Keywords: Advance Directives, Community, Ethics
Advance directives (AD) are a document giving medical instructions in the event that the patient is no longer able to express them. This system was updated, in France, by the Claeys-Leonetti law in February 2016. Nevertheless few French patients have written their AD. No Data is available in medical literature. What are or could be the factors hindering the achievement of AD since the Claeys-Leonetti law in grey literature?
What are the factors that have hindered the achievement of the advance directives since the 2016 French law? thematic analysis based on the grey literature review.
Systematic literature review was undertaken between the 1/01/2016 31/12/2017 using the adapted PRISMA guide on Google Scholar. Search equation was using “advance directive”, “community”, “ethics” as keywords. Exclusion criteria were: no reference to the French law, anticipated directives were not the main topics, the community was not mentioned, ethics was not mentioned. Inclusion criteria corresponded to the identification of hindering factors for the achievement of ADs. Documents were compiled using a thematic and hermeneutic analyses. A heuristic map was created. All of the PRISMA process and coding were achieved with two researchers working blind.
139 documents were found, 19 were eligible, 16 were included in the thematic analyses comprised 6 book extracts, one book, one study report, 5 publications, a dissertation and a thesis manuscript. 101 axial codes were identified and grouped into 19 sub-themes assembled into 11 main themes: Individual sphere, care sphere, communication, temporality, opposability, interpretation, elaboration, psychic and spirituality, law and society.
One of the obstacle is the opposability of the AD. Many other limiting factors exist in legal, ethical, sociological, and practical affairs. They concern all actors implied in the AD, from the individual to the social groups. Education of health professionals about AD should be promoted to override these constraints.
Points for discussion: