En with regard to end-of-life support, progress has certainly been made since the law of 10 June 1999 aimed at guaranteeing access to palliative care, but there is still a lot to be done: an inequality of service persists according to the regions (twenty-one departments do not have palliative care units); at home, the practice of palliative care depends on everyone’s goodwill and remains rare, erratic and dispersed. Thus, the proportion of deaths at home remains at the same level as forty years ago, ie approximately 25%. Barely 40% of people who could benefit from palliative care use it, and intolerable end-of-life situations persist.
This lack of palliative care can be explained by the lack of diffusion of the palliative culture in everyday medicine, essentially attributable to the resistance of caregivers to a “paradigm of care” which challenges modern medicine, which is overspecialized and centered on the curative, for which incurability and death are a failure. In fact, the persistence of an individualistic, competitive and hierarchical medicine is opposed in every way to interdisciplinary, even interprofessional teamwork, where everyone’s word – doctors, nurses, caregivers, pharmacists, psychologists, physiotherapists, volunteers … – is taken into account.
This resistance to palliative practice has been justified for years on the grounds of incompetence: “We don’t know how to do it. » This is how many doctors are turning their support for incurable patients onto “good death specialists”, at the risk of seeing the palliative care units overwhelmed – especially since some of these structures are in lack of staff.
Ensuring true continuity of care
Home, the lack of palliative dissemination was further aggravated by a loss of availability of doctors. At the beginning of the 2000s, doctors modified their code of ethics by abolishing the compulsory care constitutive of the profession, organizing the impermanence care. As on-call duty became optional, it was decided that the organization of on-call care would be a public service, and volunteering was decreed on September 15, 2003 (article R733 of the Public Health Code). This absence of doctors at night and on weekends (and, increasingly, from Friday evening) is combined with the development of the almost exclusive and generalized practice of consultations by appointment, as well as the tendency to the reduction in visits, in particular among the elderly and in nursing homes.
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