Provision of the Leonetti-Claeys law in France: Palliative or terminal sedation?

In this article, we discuss whether the Leonetti-Claeys Device regarding sedation instituted by the French February 2, 2016 law (LCD) comes under palliative sedation or terminal sedation, and where do the latest guidelines stand regarding this matter. It turns that the LCD doesn't seek to lower, in a fitted and proportionate way, the perception of refractory symptoms, in the respect of the end of life relational issues which would match palliative sedation. It rather consists in mastering the conditions of dying by the standardized application of a procedure of psychological and relational disconnection, and constitutes subsequently a classic example of terminal sedation. Behind this change of paradigm, a dual reduction can be feared: one of dignity to the dying conditions' control, and one of the relationship to a "right to". Conversely, the guidelines published by the French society for support and palliative care (Societe francaise d'accompagnement et de soins palliatifs [SFAP])) and the French health agency (Haute Autorite de sante [HAS]) did their best to put the LCD into a palliative aim. They distinguish now between proportionate sedation and disproportionate sedation. But question is to know whether the register itself of this efforts, highly protocolized, won't however strengthen the inner technical logic of the LCD. In addition, the HAS's comparative table between LCD and euthanasia is erroneous. At last, the LCD leads to a care that is more intensive than palliative. Such is the paradox of a technical response to the relational concerns of the end-of-life suffering. (C) 2019 Elsevier Masson SAS. All rights reserved.