The regulation of drugs used to relieve patients in palliative care must evolve, calls the High Authority for Health (HAS) - Francois Lo Presti afp.com

The public authorities must "change the regulation of drugs" used to relieve patients in palliative care. The public authorities must allow "all health professionals, city and hospital, to implement" effectively the sedation provided by the law on end of life, estimates the High Authority for Health (HAS) in a recommendation addressed this Monday to the government.

1⃣ # Press release | To help healthcare professionals support their end-of-life patients ➡ the HAS publishes the procedures for using # sedation drugs in hospitals and at home

👉 Read the press release online: https://t.co/ftKZxqjVil pic.twitter.com/7GRuyFiPQ3

- High Authority for Health (@HAS_sante) February 10, 2020

At the end of November, the case of a Norman doctor highlighted the existing obstacles to the accompaniment of a patient at the end of life at home. This doctor was charged and prohibited from practicing for having administered to five elderly people one of these drugs, normally reserved for hospital use.

A "manual" for doctors

The Claeys-Leonetti law of February 2016 established a right to "deep and continuous sedation" until death for terminally ill patients to relieve unnecessary suffering, especially after stopping treatment in the event of "unreasonable obstinacy »Or in the event of a therapeutic impasse. But the drugs used to do this - an anesthetic product, midazolam, and neuroleptics commonly used in psychiatry - are reserved, except in exceptional cases, for hospitals.

As they have not been placed on the market for this indication, there is no "leaflet" specifying how to use them. The recommendations of good practice published this Monday by the HAS intend to remove this second obstacle, by providing doctors with a "manual".

Collegial decision

From now on, "doctors who want to embark on this care" for the end of life at home "will have a practical guide", underlined Pierre Gabach, head of the department of good professional practices at the High Authority. Regarding the availability of medicines, the Minister of Health Agnès Buzyn said at the beginning of January that the services of the ministry would work "urgently" to "supervise, secure and guarantee" access outside the hospital.

This access is theoretically possible, through the system of “hospital retrocession”, via hospital pharmacies. In practice, however, it is very difficult for relatives of patients to obtain them.

Another difficulty is that the law requires that the decision to implement this sedation be taken collegially. This condition is more difficult for city doctors to fulfill, especially in medical deserts where home hospitalization structures are sometimes not available.

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  • End of life
  • Medicine
  • Society
  • Health
  • Hospital
  • patients