Pennec, SophieLépori, MélaniePontone, SilviaGuion, VincentEvin, Adrien2025-05-232025-05-23PubMed:39252040http://www.scopus.com/inward/record.url?scp=85203356321&partnerID=8YFLogxKhttps://hdl.handle.net/1885/733752211Background: French laws governing end-of-life medical practices forbid euthanasia and affirm patients’ right to deep and continuous sedation until death. Cultural traditions and disparities in health care provision, as in overseas France, could limit the enforcement of such laws and modify end-of-life medical practices. Aim: This research aims to describe end-of-life medical decisions in overseas France and to compare with those described in mainland France. Methods: A retrospective study of a random sample of adult patients who died between March 2020 and February 2021 was conducted in four overseas French departments. Physicians who certified the deaths were asked to describe end-of-life care and medical decisions in a questionnaire. Results: A total of 1815 deaths were analysed over 8730 questionnaires sent. Withholding treatments was the most frequent decision (41%), treatment for pain or symptoms was intensified for a third of patients, Deep and continuous sedation until death was implemented in 13.3% cases. The use of drugs to deliberately end life was mentioned in 1.3% deaths. At least one decision was made in 61.6% deaths. More decisions that may hasten death were made before predictable deaths. Intensification of pain and symptoms treatment was more frequent in 2022 than in 2010. Deep and continuous sedation was introduced by law in 2016 without prejudice to other decisions. Conclusion: Physicians in overseas France have implemented recent changes in end-of-life laws, including deep and continuous sedation. Comparisons with 2010 mainland France survey show a better implementation of palliative medicine in 2022, with higher proportions of treatment withholding.We want to thank all the persons involved in the data collection and data analysis at Ined; The Regional Health Agency-ARS La R\u00E9union, Besan\u00E7on university hospital -medical information department, the centre of epidemiology of causes of death (Inserm-CepiDc) ; the physicians from La R\u00E9union whom we discuss some of the results and last but not least all the physicians who took from their time to answer our questionnaires. This research was supported by the Caisse nationale de solidarit\u00E9 pour l\u2019autonomie (CNSA), as part of the call for projects launched by IReSP (project IReSP-17-Hand8-16); by the Fondation de France as part of the call for project \u201CSoigner, soulager, accompagner (2017- 788869)\u201D and by the Institut national d\u2019\u00E9tudes d\u00E9mographiques (INED).enPublisher Copyright: © The Author(s) 2024.Deep and continuous sedationEnd-of-lifeMedical decisionsOverseas France202410.1186/s12904-024-01552-x85203356321