Fin de vie aux urgences

In France, admission to emergency department (ED) of terminally ill patients is not uncommon and concerned 4 to 8% of deaths observed in hospital. In majority of cases, terminally ill patients are sent from home to emergency department by their family doctors. Death of these patients occurs also in ED for the majority following the first 24 hours after admission. Excessive intensive therapies are practiced in more than one third of them before their death. For patient himself and his family, these conditions of death are not acceptable. Feelings of isolation and unprepared by end of life care are frequently reported by emergency doctors and nurses. Numerous failures of terminally ill patients care system explained that the deaths of these patients occur in ED. Patients and their family failed to be informed about the inexorable fatal evolution of their disease. Continuity care programs including family doctors are insufficiently developed for the patients with an advanced or terminal phase of a life threatening disease. University education and hospital training formation fail to prepare medical doctors to the end of life of patients. A national palliative care program is currently developed and we hope that it will contribute to the death of a terminally ill patient in ED becoming an unusual case.