CLINICAL ETHICS

Participation of French general practitioners in end-of-life decisions for their hospitalised patients

E Ferrand¹, P Jabre¹, S Fernandez-Curiel¹, F Morin¹, C Vincent-Genod¹, P Duvaldestin¹, F Lemaire², C Hervé³ and J Marty¹

¹ Service d’Anesthésie Réanimation-SAMU 94, Hôpital Henri Mondor, AP-HP, Créteil, France
² Service de Réanimation Médicale, Hôpital Henri Mondor, AP-HP, Créteil, France
³ Departement d’Ethique Médicale et de Médecine Légale, Faculté de médecine des Saints-Pères—Paris V, Paris, France

Correspondence to:
Correspondence to:
Dr Edouard Ferrand
Service d’Anesthésie Réanimation SAMU 94, Hôpital Henri-Mondor, AP-HP 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil cedex, France; edouard.ferrand{at}hmn.aphp.fr

Background and objective: Assuming the hypothesis that the general practitioner (GP) can and should be a key player in making end-of-life decisions for hospitalised patients, perceptions of GPs’ role assigned to them by hospital doctors in making withdrawal decisions for such patients were surveyed.

Design: Questionnaire survey.

Setting: Urban (districts located near Paris) and rural (southern France) areas.

Participants: GPs.

Results: The response rate was 32.2% (161/500), and it was observed that 70.8% of respondents believed that their participation in withdrawal decisions for their hospitalised patients was essential, whereas 42.1% believed that the hospital doctors were sufficiently skilled to make withdrawal decisions without input from the GPs. Most respondents were found to believe that they had the necessary skills (91.9%) and enough time (87.6%) to participate in withdrawal decisions. The last case of treatment withdrawal in hospital for one of their patients was described by 40% (65/161) of respondents, of whom only 40.0% (26/65) believed that they had participated actively in the decision process. The major factors in the multivariate analysis were the GP’s strong belief that his or her participation was essential (p = 0.01), information on admission of the patient given to the GP by the hospital department (p = 0.007), rural practice (p = 0.03), visit to the patient dying in hospital (p = 0.02) and a request by the family to be kept informed about the patient (p = 0.003).

Conclusion: Strong interest was evinced among GPs regarding end-of-life issues, as well as considerable experience of patients dying at home. As GPs are more closely corrected to patients’ families, they may be a good choice for third-party intervention in making end-of-life decisions for hospitalised patients.

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