Explicitation de deux caractéristiques fondamentales des soins palliatifs. La diachronie et la konomie

How it is difficult to promote palliative care among some clinical teams! Everybody think to be up-to-date to take care of disabled people or old people. Despite the formations and university courses on the field of palliative care, some clinicians persist in thinking that palliative care are passive tasks and end of life. We propose in this article to discuss first of all, the diachronic dimension of palliative care and in the second time, about the inappropriate philosophic notion of autonomy, which does not respond to our clinical experience. In the first part of our work, we discuss about the diachronic dimension of palliative care to insist on the dynamic of this care and to underline the different phases of the accompaniment of a patient. We are presenting a figure that tries to explain at best. It is to show on the one hand, that it can be difficult in a few situations, as in the neurodegenerative diseases, to talk about palliative care during a long time, even though the disease does not present a possible cure. We show on the other hand how it is important to present palliative care team in order to help the patient and his family to give meaning to all treatments then proposed. In the second part of this work, we discuss the difficult question of the autonomy of the patient, especially for the conduct of care. “Who decides, and what will he/she decide ?” After discussing the complexity of the concept of the patient's autonomy, which is in fact neither Kant's autonomy nor simple utilitarist's autonomy or single autodetermination, we present a neologism “the Konomy”. The Konomy (from Greek, Koine_nomos that is to say a law that arises from a common language and understood by all) describes that the subject will be able to say “I take my decision by assuming the impact that my decision will generate on all those who surround me”. The Konomy is the ability to make a personal decision in link with all the actors who gravitate around him that they are carers or relatives so that each of them can give it sense, or in other words, the Konomy is the autonomy of the subject, which is taken in consensus with his environment.