Bioethics Blogs

Lessons from France: Decision-Making At the End-of-Life

by Craig Klugman, Ph.D.

In the United States, the notion of autonomy is held in high regard. Since the development of patient’s rights in the early 1970s, the notion that an individual has the capacity of self-governance is a cornerstone of medical ethics and a standard of medical care. But that idea has not always been held. In the early and middle parts of the 20th Century, patients were often not told about terminal diagnoses. The joke about doctors curing through the words, “take two aspirin and call me in the morning” derives from the practice that patients were not only not told about their conditions, but were also given treatments without any discussion of what the drugs would do (or not do).

A recent New York Times article talks about a shifting patient culture in France. In that country, the law holds when a patient lacks competency or capacity that a physician makes the decisions after consulting with the family. The physician does not have to listen to the family, or follow the family’s instructions, just has to consult with them. This power arises from a French trust in authority and a strong belief that with his or her years of training and experience, the physician is in the best circumstance to make life and death decisions. The physician is believed to be away from any emotional turmoil and family disputes, able to make a more reasoned, objective assessment.

It was not until 2002 that the French had the right access their medical files.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.