- Information about you
- The support person
- End of life
- Means of expression and review procedures
- A few rules and recommendations
- Your obligations
INFORMATION ABOUT YOU
Information and consent
According to their fields of skill, hospital professionals provide you with information on your state of health, its predictable development and the therapeutics under consideration.
No medical act will be undertaken without your free and informed consent.
Access to information on your health
Possibility to either consult the file on site (free) or to request the sending of copies (reproduction and sending costs will be billed).
Your file is conserved for 20 years from the date of your most recent hospitalization or external consultation.
The survivors and/or beneficiaries of a deceased patient can also have access to some of the information in the file.
In the specific cases mentioned below, you can download the form by clicking on the link: – if you are the spouse or parent of a deceased patient and if you wish to have access to that person’s medical file: demande de dossier médical par un ayant droit (request for file by a survivor or beneficiary). – if you are mandated by a patient to request access to that person’s medical file: demande de dossier médical par un mandataire (request for file by proxy). – if you are the guardian of a person of full age and wish to have access to his or her medical file: demande de dossier médical d’un incapable majeur (request for file of an adult lacking legal capacity). – if you are the parent or legal representative of a patient not of full age and wish to have access to his medical file: demande de dossier médical d’un mineur (request for file of a person under 18).
Reproduction and sending costs will be billed to the requester.
Discretion and confidentiality Information about you is not accessible to persons other than yourself. You can request that your presence not be divulged or that information on your state of health not be communicated to your family and friends.
Data protection Ever since enactment of the 6 January 1978 “Informatique et libertés” law (data protection act), a patient has the right to information, access and rectification concerning his or her nominative personal information contained in the results of data processing.
General cancer registry You can oppose the transmission of information on your subject in this registry.
THE SUPPORT PERSON
You have the possibility of designating in writing a person of your choice to accompany and assist you in making medical decisions. If you are likely not to be in a condition to express your wishes, this person can be consulted by the doctor to solicit his or her opinion.
Your designated support person can be very helpful: – to accompany you in your procedures and to be present during your medical interviews; at a later stage, he or she will be able to help you make decisions; – were your state of health not to allow you to give your opinion or to express your decisions, the doctor or, in the event of hospitalization, your treatment team, will give high priority for consultation to the support person you shall have designated.
The opinion given by the support persons will help to orient the doctor in the decision-making process.
You can also entrust your support person with your advance directives (1).
What are the action limits of your support person? The support person cannot obtain access to your medical file (except if you have expressly given him the power to do so) (2). Moreover, if you do not wish some information to be given to him, it will remain confidential, whatever the circumstances. On the other hand, if your support person has to be consulted because you are no longer able to express yourself, information deemed sufficient to allow for expression of what you would have wished will be communicated to him or her.
If you are hospitalized, the opinion of the support person will be taken into account by the medical team but, ultimately, it will be up to the doctor to make a decision. On the other hand, in the highly specific case represented by biomedical research, if you are not able to express yourself and if biomedical research is envisaged under conditions provided for by law, authorization by a support person will be requested.
Whom can I designate? Any person who is close to you, in whom you have confidence, and who is willing to assume this role: one of your parents, your spouse, your partner, one of your friends or relatives, your attending physician…
The individual whom you designate as support person can also be the one whom you have designated as “person to notify” in case of emergency; indeed, the support person and the person to notify may or may not be the same individual.
How can I designate a support person? Designation is made in writing. You are free to change your mind at any time, either canceling the designation or replacing the designated support person with somebody else. In all cases, it is preferable to proceed by writing and to take necessary measures to make sure that any changes are taken into account.
When can I designate a support person? You can designate a support person whenever you want, at any time. In the event of hospitalization, you can designate your support person at the time of admission, but you can also do so before being hospitalized or during your hospital stay. What matters most is to have given thought to the matter and to be sure, before making a decision, that the individual you wish to designate agrees to his or her designation.
Designation during a hospital stay is valid up until discharge — but not beyond. If you wish to have its validity prolonged, it will suffice to make your wish known, preferably in writing. All the information you have given to the support person will be classified in your medical file, which shall remain within the establishment.
Under what circumstances may I NOT designate a support person? If you are protected by a guardianship or tutelage measure, you cannot designate a support person. On the other hand, if you have designated someone previous to enactment of the tutelage measure, the guardianship judge can either confirm that person’s mission, or revoke his or her designation.
END OF LIFE
What is meant by the end of life? A person as considered to be at the end of life when he is she is suffering from a severe, progressive and incurable illness or disease, in an advanced or terminal stage.
What is meant by palliative care? (9 June 1999 law – “any ill person whose condition requires the right to access to palliative care and support”). Active care is given in a comprehensive approach addressed to a person suffering from a severe, progressive or terminal illness: relief from pain and bothersome symptoms, alleviation of suffering, taking into account of social and relational difficulties.
The objective of palliative care is not to cure, but rather to safeguard a patient’s quality of life and to offer support to family and friends and thereby help them to cope with the symptoms and the consequences of a severe and potentially mortal illness.
Who can receive palliative care? All persons suffering from a severe, progressive life-threatening illness, in an advanced or terminal phase, and liable to benefit from palliative care.
Where and by whom is palliative care administered? Whether at the patient’s home, in a hospital or at an institution, all professionals must be able to administer palliative care. In certain medically and socially complex situations, the professionals can call upon specialized palliative care services, particularly those provided by the mobile care team, which circulates amidst the different hospital units, and the palliative care hospital unit.
In what ways are family and friends assisted? Over the course of a severe illness, the family and friends of a patient are at times in need of support. The health care teams and patient associations can help to meet some needs. For desirous persons, a system of support and family solidarity leave was instituted in 1999; it allows a family member who works and shares the home of the patient to benefit from an exceptionally renewable paid leave lasting as long as 21 days and enabling the former to accompany and support the latter. Recourse to a social worker is also proposed in our hospital units.
Supportive volunteers With the agreement of the ill person or his family members and friends, and in keeping with medical and paramedical care procedures, trained volunteers can offer their presence and ability to listen, while respecting the intimacy and the confidentiality of the person and his family and friends.
Can I refuse or interrupt my treatments while still being relieved of my pain? Yes. The patient is free to express his will. In this case, it is up to the doctor to listen, to inform him of the consequences, to make sure that he understands the relevant information and to give him the time to think things over. The different exchanges are recorded in the patient’s medical file.
And if I am no longer able to express my wishes? In this case, it is up the doctor to render an evaluation and to make a decision. In order to decide on the right conduct to adopt, he has got to respect the following collective procedure: – The doctor must take into account the advance directives (if they have been formulated) and the opinion of the support person (if he or she has been designated); he has also got to inform the family. He will strive to make a decision as close as possible to the one the patient would have made. -The decision is collective, which means that it is based on dialogue involving the medical and paramedical teams, and that it associates a doctor external to the team.
Sedation: When, how and why?
The doctor can resort to sedative products (provoking loss of consciousness). The objective is to provide the patient with relief during end-of-life situations that he deems unbearable. Highly precise recommendations circumscribe these practices.
What happens after discontinuation of treatments considered as unreasonable? When the treatments or acts of investigation appear pointless or disproportionate and have no effect other than to keep the patient artificially alive, they may be limited and discontinued. In this case, the doctor is obliged to relieve the pain, to respect the patient’s dignity and to provide support for his close friends and family. Comfort care is privileged by the health care team.
They allow you to make known, in advance, your end-of-life wishes, which would become relevant were you to be unable to express them.
Valid for three years, renewable and revocable at any time, the directives are formulated in a written document, dated and signed by their author, who shall be duly identified by indication of his surname, given name, and date and place of birth.
What is the point of advance directives? In the event that in an end-of-life situation, you were to become unable to express your wishes, your advance directives would enable your doctor to know your wishes with regard to possible limitation or discontinuation of ongoing treatments. However, were other elements to modify his assessment, the physician would not necessarily be compelled to carry out your wishes.
A person is considered to be in an “end-of-life” condition when he or she is suffering from a severe or incurable illness, in an advanced or terminal phase.
What are the conditions to be met for my advance directives to be taken into account? 1. Age requirement Only if you are a major can you write out advance directives. 2. Form requirements The document must be written and authentifiable. Your have got to write your directives yourself. They must be dated and signed, and you have got to indicate your surname, given name, and date and place of birth. If you cannot write and sign your directives yourself, you can call upon two witnesses, including your support person (1), if you have designated one, who will attest to the fact that the document is indeed the expression of your free and informed wishes. The witnesses must indicate their names and status, and their attestation will be attached to the directives. 3. Content requirements The author of the document must be in condition to express his free and informed wishes at the time of writing. If you so desire, you can ask the doctor to whom you are entrusting your directives, which will be attached to your file, to add an appendix attesting to the fact that you are in a condition allowing you to express your wishes and that he has given you the necessary and appropriate information. The document has to have been written at most 3 years previous. More precisely, in order to be taken into account your directives have to have been written at most 3 years prior to the date starting from which, you will no longer be able to express your wishes. Your directive will consequently have to be renewed every 3 years. All you have to do, once the 3 years shall have elapsed, is to indicate on the document containing your directives that you have decided to confirm them, and to sign your confirmation. Were you to decide to modify your directives, a new 3-year period of validity would get underway.
To make sure that your directives and their possible modifications are indeed taken into account, you are requested to take all the necessary practical measures: mention of the coordinates of the person entrusted with the information, selection of the information to be conserved.
Can I change my mind after having written out the advance directives? The directives are revocable at any time, and whenever you wish, you can either totally or partially modify their contents. If you are not able to write, renewal or modification of your directives will be carried out in accordance with the above-described procedure (cf. supra II.3).
You can also cancel your directives, and it is not mandatory to do so in writing. It may nevertheless be preferable to do so in writing, particularly if your decision is made during the 3-year period of validity.
What is the import of my advance directives in future medical decision-making? If you have written your directives, a doctor must take them into account. To the extent that they attest to your wishes at a time when you were still able to put them forward, they constitute a document of prime importance in medical decision-making. Their contents will prevail over any other non-medical opinion, including that of your support person.
That much said, advance directives are not binding for a doctor, who remains free to apprise the conditions under which it would be suitable to apply the guidelines you have expressed, given the actual situation and the possible evolution of medical knowledge subsequent to the writing of the directives. .
What can I do to make sure that my advance directives will be taken into account when the time comes? Given the fact that at the time when your directives will be useful, you will no longer be able to express your wishes, it is important that for as long a time as you can, you take every measure allowing the doctor who shall decide on a possible limitation or discontinuation of treatment to easily consult your document.
If your directives are not inserted or mentioned in the file he holds, a doctor will try to find out whether you have drawn up directives and, if so, to whom you have entrusted them; he will consequently try to contact your support person, your family, your friends and your attending physician or the doctor who has had you referred to him.
To facilitate these procedures, there exist several possibilities. The most recommended, in the event of hospitalization, consists in giving your advance directives to the doctor in charge of your treatment, whether he practices in a care facility or in town. In all cases, your directives will be kept in the file containing your medical information. Another option consists in keeping the directives in your possession or giving them to the person of your choice, particularly to a support person, provided that you have designated one. In this case, it is recommended that you communicate to the doctor in charge of your treatment the contact information for the person in possession of your directives so that they be mentioned in your file.
MEANS OF EXPRESSION AND REVIEW PROCEDURES
We welcome your views!
Along with a welcome book, you are given an exit questionnaire In order to improve the quality of our services, we thank you in advance for filling it out and providing us with your remarks and suggestions. Submit your completed questionnaire to the reception staff, the health care manager, or the user/risk/quality service. .
Telephone surveys are regularly organized The patients who may be called can choose not to participate in the survey.
An observation? A claim? – During your treatment, contact the health care manager. – The user/risk/quality service staff is at your disposal to receive, hear out and respond to your observations and complaints (Art R1112-91 and R1112-92 of the French public health code).
Direction usagers, risques, qualité 2 rue de la Milétrie CS 90577 86021 Poitiers Cedex Tel : 05.49.44.46.55 firstname.lastname@example.org
– On that occasion you can propose mediation with a mediator who may or may not be a physician.
Commission for user relations, quality and treatment / Commission des relations avec les usagers, de la qualité et de la prise en charge (CRUQ) – contributes to improved policies in reception and treatment of our patients; – ensures respect of our patients’ rights; – is informed of measures pertaining to ongoing development of quality, to the number of requests for communication of medical files, to the results of surveys evaluating user satisfaction as well as the complaints voiced by users; – meets once every three months.
|The role of the mediator in complaint management (R-1112-92 to R-1112-94 of the French public health code) – physician mediators are tasked with facilitating dialogue with the medical team. They are solicited for medical questions. – non-physician mediators are informed of complaints having to do with health care organization and accommodations. – the mediators report to the user/risk/quality service on their interventions and follow-up action; they do so particularly on the occasion of CRUQ meetings.|
Composition (susceptible to change over time) – President : Jean-Pierre Dewitte, general director, Céline Biche, user/risk/quality service director – Physician mediator and substitutes: Professors Bertrand Becq-Giraudon, Jean-Pierre Fontanel and Guillaume Magnin – Non-physician mediator and substitute: Fatima Dupuis and Natacha Hays – User representatives: Bruno Cattiau, Martine Chauvin, Bernard Couturier and Claudette La Soudière – Representative of the institutional medical commission (CME): Doctor Jacques Aries – Representative of the nursing, rehabilitation and medical/technical commission (CSIRMT) : Catherine Boisseau – Representative of the personnel and substitute: Odile Pouvreau and Franck Huet – Representative of the supervisory board and substitute: Professors Alain Daban and Jacques Barbie
A FEW RULES AND RECOMMENDATIONS
Your goods and valuables
You are strongly advised not to come to the CHU of Poitiers with your valuables: jewelry, credit cards, checkbook, cash…
The CHU of Poitiers is not liable for the goods that you keep in your possession rather than having them deposited. Mobile phones, computers, digital tablets and other devices remain under your total responsibility.
If you possess objects of value, you can address the staff. An inventory will be performed and once it has been signed, your objects will be deposited in a safe deposit box under the responsibility of the CHU treasury.
Your objects will be returned to the unit where you are staying (provided that you make your request the day before).
If your discharge was not planned, you can recover your deposited objects at the treasury of the CHU of Poitiers (Monday through Friday, from 8:30 A.M. to 12:30 P.M. and from 1:30 to 4:30 P.M.).
(If you have a dental and/or auditive prosthesis, please inform the medical team as early as possible)
– The introduction of dangerous, illicit or noxious objects or products is prohibited.. – It is indispensable to establish healthy and respectful relationships with other persons (staff, fellow patients and users). – Animals are not admitted in the CHU of Poitiers. – You will be held responsible for any damage or deterioration to the facilities and premises. – The rules of the road apply to the hospital: The speed limit is set at 30km/h, and you are legally compelled to respect the signaling and the parking space reserved for ambulances, disabled persons and some staff members. – Medical recommendations and treatments must be strictly observed.. – Respect the hygiene and safety rules posted in the establishment. – In accordance with the law and consistent with the adherence of the CHU to the “tobacco-free hospital” network, it is strictly forbidden to smoke in the CHU. – Take care to respect your neighbors’ rest; use radio and television sets with discretion.