The National Assembly reopens a debate on the end of life on Thursday, studying the bill from deputy Olivier Falorni which opens up the possibility of "medical assistance and active in dying".

The government, divided on the subject, is working on a plan to strengthen palliative care systems, still unevenly distributed across the territory. 

DECRYPTION

Five years after the Claeys-Leonetti law, the subject of the end of life returns to the National Assembly this Thursday, via a text carried by the deputy Olivier Falorni, of the Freedoms and Territories group, for a "free end of life and chosen ".

A debate that may not go to the end due to the tabling of thousands of amendments, including 2,300 coming from LR deputies.

The bill would open up the possible recourse to "active medical assistance in dying" for any person "capable and of full age, in the advanced or terminal phase of a serious and incurable disease", who cannot be "appeased" or judged by her " insupportable".

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26 departments without palliative care units 

Sign of the wide echo of his cause in the Assembly, Olivier Falorni received the support of some 270 deputies from all sides, not far from the absolute majority, in a column published by the

Journal du Dimanche

.

But parliamentarians and members of the government are divided on the subject.

Emmanuelle Wargon or Eric Dupond-Moretti have taken a public stand in favor of the bill, while others are more reserved.

The Minister of Health, Olivier Véran, for his part affirms that the Claeys-Leonetti law, which provides for deep and continuous sedation that can lead to death but without active euthanasia, is not sufficiently known or applied.

The executive is also working on strengthening palliative care systems.

Twenty-six French departments still do not have such a structure, or one in four hospitals.

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In the Allier, the Jura or even the Eure-et-Loir, for example, there is nothing.

However, these units are essential in supporting patients, assures Doctor Anne-Claire Courau, of the Bourges hospital.

In his establishment, there are no units, nor in the department of Cher.

“Beyond the physical suffering, a palliative care unit will offer psychological, spiritual care if I may say so,” she explains.

"I am thinking of a palliative care unit where I worked: a cellist could come, a socio-esthetician…"

"Medicine is at several speeds when it comes to palliative care"

“Overall, what we also feel is that when faced with death, patients have a feeling of loneliness and that it is this relational care, almost in a cocoon, that they need,” adds the caregiver.

The closest unit to its territory is an hour and a half away.

For Annie Dellville, at the head of an association to support patients, this inequality is unacceptable.

"Medicine is at several speeds when it comes to palliative care," she says.

"It's a story of medical training, inevitably money."

The government has promised an increased budget, more training for healthcare professionals and simplified access to Midazolam (a sedative) in its new palliative care development plan.

A plan to improve patient support 

A plan co-piloted by Doctor Olivier Mermet, general practitioner in Allier, and Bruno Richard, university hospital.

Their mission: "to improve the conditions of support for people with serious illnesses in France", assures the first at the microphone of Europe 1. Behind the figures which suggest a medical desert, the general practitioner recalls the importance of '' care adapted to everyone.

"We should perhaps not stop at the single figure of the number of departments without a palliative care unit, because in very rural departments, for example, when you are very far from the hospital center, it is perhaps more important yet to provide human resources so that doctors and palliative care teams can come to the home ".

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In France, many structures exist, recalls Olivier Mermet.

The palliative care units mentioned are the "most specialized" places, where support is maximum, he emphasizes.

But we must not forget the mobile teams "who roam the hospital services" and directly visit patients in the homes of patients to accompany the sick, relatives and caregivers.

"There is also another particularity in France: the identified palliative care beds", explains the general practitioner.

"These are beds which are not fixed, but which are in the services. These are additional resources given to the services to support people," he recalls, also pointing to the existence of a pediatric palliative care team. .

"We must stop with this argument to say that we die badly in France"

Varied structures but still unequally distributed, he admits.

"There is still a strong territorial inequality persisting", emphasizes Olivier Mermet.

"There are a lot of efforts to be made on the training of professionals. And then, there are also a lot of efforts to be made on communication with citizens, but also caregivers on what palliative care brings, on how to express their wishes, in particular by means of advance directives or the appointment of a person of trust. "

"There have been a lot of efforts made over the past twenty years. We must stop with this argument from saying that we die badly in France," continues Dr Olivier Mermet.

"There are certainly still situations that need to be improved, it would not be fair not to say so, but it is precisely the interest of this plan to further improve the conditions of support for people."