique, having a legal framework for continuous and deep sedation (CDS). However, its use in intensive care units (ICU), combined with the withdrawal of life-sustaining therapies, still raises ethical issues, particularly its potential to hasten death. The legalization of assistance in dying, i.e., assisted suicide or euthanasia at the patient's request, is currently under discussion in France. The objectives of this national survey were first, to assess whether ICU professionals perceive CDS administered to ICU patients as a practice that hastens death, in addition to relieving unbearable suffering, and second, to assess ICU professionals' perceptions of assistance in dying. A national survey with online questionnaires for ICU physicians and nursesaddressed through the French Society of Anesthesiology and Critical Care Medicine. A total of 956 ICU professionals responded to the survey (38% physicians and 62% nurses). Of these, 22% of physicians and 12% of nurses (p < 0.001) felt that the purpose of CDS was to hasten death. For 20% of physicians, CDS combined with terminal extubation was considered an assistance in dying. For 52% of ICU professionals, the current framework did not sufficiently cover the range of situations that occur in the ICU. A favorable opinion on the potential legalization of assistance in dying was observed in 83% of nurses and 71% of physicians (p < 0.001), with no preference between assisted suicide and euthanasia. Our findings highlight the tension between CDS and assisted suicide/euthanasia in the specific context of intensive care and suggest that ICU professionals would be supportive of a legislative evolution.

Auffray L ，Mora P ，Giabicani M ，Engrand N ，Audibert G ，Perrigault PF ，Fazilleau C ，Gravier-Dumonceau R ，Le Dorze M ... -  《Anaesthesia Critical Care & Pain Medicine》

Controversies surrounding continuous deep sedation at the end of life: the parliamentary and societal debates in France.

Raus K ，Chambaere K ，Sterckx S 《BMC Medical Ethics》

[PAL-PRAT study: Healthcare workers' knowledge and perception of palliative practices in a Cancer Center].

The issue of end-of-life care is the subject of a sensitive debate in French society, particularly regarding the possibility for certain patients to have access to medical assistance in dying. The aim of this study was to assess the knowledge and opinion of healthcare providers on the care practices for patients at the end of life, as well as to highlight any specificities in their discourse. A survey of healthcare providers' opinions, composed of closed and open questions, that were analyzed using a lexicometric approach, was distributed in a cancer center. The results of the study reveal a good knowledge of the different procedures. Professionals considered that advance directives should be systematically collected; a majority of them differentiated euthanasia from deep continuous sedation and perceived the latter as a means of relieving patients' suffering without inducing death. The different procedures related to the active assistance in dying were known by a majority of professionals and the survey did not identify a dominant trend concerning the will to practice euthanasia if the legal framework allowed it. Half of the participants considered their training insufficient, indicating the need to fill this gap. This survey underlines the importance of training and support for the professionals caring for patients in palliative situation and their relatives in France.

Locatelli M ，Flahault C ，Roche N ，Mateus C ，Blot F ，Lucile Montalescot ，Le Provost JB ，Fasse L ... -  《-》

Tensions between end-of-life care and organ donation in controlled donation after circulatory death: ICU healthcare professionals experiences.

The development of controlled donation after circulatory death (cDCD) is both important and challenging. The tension between end-of-life care and organ donation raises significant ethical issues for healthcare professionals in the intensive care unit (ICU). The aim of this prospective, multicenter, observational study is to better understand ICU physicians' and nurses' experiences with cDCD. In 32 ICUs in France, ICU physicians and nurses were invited to complete a questionnaire after the death of end-of-life ICU patients identified as potential cDCD donors who had either experienced the withdrawal of life-sustaining therapies alone or with planned organ donation (OD(-) and OD( +) groups). The primary objective was to assess their anxiety (State Anxiety Inventory STAI Y-A) following the death of a potential cDCD donor. Secondary objectives were to explore potential tensions experienced between end-of-life care and organ donation. Two hundred six ICU healthcare professionals (79 physicians and 127 nurses) were included in the course of 79 potential cDCD donor situations. STAI Y-A did not differ between the OD(-) and OD( +) groups for either physicians or nurses (STAI Y-A were 34 (27-38) in OD(-) vs. 32 (27-40) in OD( +), p = 0.911, for physicians and 32 (25-37) in OD(-) vs. 39 (26-37) in OD( +), p = 0.875, for nurses). The possibility of organ donation was a factor influencing the WLST decision for nurses only, and a factor influencing the WLST implementation for both nurses and physicians. cDCD experience is perceived positively by ICU healthcare professionals overall. cDCD does not increase anxiety in ICU healthcare professionals compared to other situations of WLST. WLST and cDCD procedures could further be improved by supporting professionals in making their intentions clear between end-of-life support and the success of organ donation, and when needed, by enhancing communication between ICU physician and nurses. This research was registered in ClinicalTrials.gov (Identifier: NCT05041023, September 10, 2021).

Le Dorze M ，Barthélémy R ，Lesieur O ，Audibert G ，Azais MA ，Carpentier D ，Cerf C ，Cheisson G ，Chouquer R ，Degos V ，Fresco M ，Lambiotte F ，Mercier E ，Morel J ，Muller L ，Parmentier-Decrucq E ，Prin S ，Rouhani A ，Roussin F ，Venhard JC ，Willig M ，Vernay C ，Chousterman B ，Kentish-Barnes N ，CARE-M3 Research Group ... -  《BMC Medical Ethics》

Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students.

Anneser J ，Jox RJ ，Thurn T ，Borasio GD ... -  《-》