Le respect de la volonté du patient à l'épreuve de la culture bushinengué en Guyane : à propos d'un cas clinique

Different cultures that mix in French Guyana permitted us to measure the limits of Leonetti law's application. A 61-year-old patient, Bushinengué (an ethnic group) from Maripasoula, suffering from a lymphoma, expressed the wish to go back to Holland, where he lived and worked during 23 years, and where his two adult children are living, to end his life and be buried there. This plan conflicted with his origins' culture and his family has strongly been opposed to it, explaining that its realization would generate severe repercussions for the whole family and that the patient was the decision-maker for himself. Indeed, in Bushinengué culture, the family members on the maternal side become the interlocutors for the medical and paramedical team, be it for announcing bad news or making decisions. The arrival of the children from Holland counterbalanced this position and the final decision was to organize the departure of the patient for that country. The patient died the day he was supposed to leave. This situation is an example of the limits of Leonetti law's ethical principles application in French Guyana, which administratively belongs to France but with multiple cultures. We attach the greatest importance to the respect of these cultures, which should sometimes compel us to readapt our practices when applying the law that is far from the actual situation in French Guyana.