End-of-Life: New French Guidelines

At the end of May the French Society for Counselling and Palliative Care (“SFAP”) published 4 documents on its website, which were submitted to the French National Authority for Health (HAS). The intended goal is to update Palliative Care guidelines, after the Claeys-Leonetti law was voted on February 2, 2016.
These documents include three “benchmark guidelines” and a chart of guidelines for practicing sedation.
1° one benchmark guideline is to determine whether or not the situation is life-threatening and the criteria for defining “impending death”.   
Heated debates were held in the French National Assembly concerning this controversial and very subjective term of « impending death ». The definition specified by the “SFAP” working group reads: “Formulating a prognosis for impending death corresponds to life-expectancy in terms of several hours to several days.”  In its’ Good Practice Guidelines, the “SFAP” cautions against profound sedation which could last for weeks if the prognosis is erroneous, and thus sets a maximum two-week limit.
2° a benchmark guideline for refractory pain
Pain is defined as refractory when “all available and appropriate therapeutic measures and accompaniment procedures do not alleviate the patient’s distress, or lead to intolerable undesirable side-effects, or when therapeutic measures are not expected to have an effect within an acceptable time span.”
3° a benchmark guideline for the choice of sedatives
The “SFAP” primarily advocates the use of midazolam (for example Hypnovel) and gives very specific terms and conditions for its use: administration, titration, associated painkillers, patient monitoring, etc.
4° the « SEDAPALL » chart
This document describes the palliative care sedatives administered at the end-of-life, focusing on the intention of the decision, while emphasizing that sedatives must only be administered to relieve the patient from refractory pain, “All other intentions are excluded (especially for shortening the patient’s life span, regardless of whether it motivated by compassion, or requested by the patient.)
All these documents have one point in common: each and every decision for profound and continuous sedation until death must imperatively be subjected to a collegial panel discussion.