Study of the Consequences of Infection on Compliance of Modalities of Decisions of Limitations and Stops of Treatments (COVID-19-LAT)

University Hospital, Clermont-Ferrand2,500 enrolled

Overview

This survey is performed to examine if during the Covid's crisis, the practitionner's have respected the modalities of the law about the end of life, in particular concerning limitations and stop of therapeutics

In the current legislativ context notably the Clayes Leonetti law, a very large majority of ICU (Intensive Care Unit) patients die with the establishement of a procedure for the limitation and cessation of therapeutics (LAT). During a viral pandemic, medical resources can be saturated, limiting reflexive abilities in favour of binary decisions. This sorting of patients leads to LAT that could be performed without the elementary modalities stated by the law. Thus, arbitrary medical decisions made alone could expose patients to unjustified " loss of luck ". Increasing the resources mobilized during a pandemic must not make us forget the quality of care provided for the benefit of quantity. In therefore seems legitimate to keep the LAT modalities to ensure our ethical principles. No work in the literature based on actual facts explores the impact of a pandemic on compliance with and maintenance of ethical principles and the legisltaive framework, in particular as regards the procedures of the application of LAT. The purpose of this study is to assess whether the terms of the LAT are being complied during a pandemic for patients with or without Covid.

Study Type

OBSERVATIONAL

Enrollment

2,500

Conditions

Patient Hospitalized in Disease Infectious Unit Patient Hospitalized in Intensive Reanimation Unit Patient Hopsitalized in Internal Medicine Unit

Interventions

decisions of limitations and stop processingBEHAVIORAL

Compliance of the modalities of decisions of limitations and stop processing

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Hospitalized major patient * Infected or not with Covid-19 * having a management with a LAT defined by an anticipated or factual restriction of a therapeutic resource ( organ replacement, specific treatment) while his or her state of health requires or may require it, leading or not a death. The patient's death occurs either after a cariac massagewhich corresponds to a maximum management with therapeutic failure or within the framework or in the context of brain death, in these cases there is no LAT ; either without cardiac massage and in this case there is de facto a LAT wether or not it is performed according to legisltaive procedures. All patients who die will beclassified according to this diagram for the inclusion criterion. For surviving patients, an analysis of the record in search of LAT elments will be performed. In the absence of LAT elment in the record, i twill be considered that the patient did not have LAT and therfore will not be included. Exclusion Criteria: None

Locations (3)

CHU de Clermont-Ferrand

Clermont-Ferrand, France

RECRUITING

Hospices Civiles de Lyon

Lyon, France

NOT_YET_RECRUITING

CH de Vichy

Vichy, France

NOT_YET_RECRUITING

Outcomes

Primary Outcomes

decisions of limitations and therapeutic stops

The conformity of the modalities of the decisions of limitations and therapeutic stops will be evaluated by a composite criterion defined by the simultaneous presence of the 3 main modalities imposed by the Clayes-Leonetti law to achieve a limitation that are : An outside consultant's opinion ( required if no advance directives), the caregiver collegial discussion or adherence to patient advance directives, notification of decision in the medical record