De l'accompagnement des mourants à la médecine palliative en passant par les soins palliatifs

To change from the concept of “accompaniment of dying patients” to the concept of “palliative care”, then to that of “palliative medicine” is significant of an evolution in the way of thinking the end of life and death in our society. Confrontation with death brings on in us three representations: the death of the other, the death of me and the death of you. The very existence of palliative care structures is a reminder that “we all will die”. This reminder of limits and uncertainty is not easy to recognize for a medicine that would like all powerful and effective. This creates resistances. Palliative care can be considered as “a way of challenging the established order and of proposing alternative actions or new conceptions fulfilling objectives not met. The contribution of palliative medicine would be to reconcile scientific rigor of reasoning, the use of available technical possibilities of modern medicine, and the concern of the human being. The terminology “palliative medicine” is a larger representation, more noble, more academic than “palliative care” that requires a technical training and a specific teaching about the values of medicine for all health professionals.