End of life: psychological determinants of decision-making in a context of distress

Distress at the end of life is at the heart of public debate. It is breaking into care services and impacting patients, relatives and teams alike. The patient is experiencing an identity crisis that engages each of the players on an affective and emotional level.

Demands at the end of life are ambivalent; they are produced by significant psychic distress. They may concern stopping treatment, hospitalization, deep and continuous sedation maintained until death, or a request for early death...

In France, the law provides a framework for medical decision-making in palliative situations. Requests give rise to shared decision-making, placing the patient at the heart of his or her care, including loved ones and involving multi-professional teams.

Medical decisions cannot be completely objective. Indeed, deciding is a complex action that relies on emotional, cognitive and social components. The psychological processes underpinning decisions in palliative situations have been explored, and in particular enable us to grasp the importance of social dynamics and systems of influence in the decision-making process.

Distress has repercussions on the experience and subjective lived experiences of each of the actors in the shared decision. An intersubjective relationship is woven from these shared experiences, and invites the psychologist to work on these collective dynamics.

No study has been conducted to understand the influence of psychic distress on decision-making processes at the end of life.

Under the direction of Axelle MENEVAL VAN LANDER and Virginie GUASTELLA.

Link to theses.fr: https://www.theses.fr/s363352