End of life: what the minister’s new guidance means for structuring palliative care

This is a somewhat indigestible technical document. It is also the government’s first concrete gesture to improve end-of-life support in France. the world had access to a fifty-page manual that mandated regional health agencies (ARS) to organize “Structure of palliative care sectors”. The Ministry of Health will publish the document.

About 380,000 people die each year from cancer, cardiovascular disease, or a serious and chronic illness that causes physical pain, mental suffering, and requires palliative care. Although these patients account for more than 60% of annual deaths (613,200 deaths in France in 2019, the latest statistics before the health crisis), no study can say how many have access to palliative care. But official reports follow each other to warn of gaps in their care and territorial disparities.

Since 2008, the palliative care sector has been organized by a circular that has become outdated due to lack of updating. The manual, the sector’s new “bible”, provides ARS with the long-awaited updated specifications. The text should be published immediately, And Agnes Firmin Le Bodeau, delegate of the Minister of Territorial Organization and Health Professions, held the first meeting on Monday, June 5, to prepare the bill on active assistance in dying promised by Emmanuel Macron. “until the end of summer”. He gathered representatives of the educators to contact them to write the government copy.

Ratios were almost never met

Health professionals are generally opposed to legalizing euthanasia, or even assisted suicide. They, on the other hand, are campaigning to strengthen the offer of palliative care. The government must make commitments in this area if it wants part of the medical world to block the legal text that authorizes active assistance in dying. “The state has an obligation of results to guarantee effective and universal access to end-of-life care”Emmanuel Macron committed it on April 3.

Therefore, education is the guarantor of this political will. It includes nine annexes, four of which are aimed at leveraging the care capabilities of hospital teams. Although 53% of the population die in hospital, only 23% of these deaths involve palliative care patients. For palliative care units (USP), specialized hospital services, the text sets a minimum threshold of three beds per 100,000 population. This quota is not reached today in more than forty departments. And twenty have no beds in USP. Hospital units with high mortality may have an ‘Identified Palliative Care Bed’ (LISP). But inequality remains great. Creuse has 22.7 beds (USP and LISP) per 100,000 inhabitants, Haute-Saône 3.4…