The proposed bill "aimed at guaranteeing equal access for all to accompaniment and palliative care " has been adopted by the French Senate. The vote marks the final adoption of the proposed bill. In fact, on 11th May the senators adopted the text equal to that adopted at second reading by the National Assembly last February, in order to allow its rapid introduction.
The legal path for the text is therefore complete. The text is one of the two texts dealing with the "end of life ", the other being the controversial text on the legalisation of euthanasia and assisted suicide. François Bayrou, when he was Prime Minister, decided to split into two texts the Attal government's proposed bill which was interrupted by the dissolution of Parliament in June 2024.
As an indication of the strong consensus on the text, it obtained 325 votes "for" out of 343 votes cast. Virtual unanimous support, similar to the voting by the National Assembly, which approved it by 491 votes "for" out of a total of 560 votes cast.
The main provisions of the text
This new law follows on from the various texts adopted over the last 30 years on palliative care. A law in 1991 established palliative care among the missions of the public hospital service by distinguishing it from curative care. Access to palliative care was subsequently recognised as a guaranteed right by the law adopted in 1999.
The Claeys-Leonetti law dated 2nd February 2016 reinforced that right by establishing an obligation for health professionals to implement all means available such that every person has "a right to accompaniment and a dignified end of life with the best possible relief of suffering" (article 1).
These legal provisions, and the various development plans promoted by governments have not managed to ensure access for all. According to the French Audit Office in a report issued in 2023, a mere 48% of such needs were covered by the palliative care facilities.
The text adopted includes several technical articles: addition of the term "accompaniment" to the notion of palliative care, organisation of care by the regional health agencies, training of carers, submission of a yearly report by the government…
The new law also provides that the carer proposes to the patient the elaboration of a customised accompaniment plan. It is defined as follows:
"The customised accompaniment plan is devoted to the anticipation, coordination and monitoring of the sanitary, psychological, social and medico-social care of the patient and his/her entourage, including after the death of the patient. It includes a part relating to the evaluation and management of discomfort symptoms of the patient as well as the provision of pain relief and support following loss of autonomy".
It remains to be seen whether, in practice, a patient, under the shock of the announcement of a serious diagnosis, is in a suitable frame of mind to consider all this scenario, including his/her death.
Article 20 stipulates that a "national awareness and information campaign concerning death and its accompaniment must be conducted every year".
An essential provision in the text states that intermediate structures between the home and hospital are also to be created, to be called "accompaniment and palliative care homes" to accommodate those whose condition at their end of life is no longer compatible with remaining at home, under a general and multi-disciplinary approach.
The need for a programming law to ensure effective guaranteed access
This new law does not provide any fundamental access guarantees. That is in fact the message by Philippe Mouiller (LR), the President of the Social Affairs Commission, following the vote: "This text does not institute any funding. It includes recommendations, not commitments. Whereas the deployment of palliative care is cruelly lacking in many parts of the French territories, we are today clearly declaring the will to accelerate on the subject, but without having any financial means which would demonstrate a true capacity to act".
To that end, only a multiple-year programming law on palliative care would enable the establishment in law of a strategy and the means necessary to allow the true development of palliative care and to guarantee its access to all those who need it.
The Senate in fact devoted a discussion to the notion of an "enforceable right" in order to establish an "obligation of results" with respect to access to palliative care. Indeed, by establishing an enforceable right, the law would allow those deprived of access to refer to the courts to demand the implementation of the law. The Senate however rejected this proposal.
According to Mme Lassarade (LR), the reporter for the text, "Effective access to palliative care will not be achieved by a guarantee in a court of law, but rather by the reinforcement of means". Article 7 indeed mentions funds allocated to palliative care in the ten-year plan. But every year it will be necessary to check that the said funds are indeed allocated within the Social Security budget.
This vote has the merit of confirming an important point: the consensus of the senators is for palliative care, and not for a so-called "assistance in dying". Studies have in fact shown that palliative care, when it is effective, considerably reduces the number of requests to hasten death, which are in any case very few in number. On such an important question, wisdom would call for the government to wait for the effects of the ten-year plan before undertaking any modification of the law.