Assessment of Withholding and Withdrawing Life-Sustaining Treatments of Deceased Patients in an Emergency Department

Aim: Withholding life-sustaining treatment (WHLST) and withdrawing life-sustaining treatment (WDLST) decisions are ruled by the act of 22 April 2005 on patients' rights and the end-of-life. After its revision on February 2, 2016, this situation remains complex in the emergency department (ED). The aim of our study is to assess WHLST or WDLST decision at ED. Procedure: This was a single-center, retrospective, observational study. The data collection was done by chart review of deceased patients between January 1, 2014 and May 5, 2015. The objective of our work was to describe WHLST or WDLST decisions and their adequacy with the law. Results: We had collected 91 deceased patients' records. Of the 58 cases (64%) where autonomy was found, it was very limited in 50 patients (Knaus C + D) or 86%. The decision was registered in 74 files (81%) but detailed only in 40 (44%). Seventy-five times (83%) the family was informed. In 70 (80%) of the 87 situations where the participants were identified, the collegiate procedure was respected. Palliative therapy was initiated in 67 patients (74%). Conclusion: WHLST or WDLST decisions are still perfectible at ED to be in adequacy with the law. Improvements are possible by integrating staff training programs and protocols of ethical decision support.