Refus de traitement : le cas de Monsieur S.

The physician faces medical, psychological and ethical difficulties when confronted with a patient refusing treatment and furthermore when the previously known patient's will comes into conflict with the wishes of close family members when the patient is no longer capable of expressing his will. These difficulties are illustrated by the case of a 62-year-old man with a chronic giant thoracic and abdominal aneurysm responsible for an acute respiratory insufficiency who was hospitalized against his will by his distressed wife. He died in an intensive care unit 12 days later following infectious complications secondary to the introduction of three endotracheal prosthesis. Respecting the patient's will is a legal requirement instituted by the March 4th 2002 law which was further reinforced by the April 22nd 2005 law. A treatment refusal alters the relationship between the physician and the patient as the patient's right to decide for himself according to his own values comes into conflict with the physician's duty to preserve life and ensure the patient receives the adequate treatment. The physician is confronted with a major ethical dilemma. In order to answer best the patient's expectations, the physician must listen carefully to him to understand what is refused and why it is refused and analyze his relationship with the patient. Except in some emergency or exceptional situations, as recommended by the French national consultative committee on ethics, it is the physician's duty to accept the patient's will even if it means he/she will die.