Is there any law in France that protects medical patients?

For example, medication that excessively uses drugs as pain killers may result in bad effects.

Can the family/relatives complain about it? How is the procedure?

I want to know whether it's possible to refuse the use of excessive drugs, on the grounds that it doesn't heal the root of the problem but only to suffer more.

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    You have asked two questions in one, which is frowned upon here. I would edit to remove the first, since French patient protection is almost certainly unrelated to nationality or even residence, and focus on the second. I also think the second is more likely to be on topic at expatriates.stackexchange.com – phoog Mar 15 '16 at 16:40
  • Are you asking about whether and how you can withold/deny/withdraw/discontinue consent for a medical treatment (e.g. pain killers) proposed by the doctor, or, are you asking what the procedure is to bring a legal complaint about treatment which was give in the past? – ChrisW Mar 16 '16 at 0:50
  • This law for example is about informed consent and says what I would have guessed it would say, i.e. that doctors need informed consent from the patient, or from the patient's proches (i.e. from their "near", like kin, except that it can mean family or anyone else who the patient has designated as being the person in whom they have "confidence", including e.g. the person's GP -- this designation IMO requires lucidity but not a notary, they can give you a form at the hospital), except in emergency. – ChrisW Mar 16 '16 at 1:37
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    Google Translate will do an IMO adequate job. See also e.g. chu-nice.fr/patient-visiteur/vous-informer/droits-du-patient/… (which is a random hospital explaining it in a more lay language). Note that doctors are allowed to argue in favour of a course of treatment; but I think that the patient (or their next of kin or their "designated trusted person") should (must in principle) be consulted and may say no. Also (if it's in a hospital) one or more of the doctors may speak some English. – ChrisW Mar 16 '16 at 2:09
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    @rusticmystic -- if you have the google chrome browser it should automatically offer to translate the entire page. – Soren Mar 16 '16 at 14:32

This is a law about informed consent.

I won't translate it verbatim, but it says more or less what one might have guessed it would say: i.e. that doctors need informed consent from the patient; or must consult with the patient's proches, except in emergency.

The noun proches literally means the patient's "nears", which is a word like "kin" except that in this case it can mean family, or it can mean anyone else who the patient has designated as being the person in whom they have "confidence", which could even include e.g. the person's GP -- effecting such a designation doesn't need a notary (but may require lucidity): they can give you a form at the hospital.

The above is a law, i.e. one of the laws: there are others -- see e.g. France passes new end-of-life legislation to alleviate suffering dated 2015, which also mentions a 2005 law (named la loi Leonetti):

France legalised “passive euthanasia” in 2005, where treatment, needed to maintain life is withheld or withdrawn

I don't know of English transcriptions of these laws, but Google Translate provides an IMO mostly-understandable translation of such web pages. Alternatively it's my experience that in a French hospital you may find that the doctor (or at least, that one of the doctors or nurses) can talk in English.

See also e.g. http://www.chu-nice.fr/patient-visiteur/vous-informer/droits-du-patient/1963-consentement-du-patient-et-le-refus-de-soins (which is a random hospital explaining the "informed consent" and in a more lay language).

Note that doctors may recommend or argue in favour of a course of treatment, and not accept a first refusal, and are for example expected to inform you of the likely consequences of withdrawing from treatment (that's part of your being "informed" so that you can give or refuse informed consent), which I suppose could seem like a refusal on their part; but so far as I know (i.e. in theory, based on the information such as I've referenced here) the patient (or their next of kin or their "designated trusted person") should (must in principle) be consulted and may say no.

As an aside, some people's personal experience has been that sometimes it seems as if some French doctors are more willing to divulge apparently bad news (e.g. a fatal or terminal prognosis) to the patient's kin than to the patient themselves.

Reading the small print of Article 36 again isn't entirely clear:

  • Clearly the patient has a right to refuse treatment.
  • Equally clearly in case of emergency the doctor doesn't need permission before treating.
  • What's less clear is whether the the proches are allowed to refuse consent if the patient is incapable: what it actually says is that the doctor must "consult" with the kin.

So actually the other http://www.chu-nice.fr/patient-visiteur/vous-informer/droits-du-patient/1963-consentement-du-patient-et-le-refus-de-soins text has this paragraph which gives additional detail:

1- Patient hors d’état d’exprimer son refus :

Lorsque le patient est hors d’état d’exprimer sa volonté, que ce soit du fait d’un état passager limitant ou abolissant tout discernement (toxicomanie…) ou d’un état comateux ou d’inconscience passagère, le médecin doit prévenir la personne de confiance s’il en existe une, ou à défaut un proche.

Face au refus de soins exprimé, au nom du patient, par la personne de confiance, ou un proche, ou par le patient dans ses directives anticipées, le médecin va devoir mettre en place une procédure dite collégiale où l’intervention de la personne de confiance ou du proche n’est que consultative.

Pour prendre la décision de respecter ou non ce refus de soins, le médecin va devoir se concerter avec son équipe médicale et soignante, demander l’avis médical motivé d’un confrère. Une fois la concertation de l’équipe et la consultation du confrère médecin, le médecin prend une décision qui doit prendre en compte l’avis de la personne de confiance ou du proche.

... which says that if the patient isn't in a state to express their will (e.g. drunk, comatose, unconscious) the doctor must notify the patient's "personne de confiance" or failing that someone else close to them. If that person refuses in the name of the patient, then the doctor must put in place a "collegial" process where the intervention of the kin is merely consultative. To decide whether to respect the refusal of treatment the doctor will have to decide in concert with their medical and treatment team and ask advice from a colleague (and then decide, taking advice into account).

In other words, the kin or person of confidence (in other countries may be a.k.a. "guardian") may refuse treatment and their refusal will be taken into account and yet might not be the final decision -- the final decision might be overruled by a quorum of doctors.

There may also be an "advanced directive" previously written by the patient. The doctor may ask the patient or kin) whether there is such a directive -- and if there is, then the directive will have some weight that's similar to the weight of a kin's input (i.e. the doctor will consult it, but isn't in every case necessarily bound by it).

  • Can the use of excessive drugs be classified as "masked euthanasia"? Can it be done at places outside of the hospitals (ex. home care, retirement place, etc.)? – rusticmystic Mar 17 '16 at 6:14
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    The answer to the latter question might I guess be "it depends" (perhaps depending e.g. on what care and treatment the patient needs and maybe too how frequently they need to see a doctor) and is I'd guess a question for the kin to put to the doctor. People in France have typically/ideally each chosen a "medecin traitant" (their primary physician or family doctor, who refers the patient to specialists when necessary). If you find it difficult to talk to a specialist-doctor a second way is to talk with the medecin traitant (part of whose job seems to be to coordinate care and explain it). – ChrisW Mar 17 '16 at 8:10
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    This and this say that though most people want to die at home, medical treatment (which is more and more complex) can be complicated or impossible to arrange and deliver at home. Here is an English translation of a demographics paper from 2015, A majority of people would prefer to die at home, but few actually do so, FYI, which includes background details. – ChrisW Mar 17 '16 at 8:52
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    @rusticmystic I don't find that with Google either. The French phrase seems to me unnatural, contrived to make the acronym, yet the acronym only makes sense in English ("shade" isn't a French word). But here I found the practice (not an organization) described as HAD. Some people (e.g. Buddhists) deem it better to be lucid and therefore to minimize pain killers, but most people prefer to minimize pain instead. Also it might be possible for kin to stay next to a dying patient's bed 24x7 which can make things easier for everyone. – ChrisW Mar 18 '16 at 9:21
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    @rusticmystic There's a cancersupportfrance.fr/need-some-help organization who might be able to advise; they link to this (French) page about 'to know your legal rights', at the bottom of which is phone numbers to contact (French) lawyers from the French league against cancer, who might be able to advise. Or Googling for English lawyer in France found this list on the Australian embassy's web site. – ChrisW Mar 19 '16 at 8:46

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