Withholding and withdrawing treatments' decisions: A loss of chance from the patient's relatives point of view?

The clinical ethics consultations offered by the AP-HP Clinical Ethics Center take place when a medical decision concerning a specific patient seems difficult to make because of ethical stakes. These consultations suppose that, in a given situation, there is a values conflict between the patient or his/her representatives on the one hand, and a health care professional or a care team on the other. When these consultations are requested in situations of withholding and withdrawing treatments (WWT) decisions, the patient's relatives often express the feeling of a loss of chance for the patient as a result of this decision. Using the different meanings of the word "chance", this article proposes to set out the possible meanings of the idea of loss of chance in relation to WWT decisions from the relatives' point of view: a restriction of the patient's scope of possibilities, a deviation from his or her trajectory, an obstacle to the realization of unexpected developments. We shall explore how each of these reactions impact the way relatives understand the team's care project to withhold and/or withdraw treatments and suggest ways to avoid these misunderstandings. (c) Elsevier Masson SAS. All rights reserved.