End of life is not a situation. It’s a trajectory.
A law creating new rights for patients approaching the end of life has been adopted in French parliament . However we have to avoid the mistake of focussing the palliative care spotlight on issues related to the very end of life — such as continuous deep sedation, or advance decisions to refuse treatment. These issues are of course legitimate and important, but they may mobilize only a small number of specialists, on a particular point: the exit of the end-of-life trajectory.
The polemical and sometimes spectacular nature of the treatment of these questions may obscure the fact that if the trajectory has an exit point, it also has an entry point. What precisely happens at the entrance of the trajectory may have a decisive impact on how one exits it. In addition, early identification of the beginning of the end-of-life trajectory concerns all health professionals, not just palliative care specialists, whose services are a scarce resource in the health system.
In this regard, primary care professionals (GPs and nurses) have a major role to play in this identification: one of their main missions is to facilitate universal and equitable access to the health system for all. Therefore they may identify patients for palliative care all along their illness trajectory (whatever the place of care), and according to their needs.
What matters most here, is to be able to travel towards the end of life with maximum comfort. This final journey is not usually limited to the last few hours or days of our existence: it usually begins several months before death. Ensuring the best conditions for this journey is a public health issue which has to be addressed and implemented at different levels (public policies, health and social care sectors, civil society, …) so that early access to palliative care is definitely recognised as a fundamental human right .
General Practitioner, PhD student
Laboratoire Educations et Pratiques de Santé, EA 3412, Université Paris 13
Multi-professional Primary Health Care Center "The Vines of the Abbey", 60130 Saint Just en Chaussée, France
Scott A Murray
St Columba’s Hospice chair of primary palliative care
Primary Palliative Care Research Group, Usher Institute of Population Health Sciences and Informatics, Medical School, Edinburgh EH8 9AG, UK
 Gulland, A. French parliament passes law to allow sedation at end of life. BMJ 2016; 352: i576.
 Radbruch, L., et al. The Prague Charter: urging governments to relieve suffering and ensure the right to palliative care. Palliative Medicine 2013; 27(2): 101–102.
Competing interests: No competing interests