A serious illness or the dysfunctions of the organs of our body that often occur with advancing age bring each person closer to the end of their life. So that this inevitable moment takes place in the best possible conditions for the patient, but also for his loved ones, palliative care provides both physical and psychological support.
In 2002, the World Health Organization (WHO) provided a definition of what palliative care is:it is "all the care provided to people with a disease with a reserved prognosis ". In other words, people affected by a serious and progressive illness that threatens their vital prognosis have the possibility of benefiting from palliative care.
Palliative care refers to a whole range of types of care provided to people at the end of life. First of all, essential medical care, but also more comprehensive support for the patient himself, his relatives, and all the people who work with him, such as a social worker, a psychologist, volunteers from associations specializing in support for people at the end of life, etc.
In the context of palliative care, the patient benefits from support to relieve their pain, breathing difficulties, or other nausea suffered by people whose vital prognosis is committed in the short term. He is also accompanied psychologically to approach his end of life in the best possible way and to be able to talk about his anguish, his sadness and other legitimate feelings at the time of his life. It is also often a question of taking stock of his life with the patient and of broaching more spiritual subjects.
Palliative care also includes everything related to relationships and a social approach to those close to the patient. Their aim is to relieve the sick person and to support those around him at the end of his life, by evoking, for example, possible financial problems that will result from the death of a person.
Palliative care initially accompanies and supplements medical care proper, then it replaces the latter as the end of life approaches. Their goal is mainly to safeguard the best possible quality of life for the patient and his entourage and to soothe his psychological suffering and that of his loved ones. In this sense, they also have the objective of avoiding at all costs therapeutic relentlessness if it appears unreasonable.
A patient at the end of life can benefit from palliative care in a health establishment, in a retirement home, etc., but also at home, according to the wishes of the person and his relatives.
There are medical units specializing in this type of care:palliative care units (USP) which generally receive a small number of patients and those whose situations are the most difficult to manage; hospitals also have a certain number of beds reserved for patients who require palliative care; and mobile palliative care teams (EMSP), made up of several professions (doctors, nurses, and psychologists), who travel to patients to listen to them and support them, but who also accompany caregivers who intervene for this type of care .
At home, palliative care is supported by home hospitalization services (HAD) which depend on a hospital structure. This form of care is the one that is preferred when the patient's situation allows it. But palliative care is set up at home only if a team of doctors, nurses, physiotherapists, etc., is available near the patient's home and after ensuring that the patient's entourage has the capacity to ensure this support at home.
The doctor of the person requiring palliative care is there to refer the patient to one of these specialized structures. The French support and palliative care society also makes available on its website a national directory of palliative care structures, and also the contact details of volunteer associations for this support. There is also a national helpline "supporting the end of life, getting information, talking about it" which can be called on 01 53 72 33 04 to answer questions about palliative care.
The “Leonetti” law of April 22, 2005 relating to the rights of patients and at the end of life defined and above all clarified the rights of patients at the end of life who can benefit from palliative care in particular. The philosophy of this text is to draw the contours of the right to "let die", without avoidable suffering and with respect for the patient's dignity.
The broad outlines of the law are the refusal of therapeutic relentlessness, the authorization to stop or limit treatments and the fact of admitting “only to relieve the suffering of a person at the end of life, can be taken the risk of pain treatment having the side effect of shortening life ”, as indicated by the Ministry of Health.
Thus, in order to respect the dignity of a person at the end of life and to safeguard the best possible quality of life for the patient, the law specifies that:"in all circumstances, the doctor must endeavor to relieve the suffering of his patient, assist him morally and avoid any unreasonable obstinacy in the investigations or the therapy ", and also that "the doctor must accompany the dying until his last moments, ensure by appropriate care and measures the quality of a life that is ending, safeguard the dignity of the patient and comfort those around him. .
For his part, a person at the end of life can refuse any therapeutic relentlessness if he is able to express his will. In this situation, pain management and palliative care should always be provided.
In the case of people whose state of health no longer allows them to express their wishes regarding their end of life, in the absence of advance directives or a person of trust, designated in advance by the patient, who knows his wishes, the doctor has the possibility of stopping any therapeutic relentlessness in consultation with the care team, after having taken the opinion of a doctor outside his service, and of the patient's relatives. In all cases, the doctor's decision must be justified and recorded in the patient's medical file.
