The psychological dimension of palliative care

Abstract

In France, approximately 600,000 people die each year, affecting a far greater number of relatives and loved ones who are then directly confronted with the experience of grief. Behind each death, several individuals — partners, children, friends, caregivers — must come to terms with an irreversible loss. Living with a serious, progressive, and potentially life-threatening illness represents one of the most challenging experiences a person and their loved ones can face, affecting them psychologically, physically, socially, and existentially. It is now widely acknowledged that the circumstances surrounding the end of life profoundly influence the grieving process: they can either support its elaboration or, conversely, make it more difficult, potentially leading to complicated or pathological grief. In this context, palliative care offers an appropriate response to the complexity of such situations. However, despite being enshrined in French law since 1999 as a right for all individuals suffering from serious illness, its implementation remains uneven and largely misunderstood. Too often, palliative care is associated with last-minute interventions, limited to the final days of life, and perceived as a form of therapeutic abandonment. These reductive representations hinder its comprehension and integration, both by healthcare professionals and by patients and their families. It is essential to remember that palliative care does not oppose curative treatment: it follows a logic of comprehensive support aimed at preserving quality of life, relieving symptoms, supporting the person through their journey, and, where possible, enabling the expression of their wishes. Over the past decade, efforts have been made to better incorporate this approach into the training of healthcare professionals. Medical students, nurses, and care assistants are gradually being introduced to palliative care principles through specific courses or clinical placements. Complementary training programs, such as the University Diploma in Palliative Care (DUSP) or the Inter-University Diploma (DIUSP), also offer opportunities for further specialization. However, these programs remain optional, vary widely in availability depending on the region, and are still undervalued in professional development pathways. As a result, the dissemination of palliative care continues to suffer from a lack of structured training, institutional recognition, time, and adequate human and logistical resources. The situation is even more concerning for psychologists. To date, there is no compulsory module on palliative or end-of-life care within initial psychology training. This represents a significant gap, considering the specific demands of this clinical field. While psychologists are increasingly recognized within healthcare and social institutions, their involvement in palliative care settings requires particular cross-disciplinary skills. These include the ability to receive and work with psychological and existential suffering, to support families, to contribute meaningfully to clinical discussions, to help caregivers facing exhaustion or ethical dilemmas, and to question the appropriateness of care arrangements on a case-by-case basis. Such work calls for clinical flexibility, the capacity to adapt to uncertain temporalities, and a solid understanding of public health issues, patient rights, and interdisciplinary collaboration. In this interview with Jean-Pierre Bouchard, Nicolas Nieuviarts, Romain Jallet, Isabelle Triol, Camille Baussant-Crenn, and Carole Carnémolla Cousin discuss the reality of palliative care, outlining its clinical and human dimensions, while calling for enhanced interprofessional cooperation. They specifically invite psychologists to engage with this field — too often reduced merely to the question of death — emphasizing instead an ethic of care and presence above all. Ultimately, it is about promoting a global, humane, and responsive approach to care, where medical technique finds its full meaning only when accompanied by a deep attention to subjectivity, relationships, words, and the values of those we accompany.