End of life: the “overwhelming” observation of palliative care in France

“Insofar as medicine now has the means to relieve pain, benefiting from it is a right for all patients and a duty of the medical profession”, was one of the strong demands of a panel of 18 citizens gathered at the end of 2013 by the National Consultative Ethics Committee during a citizens’ conference on the end of life. But to ensure that this right is respected, the French are calling for the development of palliative care. Access to this care remains very difficult in France. This is what emerges from the report on the public debate concerning the end of life released this Thursday by CCNE.

Failure to respect the right to access palliative care
“Despite a significant development in palliative care in recent years in France, only 20% of people who should benefit from palliative care have access to structures with, in addition, serious territorial inequalities that exist with regard to palliative structures such as the number of dedicated beds in hospitals, ”the CCNE lamented yesterday in presenting its report to the press.
Incidentally, the Committee recalls that “IGAS (1) noted in 2009 (that) only 2.5% of people who die in hospital were identified in a GHS (homogeneous stay group) corresponding to a load in a palliative care unit. “

An unbearable end of life for many people
In addition, the study “Death in hospital”, carried out in 200 French hospitals, and published in 2008 indicated that more than two thirds of nurses declared that they considered the end-of-life conditions of the people they treated as unacceptable to themselves when they were at the end of their life.
To put images on this situation, the CCNE referred yesterday to one of the conclusions of the Commission for reflection on the end of life of Professor Didier Sicard (December 2012) which indicated that “sick people at the end of life experience, for most of them, the feeling is to be subjected to a medicine which privileges the technical performance to the detriment of the attention which should be paid to them; or to be purely and simply abandoned. ”

Lack of training for professionals
And to understand the attitude not always up to the standard of caregivers towards patients, we must look at the deficient training of health professionals at the end of life in France.
In its report, CCNE states that in medical and paramedical studies, little or no time is given to approaching, supporting and caring for people at the end of their life.
“Of course, the question of death and end of life was introduced in the first cycle but within a very broad module. During the second cycle, the number of hours devoted to the “pain, palliative care, anesthesia” module can vary from 2h to 35h … “
In addition, there is no longer any training apart from the diplomas of complementary specialized studies. The majority of palliative care units are in fact not authorized as a validating internship for the DES in general medicine or the DES in oncology.
Finally, continuing education also remains little valued. There is a university degree in palliative care, where according to the National End of Life Observatory (ONFV), doctors represent only 28% of participants. And the Observatory estimates that 80% of doctors have not received any training in pain management. As an example: “Only 3 out of 150 oncologists in Ile de France were trained in palliative care in 2008 and 63% of doctors say they have never received training on treatment limitations”, concludes the CCNE report on this issue.