For or against midazolam in the city? A generalist at the head of palliative care professionals positions himself

The launch of a manifesto in support of the general practitioner accused of euthanasia for giving midazolam to end-of-life patients provoked strong reactions. Should the Liberals’ right to use this product be opened or not? How to manage end of life at home in medical deserts? And more generally, what support for palliative care at home? If for Jean-Paul Hamon, president of the Federation of doctors of France, the prohibition of midazolam for general practitioners contributes to the deterioration of the conditions of exercise, Dr. Olivier Mermet, president of the French Society of accompaniment and care palliative (Sfap) and liberal doctor, insists on the imperative concept of team and collegiality.-

Egora.fr: How do you view the indictment of Dr Méheut and the manifesto launched in support by the Federation of Doctors of France?

Dr Olivier Mermet : For us, this debate should not be limited to the sole access of midazolam. This possibility of sedation at home should not be trivialized as if it were something easy. Situations requiring a sedative product at home for patients at the end of life are rare situations and it is not so frequent to use this type of product, especially among general practitioners. It is also not without repercussions on the healthcare team. Our position is therefore not to limit the reflection to the only limitation of midazolam but rather to question the means that we put on palliative care at home.

Are you in favor of generalists’ access to products allowing deep sedation such as midazolam?

I think this shows that suspicion can arise from acting in isolation. However, it must be understood that we do not do palliative care alone but in a team. These are also special products to handle, especially when you are not used to it. Doctors need to be trained. Palliative patients should be given the opportunity to have teams who can travel home. The general practitioners alone, the primary care teams, already take on a good part of the palliative situations independently but there are complex situations. The situation where we plan to introduce a sedative product is enough to call on a dedicated team.

Midazolam is available in town as soon as the patient is treated in HAD since the product can be brought by hospital staff. What is most often overlooked is that a decree dating from 2004 allows the retrocession of hospital products by hospital pharmacies for patients in the city as soon as there is the mention “palliative care” on the prescription made by the general practitioner.

You insist on the concept of team, do you believe that the liberal general practitioner cannot therefore take care of an end of life at home?

It’s not that he can’t. In an emergency, you must be able to benefit from a temporary sedation to pass a painful peak or a cataclysmic hemorrhage, for example. But when it comes to setting up a long-term sedative practice, it is harmless neither for the patient, nor for those around him, nor for the healthcare team …

–