Relation soignant-soigné et décision de chimiothérapie en phase avancée: Quels enjeux éthiques?

Introduction: Notable progress in oncology in recent decades has greatly increased patients' quality of life and lifespan. However, the few literature data regarding specific treatment after the third-line chemotherapy show how complex is the decision to stop specific cancer treatments. Literature also shows that a significant number of patients still receive chemotherapy in their last month of life, even the last fortnight. Related to the Axel Kahn opinion published in the Éthique & Cancer bulletin about last-line chemotherapy, our clinical practice has led us rethink about elements that -in the patient-carer relationship- led the oncologist to prescribe a so-called compassionate palliative chemotherapy in response to the patient's request. JérÔme Alric argues that too much information on poor prognosis of the disease may cause "psychological death" by fixing patients in a position of "lethal subject without any life project.". Material and methods: We have conducted a literature survey and compared opinions of various authors on ethical issues regarding patient-carer relationship and the decision of palliative chemotherapy at patient's request. Results: Some authors object to the so-called "compassionate chemotherapy" for, on the one hand, the potential induced toxicities and, secondly, because of the confusion that might be created by the pursuit of specific treatments -a source of hope- and delaying the introduction of palliative care. In contrast, other authors emphasize that it is sometimes emotionally overwhelming for some patients to stop the fight against the disease by stopping chemotherapy. They suggest renaming this to "non-indication to pursue specific treatment.". Conclusion: This is therefore an ethical reflection through a qualitative research project. Indeed, it seems appropriate to go beyond the educational side of the biomedical ethics principles, confronting the treatment risk-benefit balance to the patient's autonomy and the equity principle in a societal reflection process. That is why we want to question the oncologists about the issues of patient-carer relationship that lead to the decision of palliative chemotherapy on the patient's request.