Abstract
The French and German cultural and legal decision-making frameworks concerning professional practices at the end of life differ. This has an impact on the way ethical questions are addressed, but it is unclear to what extent such differences also concern “everyday” questions and decisions in the care and treatment of critically ill and dying patients, as they occur especially in intensive care units (ICUs). This contribution draws on results from two parallel qualitative studies in the ICUs, one in France and the other in Germany, concerning the role of time in end-of-life decisions. The results are discussed comparatively against the national legal regulations on Advance Directives as well as the withdrawing and withholding of treatment. Although the legal basis for decisions differs in the two countries, the studies show remarkably similar ethical challenges and problems. It is argued that besides the law, other important factors – such as medical professionalism – might influence physicians’ behaviour in end-of-life decision-making at the ICU and should be given more consideration.
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Notes
- 1.
The French concept of “unreasonable obstinacy” indicates that therapies have been continued beyond what may be considered as reasonable. It is the functional equivalent of the expression “futile treatment”. For an interesting analysis of the difference between the two terms, see Fournier (2017).
- 2.
Law n° 2016-87 of 2 February 2016. (https://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000031970253&categorieLien=id. Accessed 17 February 2020).
- 3.
Translation by authors.
- 4.
Art. L. 1111-11 of n° 2016-87 of 2 February 2016.
- 5.
Marta Spranzi conducted the study as the principal investigator, with two of the Center’s doctors, Véronique Fournier and Nicolas Fouteur.
- 6.
Whereas the “equivalence thesis” for WD and WH is widely considered as ethically justified, there is empirical evidence that doctors perceive WD as more morally problematic than WH. The empirical study is also meant to explore doctors’ preferences and, above all, their reasons for them.
- 7.
Approval from an institutional review board committee is not required in France if interviews do not involve patients.
- 8.
The study was conducted by Anna-Henrikje Seidlein and Sabine Salloch together with Andre Nowak and Matthias Gründling.
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Seidlein, AH., Salloch, S., Spranzi, M. (2022). The Role of Time in End-of-Life Decision-Making at the Intensive Care Unit in France and Germany: Qualitative-Empirical Data and Ethical Reflection. In: Seidlein, AH., Salloch, S. (eds) Ethical Challenges for Healthcare Practices at the End of Life: Interdisciplinary Perspectives. Philosophy and Medicine, vol 141. Springer, Cham. https://doi.org/10.1007/978-3-030-83186-8_5
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