Y a-t-il une place pour les lits identifiés de soins palliatifs ? Bilan d'une expérience dans un CHU parisien

Passionate debates were triggered by the development of palliative care practices and the growing contingent of dedicated beds in hospital units. Insufficient transparency in fund allocations, mission definitions and control of new structures generated legitimate fears in the world of palliative care. The risks cannot be denied; the main one being that the resources attributed to these dedicated beds might not be truly applied for palliative care, but merely correspond to an accounting trick to increase the funds controlled by a given unit. The question was whether this new offer of care might overlap with the competencies of palliative care units and mobile teams. In this context and in order to identify factors for reflection, we describe our experience during the past two years in an oncology unit of a Paris hospital, which has nine beds dedicated for palliative care. Is this experience representative? Transposable? The current situation shows that existing organizations differ greatly, suggesting the need for a serious debate about the usefulness of the concept in itself. What were the conditions leading the decision to identify beds specifically dedicated to palliative care? The debate presently limited to the world of palliative care, might also be usefully approached by health authorities who have a real responsibility in the matter.