This is the government’s first concrete gesture to improve end-of-life support in France. The world had access to the instruction of about fifty pages which gives mandate to the regional health agencies (ARS) to organize “the structuring of palliative care sectors”. This somewhat indigestible technical document is about to be published by the Ministry of Health.
Each year, some 380,000 people die of cancer, cardiovascular disease or a serious and chronic pathology that causes physical pain, mental suffering, requiring care to soothe it. While these patients account for more than 60% of annual deaths (613,200 deaths in France in 2019, the last statistic before the health crisis), no study can say how many have access to palliative care. But the official reports follow one another to alert on the deficiencies and the territorial disparities of their care.
Since 2008, the palliative care sector has been organized by a circular, which has become obsolete for lack of updating. The instruction, the sector’s new “bible”, provides the ARS with renewed specifications, which have been long awaited. The text must be published imminently, while Agnès Firmin Le Bodo, Minister Delegate in charge of Territorial Organization and Health Professions, held, on Monday June 5, a first meeting to prepare the bill on active assistance in dying promised by Emmanuel Macron “by the end of summer”. It brought together representatives of caregivers to associate them with the writing of the government copy.
Ratios almost never respected
Health professionals are largely opposed to legalizing euthanasia, or even assisted suicide. They campaign, on the other hand, for a strengthening of the palliative care offer. The government must make commitments in this area if it wants to dissuade part of the medical world from blocking a legal text that authorizes active assistance in dying. “On the guarantee of effective and universal access to end-of-life care, the State has an obligation of result”committed Emmanuel Macron, on April 3.
Education is therefore a guarantee of this political will. It includes nine annexes, four of which aim to deploy the capacities of care by hospital teams. While 53% of the population dies in hospital, only 23% of these deaths concern patients admitted to palliative care. For palliative care units (USP), specialized services within hospitals, the text establishes a minimum threshold of three beds per 100,000 inhabitants. This quota is not reached today in more than forty departments. And twenty has no bed in USP. Hospital departments in which deaths are frequent may have “identified palliative care beds” (LISP). But the disparities remain large. Creuse has 22.7 beds (USP and LISP) per 100,000 inhabitants, Haute-Saône 3.4…
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