Palliative care

When medicine can no longer cure a person's condition, whether the person is in a medically incurable condition as a result of an accident or illness, palliative care may be given to the person at the end of their life to relieve their pain, preserve their dignity, and maintain a certain level of quality of life.

Definition

Palliative care is active care administered to a person nearing the end of their life who is in a situation that medicine cannot remedy, in the wake of an accident or a serious, progressive and incurable illness.

Such care preserves dignity and respects the choices of the person at the end of their life. It is administered continuously by a multidisciplinary team of professionals: doctors, nurses, psychologists, healthcare assistants, physiotherapists and more.

Objectives

The purpose of palliative care is to:

• relieve pain and other discomforts,
• include psychological and mental wellbeing in the care plan,
• offer a support system to help patients' families and loved ones to come to terms with the disease,
• improve the quality of life of the terminally ill patient, and that of their loved ones.

The right to palliative care

Any person at the end of their life who is in an advanced or terminal stage of a serious, progressive and incurable illness may receive palliative care, either at their own request or that of their loved ones.

That right is enshrined in the Law of 16 March 2009 on palliative care, advance healthcare directives and end-of-life care.

To receive palliative care, you first need to consult your doctor, who will file a declaration with the Social Security Medical Board (Contrôle médical de la sécurité sociale). That declaration is made using a special form, attached to the draft Grand-Ducal regulation of 28 April 2009, specifying the means of delivery of palliative care.

The Board will make a decision as to whether the declaration is medically valid after consulting the physicians who signed it. Once that approval has been given, the patient is entitled to palliative care for 35 days. This allowance can always be renewed for one or many additional periods of 35 days, but only at the request of the physician, with reasons stated.

After validation of the declaration to administer or extend palliative care, the National Health Fund (Caisse nationale de santé) will issue a treatment permit which is sent to the physician in charge of the person's care, and to other healthcare providers serving the patient. The GP must attach that treatment permit to the patient's medical file.

Refusal of unreasonable obstinacy

The law does not criminally penalise a physician who refuses, or refrains from prescribing, tests or treatments that are not appropriate for a person at the end of their life, or that have no prospect of providing relief, improvement in their condition or hope of recovery. This stance is known as 'refusal of unreasonable obstinacy' (refus de l’obstination déraisonnable').

Conversely, when a patient is nearing the end of their life, the physician is duty-bound to allow them to receive palliative care.

Training of professionals and volunteers

Omega 90 is the Luxembourg association for palliative care, and provides support to people at the end of their lives and the bereaved. The association organises training courses in palliative care, aimed at all professionals in the field of healthcare and psycho-social-educational care. The aim of these courses is to raise awareness of palliative care within healthcare institutions.