Decryption : Palliative care and accompaniment
Bill No. 1102 concerning palliative care and accompaniment is scheduled to be examined in May, in joint discussion with bill No. 1100 regarding “assistance in dying” through assisted suicide and euthanasia.
It will be introduced by MPs Annie Vidal (Ensemble pour le République) and François Gernigon (Horizons) who are its joint reporters. As indicated in the motivation text “This bill picks up fully and scrupulously the provisions of the 1st item regarding palliative care and accompaniment as well as the rights of the sick in accordance with bill No. 2642, as adopted by the special commission to the National Assembly on 18thMay 2024. It also includes all the amendments adopted during the session on the subject prior to the interruption of the debates due to the dissolution of the National Assembly.”
What exactly is included in the bill?
The bill is partly intended to implement the 10-year plan for palliative care, presented in 2024. The plan aimed to provide 1.1 billion euros funding over the next10 years.
Accompaniment in question
The bill introduces a new notion in the context of the public health code replacing the notion of palliative care by the expression “palliative care and accompaniment”. This addition is controversial inasmuch as that term does not correspond to any international standard associated with palliative medicine, since accompaniment is an integral part of that approach and cannot be separated from it.
In support of this notion, article 10 explains, what is presented as a “new category of medico-social establishment (ESMS) namely “Palliative care and accompaniment home“. Such establishments are in fact intermediate establishments between hospital and the private home. They correspond to the need for palliative care outside dedicated palliative care units, such establishments have already been experimented.
They are “Intended to accommodate and accompany people during their end of life together with their next of kin”. They can agree conventions with palliative care units and teams. It is intended through this law that the State will study the creation of 101 such establishments by 2034.
Visiting rights reasserted
This measure results from the malfunctions during the Covid crisis which generated traumatic situations. Patients at their end of life were unable to obtain the support of their loved ones during their last days. Such unconditional visiting rights adopted in the “ageing well” law is being reasserted for patients receiving palliative care in health and medico-social establishments.
Referral to mediation by next of kin facing a collegial decision
Article 16 specifies the collegial conditions for triggering a procedure for limiting a treatment or for sedation as well as the possibility of referring to mediation by next of kin in the event of disagreement with the collegial decision.
Monitoring and traceability of deep sedation procedures
During the work by the evaluation mission of the Claeys Leonetti law, deep and continuous sedation until death could not be counted due to the lack of any suitable coding. That is corrected by this article through application of a code and the creation of a “voluntary” monitoring and evaluation commission to check the medical records a posteriori.
The other measures concern organisation details and clarifications.
A programming law for palliative care, a prerequisite
Article 16 includes the adoption by parliament of a programming law for “palliative care and accompaniment” to be put to the vote no later than 31st December 2025.
The presentation of a programming law for palliative care (the only way to plan the necessary funds) and its complete implementation over several years and subsequent evaluation should be a prerequisite to any modification of the 2016 Claeys-Léonetti law through the legalisation of assisted suicide and euthanasia. It is therefore contradictory to adopt it subsequent to the vote on that law.
Chaotic application of the 10-year plan
In an interview for Le Monde published on 6th April 2024, the Health Minister Catherine Vautrin revealed the content of a 10-year development plan for palliative care, announcing an additional funding of 1.1 billion euros over ten years. The yearly expenditure would therefore increase from 1.6 billion euros to 2.7 billion euros in 2034, which equates to a yearly increase of a mere 6 %. Taking into account inflation which reduces the positive impact of that increase, it is difficult to understand how the actual needs of the French population will be covered by 2034.
The minister has declared: “Prior to the opening of access to assistance in dying, we will have already increased the availability of palliative care” . She has announced the opening of palliative care units as soon as 2024 in some ten departments which currently have none. That corresponds to the creation of 220 extra beds. That remains blatantly inadequate in relation to the stakes, since 50 % of French people who need palliative care still have no access to it. In particular, the considerable increase in needs associated with the ageing of the population has not been taken into account.
A year later, a palliative care monitoring committee meeting on 18th March 2025 found that the promises have still not been met : The announced opening of palliative care units in 2024 in ten departments which do not have any, have still not been achieved. Only three have opened in the Jura, Lot and Cher. 427 mobile palliative care teams were announced, in March 2025, there are 420.
Thus, the scissors effect of increasing needs and wanting means is liable to lead to further deterioration of the care which those at their end of life will need.
The reason according to Yannick Neuder, the Minister for Health and Access to Care, is the inadequate number of carers.
How can one begin to believe the planned creation of so-called accompaniment establishments ? Where will the carers come from when they are already in short supply for the opening of palliative care units, in the absence of a truly ambitious policy which can be sustained over successive governments ?
In a 2018 study titled “Revision of the bioethics law : which options for tomorrow ?”, the State Council considered that “The expression of a request for anticipated assistance in dying must never be the result of inadequate access to palliative care”. Access to high quality palliative care thus constitutes an indispensable condition to the expression of the free and enlightened will of the patient in the last moments of their life and, more generally, a necessary prerequisite to any serious ethical thinking on the question of the end of life.” The State Council warned against the risk that assisted suicide and euthanasia should be forced onto patients due to the lack of access to the care which they need.
This risk must be considered inasmuch as the bill relative to “assistance in dying”, if it is adopted, could come into effect by the end 2025 whereas the “Ten-year strategy for accompaniment care” will be spread over ten years.
Suivez-nous sur les réseaux sociaux :
