Among the 55 explicit requests for euthanasia reported by the physicians, 6 were granted, whereas in 44 cases the physician chose to intensify the alleviation of symptoms, and in 1 case no decision was reported, except for doing everything possible to prolong the life. For almost half of the physicians, “deep sedation for distress in terminal phase” Inhibitors,research,lifescience,medical was the term that best described the decision to deliberately administer a medication to hasten death; much less frequently “symptom treatment” or “non-treatment decision”. Only 5 physicians reported “euthanasia”. Discussion and conclusions Main findings For the first time, this study provides data on end-of-life medical decisions on a

representative sample of all deaths in France. In 12.2% of cases, the decision was to do everything possible

to prolong life. Non-treatment decisions were Inhibitors,research,lifescience,medical made in 16.8% of cases, treatment was withheld in 14.6% and withdrawn in 4.2%. Alleviation of symptoms with opioids and/or benzodiazepines was intensified in 28.1% of cases, A drug was administered to deliberately hasten death Inhibitors,research,lifescience,medical in 0.8% of cases, at the patient’s request in 11 out of the 38 cases concerned. The study shows that end-of-life medical decisions that may hasten death are relatively frequent in France. Most of such decisions are in compliance with the law, which allows physicians to withhold or withdraw life prolonging treatment and to intensify alleviation of symptoms even if unintended side effects may hasten death (“double effect”), Inhibitors,research,lifescience,medical as long

as the first intention is not to hasten death. In a much smaller number of cases (3.1%), the death followed a decision made with the declared intention of hastening death. The patient’s pathology is the main factor governing this type of decision. Even though most end-of-life medical decisions are made in compliance with the 2005 law, and decisions leading to a strong likelihood of death are more frequently taken after discussion with the patient or trusted third party and the medical staff (other doctors, nursing staff), the study Inhibitors,research,lifescience,medical shows that the legal provisions governing these decisions are not always fully respected. Strengths and limitations For the Thalidomide first time in France, this study provides data on end-of-life decisions on a representative sample of deaths, whatever the cause, wherever the death took place. It gives objective results on this important issue that will inform and assist both public and legislative debate. The Doxorubicin French national end-of-life watchdog Observatoire National de la Fin de Vie (ONFV) has noted the lack of available scientific data on medical practices in this regard in France [13]. This survey also shows that investigating this sensitive topic and even exploring illegal practices is possible in France; this was by no means certain when the study was first launched.