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Every medical student is confronted with death at some point in his/her career. This inevitable experience is often accompanied by intense emotions, both enriching and painful. However, too little attention is paid to these aspects during the training course, and the support given to students by their trainers is often uncertain. We will discuss these aspects here, along with a few ideas for improvement, based on the international literature and our own experience in the field., Competing Interests: Les auteur-es n’ont déclaré aucun conflit d’intérêt en relation avec cet article.

The care of patients suffering from a borderline personality disorder confronted with death is a relational and clinical challenge for interdisciplinary teams. In this specific context, the particular psychic vulnerability of these patients highlights multiple issues. Based on the scarce existing literature and our clinical experience, this article presents management strategies in order to best support this population weakened by serious illness as well as the interdisciplinary teams that care for them., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en lien avec cet article.

This article focuses on the recommendations and issues of artificial nutrition (AN) in advanced palliative situations. In oncological situations, stages of cachexia and performance indexes help guide the decision-making process regarding the indications for AN. AN is usually not recommended in low performance indexes (Karnofsky ≤50 %, ECOG ≥ 3) nor in refractory cachexia. In some cases, a time-limited therapeutic trial may be suggested, with its effectiveness assessed by measurable goals. In advanced dementia, AN is not recommended. Often at the source of an AN request, the emotional aspect deserves to be explored in order to assess the patient's and his/her family's expectations and fears., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Suffering is a universal entity, multidimensional, but also unique and personal. Unfortunately, it is often underdiagnosed, while it is omnipresent in our hospital practice. This article offers to physicians some ideas for the exploration and identification of the suffering of an end of life patient's relatives, and especially some tools for improving ways to support., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Death anxiety is a frequent symptom in patients in the palliative phase of their disease, yet it is rarely explored. Several obstacles are responsible for this undervaluation including some on the medical side. For example: the fear of hurting the patient's feelings, one's own representations and projections onto patients. The lack of exploration and consequently the lack of support can have a dramatic impact on patients' quality of life. So, as to do the right thing, how should one act? This paper will, based on the literature and experience, explore some of the different avenues to help primary care physicians overcome this taboo., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The death of a patient taking opioids can generate strong feelings of guilt. « Have I hastened my patient's death by my administration of opioids ? » Doubts may arise in certain situations, despite the proven safety of appropriate opioid use in the management of dyspnea and pain in the palliative care setting. Fearing the harms of opioid administration, some medical practitioners may undertreat patients, forsaking them to suffering. Other doctors, desperate to relieve their excruciating suffering at all cost, may in fact have recourse to euthanizing acts. This article seeks to answer this ethical dilemma with an overview of the double effect principle., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Opiophobia is one of the principal causes of opioids' under-prescription in palliative care. From periods of abuse to times where their use was banned - which is still the case in some countries - the history of opioids is complex and it partially explains opiophobia. One of the main concern about the use of opioids is the risk of -dependence. Furthermore, scientific literature is not clear on this subject, in particular due to the fact that the scientific community has not yet come to an agreement on the terminology. This article shows, on the basis of specific studies, the predominance of opiophobia among the population and it outlines an historic overview of the use of opioids. In the last section, it focuses on the concept of dependence and the difficulty of measuring it in chronic opioid therapies., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The issue of prognostication is seldom approached in medical education, even though it represents an important question for the patients. Clinical assessment alone is inaccurate and systematically over-optimistic, especially if the question is formulated in temporal terms (how long will the patient live ?). The inaccuracy augments if the doctor has known the patient for a long time. However, other ways of addressing the question exist, and several validated clinical tools are available to improve the accuracy of the prognosis. The patients' self-rating and the evaluation by the nursing staff should also be considered as valuable information., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Thanks to medical progress, the life expectancy of a majority of severely ill patients has greatly improved. The fact that these patients will live longer with their disease encourages new solutions to respond to the challenges of care continuity, coordination, interprofessional and interinstitutional collaboration. Palliative care represents a chain management based on the involvement of every professional in acute care hospitals, palliative care units, nursing homes and private homes. The collaboration among the different players as well as their education are essential elements linked to the quality of care, to the quality of life for both patients and their relatives.

Breaking bad news is a daily task for doctors and nurses. These health professionals may feel powerless to achieve this task and to deal with the emotions that arise in the patient when they are doing so. The interdisciplinary approach and a specific training are essential resources to feel more comfortable in this context. "EPICES", the French translation of the mnemonic acronym "SPIKES", of Buckman, gives a guide for this sensitive practice.

Palliative patients (patients with progressive incurable illnesses) have a number of needs, early and late in their illness trajectories. This article highlights some of the most important competencies required by physicians to address these needs. They cover a broad spectrum of domains and include pain and symptom management, communication, disclosure, prognostication, and psychological, social and spiritual needs. All physicians, generalists and specialists alike, should possess the basic competencies but should also recognize that some patients, especially those not responding to initial strategies, require timely referrals to specialized palliative care teams.