Psychothérapie et réflexion éthique d’une équipe de soins palliatifs confrontée à la demande de mourir d’une patiente bipolaire

Objective

The person's wishes at the end of their life bring a variety of relational and psychological issues into question. French law allows for Deep and Continuous Sedation Maintained Until Death (SPCMD) under certain conditions. The question then arises of the accuracy of a medical decision in its deontological and ethical dimensions.

Method

We present the request to die of Ms. M., a patient suffering from bipolar disorder treated for several years and a cancer for which treatments have been stopped. This clinical case study highlights the work of reflection around the question of supporting a person whose refractory existential suffering is associated with mental depression.

Results

The request for SPCMD is not admissible within the framework of the Claeys-Leonetti law, as it does not meet the criterion of a short-term lethal prognosis. We offer psychodynamic supportive psychotherapy to the patient. The psychological support undertaken invites us to read the psychological processes that emerge in the meeting space between Ms. M. and a clinical psychologist with a psychoanalytic orientation.

Discussion

The therapeutic listening device specific to the function of the clinical psychologist allows for a space of speech where it is possible to return to what had not been said until then, in this final time of a final accomplishment of a speech act that strengthens and soothes family ties and Ms. M.’s relationship with herself.

Conclusion

The request to die is thus presented as the unconscious revealer of psychological processes neglected by medical decision-making.