Analysis: Modifications to the Palliative Care Bill Amended During the Public Parliamentary Session
This analysis is intended to identify the major changes introduced by the social affairs commission and the public parliamentary session in relation to the initial text.
The examination of the bill for accompaniment and palliative care was conducted by the Committee on Social Affairs between 9th and 11th April 2025 followed on 12th to 16th May 2025 by the public parliamentary session. The text issued by the committee was published on 16th April. The modifications introduced in general provide clarification of the terms and aim to ensure the effective establishment of the 10-year plan announced by the government in April 2024.
Do not confuse palliative care and “assistance in dying”
Training in “assistance in dying”?
Article 8 of the bill incorporates training for end-of-life accompaniment and the palliative approach within medical studies, as well as training for health professionals and medico-social workers. However, an amendment submitted by Agnès Firmin Le Bodo, an MP from the Horizons party, and ex-reporter for the 2024 end-of-life bill, and by François Gergnigon, the co-reporter of the present bill, added training in “assistance in dying” although that specific term has not been defined and refers to the so-called Falorni end-of-life bill. Following the opposition by several MPs, René Pilato an PM from the LFI party stated that it was not “active” assistance in dying. According to Agnès Firmin Le Bodo, deep and continuous sedation until death comes under the category of “assistance in dying”. In so doing, those MPs are deliberately maintaining the confusion between the two texts which are however separate and are attempting to establish a continuum between palliative care and “assistance in dying” whereas the latter notion in fact includes euthanasia and assisted suicide.
Rejection of article 8 and call for a second vote
During the examination session, the MPs rejected article 8 as a whole, which could be re-submitted to a vote on 27th May, prior to the solemn vote.
Rejection of information sessions in primary schools
During the Committee session, MP Agnès Firmin le Bodo put to a vote the inclusion of an information session in the primary and secondary school syllabuses on the end-of-life and on death, including “witness accounts by voluntary accompaniment workers from “recognised secular, apolitical and non-religious accompaniment associations. Some MPs called for particular vigilance on this type of subject which is primarily the responsibility of families, all the more since the perimeter has not been clearly defined, nor has the type of the “recognised” associations. This article was deleted during the examination session.
Adjustment of the terms “accompaniment” and “palliative care”
Annie Vidal, the reporter, suggested replacing the term “palliative care and accompaniment’ by the one used in the bill, namely “accompaniment and palliative care”. In explaining the motives behind her amendment, she explained that the term “palliative care and accompaniment” deviates from international standards, which do not recognise the term “accompaniment medicine”, as opposed to palliative care and “palliative medicine” which have proved their effectiveness and whose definition remains highly consensual. That is the reason why the adopted amendment reinforces the distinction between the notions of palliative care and accompaniment, without however rejecting the latter. Accompaniment, which describes an approach and not the nature of care, is an integral part of palliative care. The term recognised by the dedicated knowledgeable association in France (Société française d’accompagnement et de soins palliatifs) includes the notion of accompaniment. Similarly, the ten-year strategy includes the notion of accompaniment in order to reinforce the overall nature of the care.
Creation of “accompaniment and palliative care centres”
The MPs called for better definition of such centres, which are intermediate establishments between the home and hospitals. Their definition was adjusted between the commission and the parliamentary session. They are defined as centres which “provide accommodation, including on a temporary basis, and which offer specialist care and medico-social accompaniment, in association with family members, for those at their end of life whose medical condition is stable and who cannot or do not wish to remain at home for medical or social reasons. They are establishments governed by public law or private non-profit organisations. They are ready to accept handicapped inmates.” This was a proposal in the report by Professor Chauvin submitted to the government in 2022 and which was used as a basis for the elaboration of the 2024-2034 ten-year strategy.
Establishment of an enforceable right to palliative care
Through article 4, the right to benefit from accompaniment and palliative care as specified in article 1110-10 of the public health code [1] is guaranteed for all those whose state of health so requires. The patient or if his/her condition does not allow it, the person of confidence or failing that, a family member, may submit a claim to an administrative or judiciary court if they were unable to obtain such care in order that suitable care may be ordered.
Ending of treatments and evaluation of unreasonable therapeutic obstinacy
The experience of disputes over the termination of treatments has led to clarification of the operation of the collegial procedure in which “The person of confidence and family members may participate” (…) except in the event of explicit prior refusal by the patient“.
Moreover, an amendment was adopted by the committee to specify by decree the conditions for ending artificial nutrition and hydration of a patient unable to express him/herself “in order to avoid abuse and suffering“. The authors specified that “For many people in a complex handicap situation, artificial nutrition or hydration is common and constitutes an act of day-to-day life, a care which improves their quality of life“. However, since the law dated 2nd February 2016, the public health code states that “artificial nutrition and hydration constitute treatments which may be terminated” under certain conditions which were not explicitly defined.
This article was deleted during the parliamentary session, the government claiming that “the conditions for terminating artificial nutrition and hydration are dependent on, as stated in the law, a decision by the doctor on completion of the collegial procedure. It does not therefore appear appropriate to refer their determination to a decree, even if it were through the State Council, which cannot by nature foresee all the circumstances particular to each patient”
The urgent need for a programming law
Several items are included in the bill to ensure the effectiveness of the 10-year strategy, whose sums must be invested and incremented each year until 2034. A multi-year programming law for accompaniment and palliative care must determine by 31st December 2025, and every five years, the development path for the availability of accompaniment and palliative care.
This is what Alliance VITA is calling for. As they stated during their audition by the Committee on Social Affairs on 1st April. This programming law and its application should be a prerequisite to any modification in the end-of-life law.
The official vote on the bill was scheduled for Tuesday 27th May 2025.
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