Death in the Emergency Department: practices and ethics

Résumé En

Death in the Emergency Department is a reality. In French hospitals, it generally occurs in the short term hospitalisation unit linked to the Emergency Department. The primary aim of these units is to welcome emergency patients waiting for being allocated a bed in an hospital ward or needing just monitoring watching for a short period. In France, the number of deaths in these units is quite high (the third higher after intensive care unit and oncology or internal medicine ward in our study). However these units are neither meant, nor seem to be organized, to provide palliative care. There is a gap between the goal to provide rapid and temporary acute care and the reality of end of life. The aim of this study is to explore care and support practices to dying patients and their relatives and to analyze the caregivers' feelings about their work. Various methodologies have been combined to study death in two French Emergency Departments (one in the west France and one in the suburbs of Paris): an epidemiological retrospective patients' records analysis, sociological observation and focus groups sessions carried out with a psychodynamic work approach. We will present two different types of end of life trajectories and explore the major issues concerning care management : First : how to identify occurences of end of life period and, more generally speaking, possible cases of withholding treatment Second : decision making process to withhold or withdraw futile care Third : how to find an hospital bed for patients with short expected life time Fourth : how to develop early team work with the palliative care team to provide continuity and quality of care This study underlines the necessity to develop an ethical reflection on the place of death not only in the emergency departments faced with this serious and frequent event but also for the acute hospital wards under drastic economic constraints.