Foch Hospital, Suresnes, France.
Eur J Cancer. 2012 Feb;48(3):368-76. doi: 10.1016/j.ejca.2011.09.020. Epub 2011 Oct 28.
Strongly marked ideological positions on the impact of palliative care and limited hard data plague the debate on physician-assisted death.
A national cross-sectional study on the requests to hasten death (RHD) was conducted among 789 French palliative care organisations. Data were collected for all patients with RHD encountered during year 2010. Data on patients' characteristics, medical, psychological and social context, symptoms, nature of palliative management, patient's evolution and palliative care team's interpretation of the request were obtained.
A majority of centres responded and 342 teams provided descriptions of 783 RHD, 476 by a patient, 258 by relatives or close friends and 49 by the nursing staff. Cancer was the most frequent pathology (72%) and 68% of the patients had entered terminal stage. Patients rarely appeared with uncontrolled pain (3.7%), but had difficulties with feeding (65%), moving (54%), excretion (49%), or were cachectic (39%); 31% were considered to be anxio-depressive; 79% did not give physical reasons for their request; 37% of RHD were maintained and 24% fluctuated despite provision of regular follow-up by a palliative care team to 83% of all cases; 68% of patients died within a month; the interpretation of RHD by the staff was a wish for relief (69%), patient's inextricable situation (44%), actual desire not to continue living (36%) or to be helped to die (30%).
The large number of described cases provides, for the first time, comprehensive hard data on the evolution of RHDs in a country that has not legalised euthanasia. Whatever the way RHD are expressed, they are frequently maintained despite adequate palliative care with suitable control of pain and psychological support by specialists.
对姑息治疗影响的强烈立场和有限的硬数据限制了关于医生协助死亡的争论。
在法国 789 家姑息治疗组织中开展了一项关于加速死亡请求（RHD）的全国性横断面研究。在 2010 年期间收集了所有遇到 RHD 的患者的数据。获得了患者特征、医疗、心理和社会背景、症状、姑息治疗管理的性质、患者的演变以及姑息治疗团队对请求的解释的数据。
大多数中心做出了回应，342 个团队描述了 783 例 RHD，其中 476 例由患者提出，258 例由亲属或亲密朋友提出，49 例由护理人员提出。癌症是最常见的病理（72%），68%的患者已进入终末期。患者很少出现无法控制的疼痛（3.7%），但存在进食困难（65%）、移动困难（54%）、排泄困难（49%）或消瘦（39%）；31%的患者被认为有焦虑抑郁；79%的患者没有给出要求的身体原因；37%的 RHD 得到维持，24%波动，尽管 83%的所有病例都由姑息治疗团队定期随访；68%的患者在一个月内死亡；工作人员对 RHD 的解释是希望缓解（69%）、患者无法摆脱的情况（44%）、实际不想继续生存（36%）或希望得到帮助死亡（30%）。
在没有合法化安乐死的国家，首次提供了大量关于 RHD 演变的综合硬数据。无论 RHD 的表达方式如何，它们都经常得到维持，尽管姑息治疗专家提供了适当的疼痛控制和心理支持。
