Withholding and withdrawal of care in the ICU of Eastern France modalities and families feeling

BACKGROUND: Withholding or withdrawing life-sustaining therapies (WLST) was introduced in France in 2005 through the Leonetti law to prevent futile treatments and "unreasonable obstinacy." In France, WLST decisions affect 8.5-14% of ICU patients, according to the literature. The 2016 Claeys-Leonetti law updated the previous legislation, but debates surrounding end-of-life care persist. METHODS: To describe WLST patients and practices under current legislation, we conducted a multicenter, prospective, observational study in ICUs across Eastern France. Eligible adult patients facing WLST decisions were included, requiring written consent from the patient or a trusted person. Patients were followed for 1 month. We described the decision-making process and assessed family satisfaction using the FS-24R-ICU questionnaire. RESULTS: Between May 3rd and October 3rd, 2023, 73 patients were included (mean age 69 years). The majority of admissions were medical (72.7%), and 50.7% of patients had neurological impairments. ICU staff initiated WLST discussions primarily due to poor survival or quality of life prospects. Only 12.5% of patients had written advance directives, and 59.1% had designated a trusted person. External consultation was not involved in 19.1% of decisions. Families were informed in 91.7% of cases. Decisions to withhold therapies occurred in 68.1% of cases, with resuscitation during cardiac arrest being the most commonly withheld intervention (98.0%). Treatment withdrawal occurred in 31.9% of cases. Family satisfaction was generally positive. CONCLUSIONS: WLST management in Eastern French ICUs is partially compliant with the Claeys-Leonetti law. Improved law application and public awareness could enhance end-of-life care management in France.