“Palliative care is creative and rewarding”

Is being a doctor a choice of reason, a vocation or a family tradition?

When I was little, I was hesitant between becoming a veterinarian or a doctor. My thinking was still quite immature, but I could see that some animals were not very friendly… After my baccalaureate, I enrolled in medical studies. Then, during my internship, I began to deconstruct my preconceived ideas. Like many, I had a somewhat heroic vision of the profession, that of the doctor who saves. My time in the emergency room particularly marked me. Far from dealing with vital emergencies all day long, our mission included a lot of support for single, destitute people, coming to seek something other than a technical medical procedure. Faced with this social suffering, I discovered another medicine, which consists of taking care.

How did your career as a palliative care specialist develop?

I didn’t want to set up as a general practitioner in the city. I had this image, perhaps false, of a solitary practice. I like working in a team and so I wanted to stay in the hospital. At the end of my studies, I joined a comprehensive medicine service, where I discovered palliative care when mobile teams were set up. I trained in pain management, then in the palliative approach.

What particularly interested you about this approach?

Palliative care offers a different perspective, with a medicine that is undoubtedly more humble, because it is aware that cure will not be the outcome – whereas this is generally the hope of patients. We must position ourselves differently, accepting the limits of medical power, without giving up. This medicine is not a sad or sinister specialty. On the contrary, it is creative, human and rewarding. Beyond the symptoms, it is about considering the person as a whole, not just based on their pathology. Like Claire Fourcade, to whom I succeed as head of Sfap (association which brings together 16,000 French caregivers, editor’s note), I believe we must take care of people, whatever their condition. We are not responsible for illness or suffering, but we are responsible for what we do with it. The good that can be done, for the patient and their loved ones, is immense.

Death is omnipresent in your profession. How are you holding up?

We will all die one day or another, but palliative care teaches us that death should not be experienced as a medical failure, but rather accepted as a part of life. We know that at some point we will have to stop trying so hard to prevent death from happening at all costs. This does not mean that she will be provoked, but that she will be properly supported. The failure would be to not support people accurately in this moment of their life. Incredible things are happening in our services!

Recently, a young patient dreamed of going to see a PSG match. The members of the team contacted the PSG Foundation, and he was able to go to the match, meet the players… It was an extraordinary moment. For us, in palliative care, a patient is fully alive until the end, even if he loses his physical, relational or cognitive capacities. He deserves to be given the best we can offer him, until his last breath. It is also the small daily gestures, the attention, the presence that give us the strength to continue. Every night, I go to bed knowing that, collectively, we have contributed something to our patients.

What type of relationship do you have with your teammates?

I wouldn’t say my team members are friends. Some people do, of course, but that’s not the point. On the other hand, they are, in a way, close people. We truly share a common vision of care.

In current debates on the end of life, the question of suffering is often put forward to justify medical assistance in dying…

I understand very well that we can be afraid of suffering. I have this fear myself, and perhaps that’s why I became a palliative care doctor. I fear pain and suffering, and am committed to fighting against it. However, it is necessary to repeat that no, we do not all die screaming in pain: even without medical support, death is not always painful. And above all, we know how to relieve. The means exist: human, medical, relational, communicational. The difficulty is being able to mobilize them. Medicine has made enormous technical progress since the Second World War, but as far as humanity is concerned, it has undoubtedly sometimes been left behind. It needs to be upgraded. It is not a question of reducing technology, but of restoring its place to humans.

How do you understand the people who are calling for the legalization of active assistance in dying?

Faced with a person who asks to die, my role as caregiver is to sit next to them, to listen to them to try to understand what makes their life so difficult. And then to see how I can relieve it – physically, psychologically, socially, existentially. My goal is not to convince her to change her mind, but to help her find, if possible, meaning, or even pleasure, in life. Like psychiatrists, who support people in suffering, sometimes suicidal, every day. That’s what care is, not causing death.

Supporters of active assistance in dying say it does not conflict with palliative care. What do you think?

The palliative vision is, in my opinion, difficult to reconcile with the legalization of an induced death. Not for moral reasons, but because it is another way of looking at the person at the end of life. To justify his desire to legislate on assisted dying, Emmanuel Macron, in an interview given to The Cross and to Release, said he wanted to allow the choice “when death is already here”, as if some patients were already half dead! For us, in palliative care, a patient is fully alive until the end, even if he loses his physical, relational or cognitive capacities. He deserves to be given the best we can offer him, until his last breath.

Euthanasia and palliative care would therefore be decidedly incompatible?

We cannot both consider a person to be fully alive and say that “death is already here”. It’s either one or the other. This opposition is at the heart of the debate. This is why those involved in palliative care are worried about legislative developments: they know that even in a hospital bed, even in tragic situations, life can still have value. They know it because they come into contact with this life every day.

What would you say to the parliamentarians who will have to vote on these questions?

Come meet the palliative care teams! And above all, pay attention to what you do. We are talking here about life and death. They will vote for a law, then move on to another issue. But for us, our entire professional life will be impacted, not to mention, of course, that of patients. I would also tell them to look at what is happening abroad. In Canada, legalization initially concerned exceptional cases; it now represents up to 7% of deaths in certain provinces. Applied to France, this rate would be equivalent to 45,000 deaths per year. We are far from the exception. We can’t say we didn’t know.