Author’s response to reviews
Title: Opinions about the new law on end-of-life issues in a sample of French patients receiving
palliative care
Authors:
Augustin Boulanger ([email protected])
Theo Chabal ([email protected])
Marie Fichaux ([email protected])
Mireille Destandau ([email protected])
Jean Marc La Pianna ([email protected])
Pascal Auquier ([email protected])
Karine Baumstarck ([email protected])
Sebastien Salas ([email protected])
Version: 2 Date: 04 Nov 2016
Author’s response to reviews:
Dear editor,
We are honoured by the attention you have given to our manuscript. We want to thank the
reviewers for the helpful criticisms that have improved the manuscript. We responded point by
point to the comments, documenting any changes we made to the original manuscript
The authors have comprehensively addressed the reviewers' comments. However to finalise
submission there are some minor typographical, grammatical and translation edits to be
addressed.
Please see as follows:
Revision suggestions:
Abstract:
- Line 9 of abstract: The aim of this report is to investigate individuals receiving
palliative care about their opinion about euthanasia, right to deep and continue sedation, right
stopping on the artificial feeding hydration, and advance directives.
Revise to: The aim of this report is to investigate individuals receiving palliative care about their
opinion about euthanasia, about advance directives, about the right to deep and continuous
sedation, and the right to stopping artificial feeding and hydration.
Authors: We revised it (abstract line 9)
- Change: 58% expressed the wish that advance directives be imposed on doctors
- to as follows: 58% of the patients interviewed would like to see doctors follow the express
wishes contained in advance care directives.
Authors: We changed it (abstract line 22)
Introduction:
- Change final sentence to same as in abstract…. The aim of this report is to investigate
individuals receiving palliative care about their opinion about euthanasia, about advance
directives, about the right to deep and continuous sedation, and the right to stopping artificial
feeding and hydration.
Authors: We changed it (introduction line 31)
Methods:
- (survey shows in additional file): replace with Survey available in Appendix 1.
Authors: We replaced it (data collection line 6)
- Change additional sentence: Patients were free to develop their opinions about the questions
asked in a discussion with investigators but the qualitative data weren‟t collected in this study. At
the end of the survey, the investigators asked patients if a question has disturbed them or if they
have something to say about the survey.
to:
Patients were free to develop their opinions about the questions asked in a discussion with
investigators but these qualitative data were not included in this study. At the end of the survey,
the investigators asked patients if any question has disturbed them or if they had comments about
the survey.
Authors: We changed it (data collection line 17)
Discussion:
- Line 6: At the end of the survey, the investigators asked patients if a question has disturbed
them or if they have something to say about the survey. No one express a negative feeling during
or after the interview.
Change to: During or following the interview, no negative feelings were expressed.
Authors: We changed it (discussion line 6)
- Page 8 line 6: “In France, limiting or withdrawing life-sustaining treatment is not considered as
euthanasia. There is a notion of intentionality to hasten end of life in euthanasia. But in this case
the goal is to relieve suffering and do not make irrational obstinacy.”
It is not clear what “in this case‟ refers to – is it euthanasia, or continuous sedation or cessation
of artificial hydration/nutrition? Please amend the sentence to clarify.
Authors: We changed the sentence by “… but in the continuous sedation, the goal is to
relieve…” (page 8 line 6)
- Furthermore, I wonder about the translation of the term irrational obstinacy which also appears
in the survey – could you please reconsider the term‟s translation. It maybe that the translation is
true but the intention may be different in the complexity of language.
Authors: we deleted this term because there is not equivalence, it‟s like therapeutic obstinacy
Limitations:
- Omit sentence 21-23: „Future qualitative studies should be scheduled to bring complementary
information. These approaches require interviews performed by experimented researchers and
specific analysis of the interview content.‟
This is now covered by the previous sentence.
Authors: We deleted it (limitations line 20-21)
Conclusion:
Change: “This study shows in one hand the feasibility of discussing euthanasia, deep and
continuous sedation and advance directives with end of life patient. In the other hand, it suggests
that they are probably more reticent to legalize euthanasia, they approve deep and continuous
sedation, they consider artificial nutrition and hydration as care and they want to see their
advance directives respected.”
To: “This study demonstrates the feasibility of discussing euthanasia…..patient. It reveals that
they are probably…..”
Authors: We changed it (conclusion line 2)
Survey:
Suggest that you consider the survey translation which while maybe technically correct may
have some altered meaning / understanding in English.
For example; the term: „whose prognosis is engaged in short term‟ would not be routinely used
in English, would more likely say…. Whose prognosis is short?
Authors: we changed the sentences in “incurable disease whose prognosis is short” and “this
decision engaged his short prognosis”
And the term: refusal of unreasonable obstinacy – is not clearly understood in its current form in
English.
Authors: we deleted this term