Dying at home can mean a long wait for a doctor

DOUAI, France — Her mother’s death had been expected. Terminally ill with breast cancer, she lay in a medical bed in her living room, visited daily by a nurse.

But when Sandra Lambryczak’s 80yearold mother died earlier this year, in the predawn hours of a Saturday morning, the daughter suddenly discovered a growing problem in France’s medical system: By law, the body couldn’t be moved until the death was certified by a medical doctor, but a shortage of personnel can sometimes force families to keep their deceased loved ones at home for hours or even days.

“Madame, there’s nobody on weekends, there’s no doctor,” she was told when she called the emergency services.

She turned off the heaters and flung open the windows. Police officers came, followed by the mayor of Monchecourt, the local municipality, solicitous but powerless in finding a doctor. Only half a day later, after her mother’s nurse was able to locate her personal physician, was the body allowed to be taken to the funeral home.

Such agonizing waits have been occurring with increasing frequency around Douai, a city of 40,000 in northern France, and in other areas with a scarcity of physicians. A local newspaper summed up the situation in a headline: “It’s not good to die at home on a weekend.”

Mayors, councilors, police officers, firefighters and other officials find themselves scrambling to help families locate a willing doctor capable of coming to certify a death.

Exasperated, one town issued a bylaw forbidding its residents to die at home.

Nurses, coroners, pathologists and other officials can certify deaths in countries like the United States. But in France, where a quarter of the population dies at home, the role is reserved for medical doctors, who must visit the deceased’s home, verify that the death was natural and note its cause.

It is a system that functioned well when France had a surfeit of general practitioners, many of whom made house calls. Today, while an acute shortage of doctors in some areas has created what the French called “medical deserts,” the requirements for obtaining death certificates have essentially remained the same.

Moreover, officials are bracing for a big wave of retirements over the next decade since half of all family doctors are over 55.