End-of-life legal provisions vary widely across Europe. In France, the Act of 22 April 2005 on Patients’ Rights and End-of-Life Care [1] introduced three main measures: Firstly, it prohibits “unreasonable

obstinacy” and therefore the continuation of futile medical treatments. Secondly, it strengthens the right of access to palliative care for any person whose condition requires such care, and recognizes that, under certain conditions, pain and symptom relief may require drugs that, at high doses, may have the unintended effect of shortening the patient’s life. Thirdly, it strengthens the principle of patient autonomy and of discussion with the patient. If the Inhibitors,research,lifescience,medical patient is not competent, the end-of-life medical decision must be taken after discussion with a trusted third party or surrogate (if the patient Inhibitors,research,lifescience,medical has named one), and the family, if any, and after consultation with medical staff or colleagues. Nevertheless, legalising euthanasia remains a highly controversial topic in the

public and political arena, as seen during the 2012 presidential election. In ABT-199 research buy Europe, various surveys [2-5] have shown that in order to better understand end-of-life conditions, it is important to study the medical decisions taken prior to death. In France, the only surveys on end-of-life decisions conducted until now focused on deaths in hospital or emergency wards [6-9]. The survey Fin de Vie Inhibitors,research,lifescience,medical en France (“End of life in France”), conducted in 2010, concerned all deaths, regardless of cause or place (hospital, home, nursing home…). It provides

an overview of end-of-life care in France that can be used as a baseline for assessing future developments. This Inhibitors,research,lifescience,medical paper focuses on the medical decisions relating to end-of-life care in France. It looks at how the decisions varied according to the person’s and physician’s characteristics. It also investigates the extent to which these decisions comply with the 2005 law. Methods Retrospective survey Inhibitors,research,lifescience,medical of physicians As in previous European surveys [10], we conducted a retrospective survey on a sample of deaths where the respondents were the certifying physicians. This sample of 14,999 deaths was selected by Inserm-CepiDc (Centre d’épidémiologie sur les causes médicales de décès) using a systematic random procedure. We ensured that it was representative (in terms of age, sex, place of death and region of death) of the 47,872 persons Parvulin aged 18 and over who died in France in December 2009. Stratification by cause of death (a proxy for the likelihood of an end-of-life decision) was not possible because of the delay in registration of causes of death. For each death, we identified the certifying physicians on the death certificates and we mailed them the questionnaire with instructions for replying. Physicians could respond either by post (with paid-reply envelope) or online.