"End of life and territories - Multidisciplinary research to reduce territorial inequalities in support for people at the end of life"

At the same time as support for people at the end of life continues to suffer from territorial inequalities, and despite the clear progress that has been made in the palliative care sector, attempts to change our legislation in favor of legalizing active assistance in dying continue to grow. In addition, the announcement by the President of the Republic of a Citizens' Convention on the End of Life during his second term in office helps to illustrate the growing importance of a debate raising numerous and complex questions.

In the above context, the primary aim of the present project is to lead us to question the objectives and actions targeted by the National Plan 2021-2024 mobilizing 171 million euros alone for its implementation. One of these aims in particular to "ensure that everyone can be cared for within the framework of an early assessment of their needs and anticipation of end-of-life situations,in all territories, by trained and expert professionals" (Plan 2021-2024, p.11).

Our ambition is in line with the recommendations of the IGAS, which regretted that there were still too few works, publications and research programs on the end of life, and strongly hoped that they would be strengthened.

With this in mind, the authors of the fifth Plan invite researchers from all disciplines to mobilize, going beyond disciplinary silos (Plan 2021-2024, p.35).

The aim of our project is to meet the Plan's expectations not only from a research point of view, but also from that of training in a field that is just waiting to be deployed within the university sphere.

It is therefore from a multidisciplinary perspective with a legal focus that the present project aims to present and analyze the various issues and remedies raised by unequal access to palliative care throughout France.

First, on the issues side, we need to question the reasons for and effects of a persistence of territorial inequalities known and recalled over the years within the various reports published on the subject as more recently by the Atlas 2020 des soins palliatifs et de la fin de vie en France. Is the argument regularly put forward that care teams' mastery of positive law is still too fragile still valid? Are we witnessing a violation of the constitutional principles of the right to health and respect for human dignity? Can we expect the right to guaranteed access to palliative care, the right not to be subjected to unreasonable obstinacy or the right to deep and continuous sedation to be applied uniformly and equitably throughout the country?

Faced with this type of questioning, the question of remedies must necessarily be asked also prompting reflection on the part of the jurist. First of all, the lack of equal access to palliative care is provoking a desire to change our legislation. While the Claeys-Leonetti law remains the last "major law" on end-of-life care, attempts to change our legislation continue to develop in favor of legalizing active assistance in dying.

On the players' side, the articulation and coordination of healthcare policies between the national and local levels also lies at the heart of the fight against social inequalities in health. Thus, the work carried out by ARS to regulate healthcare provision in the regions, and by local authorities to combat health inequalities and develop preventive action using tools such as local contracts or the creation of CCASs, is to be welcomed but above all encouraged to be strengthened. In addition, we can only hope that the possibility offered to local authorities of combating medical deserts through the allocation of installation grants will help to reduce the isolation of people who are supposed to be able to benefit from support in places where palliative care is still lacking. Finally, support for people at the end of their lives must extend beyond the hospital to the home, in order to guarantee the right to a dignified end of life and the best possible relief of suffering throughout the country. This is one of the main actions targeted by the 2021-2024 Plan, encouraging the development not only of out-of-hospital interventions by specialized palliative care teams, but also of agreements between mobile palliative care teams and establishments in the social and medico-social sector caring for the frail elderly or people with disabilities.