In France, people over the age of 18 can provide written instructions to medical staff about the level of treatment they want to receive in their dying days. These written instructions are known as directives anticipées.
These directives anticipées are only used when a patient is no longer able to express themselves - as with long-term coma patients for example, or those suffering from severe brain injury.
What kind of instructions can you leave?
When writing your directives anticipées, you can indicate whether or not you would like to receive treatments or emergency procedures such as cardiac and respiratory resuscitation; breathing support; or artificial feeding and hydration. This is similar to a 'do-not-resuscitate' order in the United States.
French law states that directives anticipées specifically protect from medical procedures that may appear "unnecessary, disproportionate or as having no effect other than the artificial maintenance of life."
It is worth noting that as of 2023, French law prohibited active euthanasia and assisted suicide, as per the 2016 Claeys-Leonetti law.
These terms carry different meanings and should not be confused with directives anticipées - euthanasia is defined as a doctor being allowed by law to end a person’s life by a painless means, as long as the person and their family agree. Assisted suicide, in contrast, is defined as a doctor assisting an individual in taking their own life if the person requests it.
What if I haven't written any directives anticipées?
If you have not written any directives anticipées and are unable to express your own treatment preferences in a life threatening situation, medical staff will speak to your personne de confiance or 'trusted contact' - this is someone that you have designated to take such decisions for you in the event of hospitalisation.
If you have also not designated a personne de confiance, medical staff have a duty to enquire about your wishes to family or friends.
Who can write directives anticipées?
You must write your own directives anticipées and can only do so if you are over the age of 18.
If you are legally sous tutelle - in this case meaning the status given to an adult living under someone else's care because of a physical or mental handicap - you can also write your own directives anticipées, as long as you are authorised by a judge or conseil de famille to do so. This authorisation must be submitted alongside the directives anticipées themselves.
How can I write directives anticipées?
Directives anticipées can either be handwritten or typed and must include your first name, middle names and family name. They must also signed, dated and include your date of birth and place of birth.
You can find a model letter here. You can stray from this format if you want, but it isn't recommended.
If you are physically unable to write and sign a letter, but still mentally capable of expressing your wishes, you can ask someone else to write it in your name. You will then need two witnesses, including ideally your personne de confiance, to provide written testimony declaring that the directives anticipées have been written in good faith.
These declarations must include the surname and first names of the witnesses as well as their relationship to you (brother, mother, friend etc.). The declarations must be attached to the directives anticipées.
How can you be sure that your directives anticipées will be used?
If you are in hospital and unable to express yourself, it is important that doctors know whether you have written directives anticipées and where to find them.
The best way to ensure that your directives anticipées are available is to upload them to your profile on Mon espace santé in the dossier médical partagé section. You should inform people close to you that you have done this - particularly if you needed someone else to fill out the form for you (in which case you also should let the witnesses know).
Alternatively, if you have a médecin traitant, you should tell them that you have written directives anticipées and explain to them where you keep the document. You should also be sure to explain to family and friends that you have written directives anticipées in case your doctor isn't reachable.
If you are still conscious when you arrive at the hospital, you can always bring the document with you and hand it over directly to medical staff working there. Equally, if you are resident in a care-home, you can hand over the document to those running the facility.
You can also leave your directives anticipées with your personne de confiance, a family member or a trusted friend prior to falling ill. You could also leave the document at your house - as long as you carried some kind of documentation with you explaining to medical staff where exactly they could find it in case of emergency.
Do doctors always respect the directives anticipées?
There are limited cases in which doctors are not obliged to follow the instructions left in the directives anticipées.
The first is if urgent action is needed to save your life in a timeframe that is too short to find and consult your directives anticipées. This could be the case if you are involved in a sudden, unexpected accident.
The second is more discretionary. If a doctor judges your directives anticipées to be clearly inappropriate - in cases which are not so serious for example - he or she can decide not to implement your instructions. Such a decision is only taken following discussions with colleagues and will be registered on your patient file. Doctors have a responsibility to let their decision be known to your personne de confiance, or if you don't have one, to your family or friends.
How long do directives anticipées remain valid?
This document remains valid for life.
You can however cancel or modify your directives anticipées.
To cancel, you should fill out the last page of this form and make it available to doctors, your personne de confiance, family and friends.
To modify, you should simply write the document again and follow the same procedures as before. You should ask anyone with a copy of your previous directives anticipées to get rid of them.
If you uploaded new directives anticipées onto Mon espace santé, only the most recent copy will be taken into account.
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