Alarming Report Reveals Over 70 Percent of Adverse Healthcare Events in End-of-Life Patients Are Preventable

A comprehensive report published by the French National Authority for Health (Haute Autorité de Santé, HAS) on September 16, 2026, has cast a somber light on the quality and safety of care provided to patients at the end of life. According to the findings, more than seven out of ten severe adverse events related to care (EIGS) occurring in palliative or end-of-life contexts were deemed avoidable or likely avoidable. This revelation emerges against a backdrop of increasing reports of medical errors across the French healthcare system, which saw a 20 percent surge in total declared adverse events in 2025.

The report, the first of its kind dedicated exclusively to the end-of-life demographic, provides a rigorous analysis of data collected from the national EIGS database between March 2017 and September 2025. By scrutinizing 1,898 initial declarations, the HAS filtered the data to isolate 385 verified, high-impact cases. The findings highlight systemic vulnerabilities in how medical facilities manage the fragile transition of patients nearing the end of their lives, underscoring a critical need for structural reform in clinical protocols and staff training.

Chronology of the Investigation and Data Scope

The impetus for this specific investigation was the heightened national debate regarding end-of-life care in France, which intensified throughout 2025. Recognizing that end-of-life patients represent a particularly vulnerable cohort, the HAS initiated this deep-dive analysis to identify specific safety gaps.

The data pool consisted of 385 cases where clinical outcomes were significantly compromised. The demographic profile of these patients skewed toward the elderly: 42 percent were between 60 and 80 years old, while 38 percent were aged 80 to 100. Nearly half of the affected patients were women. In terms of underlying pathologies, the report found that 65 percent of these patients suffered from cancer, 13 percent from progressive neurological diseases, 12 percent from advanced organ failure, and 8 percent from complex multi-pathology scenarios.

This statistical snapshot provides a stark reminder that while these patients require specialized, compassionate care, the complexity of their conditions often makes them the most susceptible to administrative and medical errors.

The Anatomy of Preventability

The most alarming metric within the report is the "preventability index." Among the 385 analyzed cases, 272—or 71 percent—were categorized as avoidable or likely avoidable by the healthcare professionals who reported them. This figure stands in sharp contrast to the typical 50 to 60 percent preventability rate observed in general hospital adverse event reporting, suggesting that end-of-life care settings may be uniquely prone to errors that, with proper oversight, could be eliminated.

The consequences for patients were severe. Of these preventable incidents, 144 resulted in the patient’s death, while 118 cases resulted in life-threatening complications. In 10 instances, the patient suffered a permanent functional deficit. Candice Legris, Deputy Head of the Service for Evaluation and Tools for Quality and Safety of Care at the HAS, noted that this proportion is "particularly high," warranting immediate intervention from hospital administrators and policymakers.

Analyzing the Root Causes of Clinical Failure

The HAS report employs a dual-layered approach to causality, distinguishing between "immediate causes" (the direct trigger of the event) and "deep-seated causes" (the underlying systemic or environmental factors).

Immediate causes were identified in 88 percent of the incidents. At the top of the list were organizational failures, accounting for 32 percent of cases. These failures generally involved a lack of coordination between multidisciplinary teams and insufficient monitoring of patient conditions. Medication errors followed closely at 28 percent, while equipment-related failures accounted for 25 percent. The medication errors were particularly concentrated around sedatives and analgesics, with 81 recorded cases of overdosage. Equipment failures were largely linked to the malfunctioning or improper programming of electric syringe drivers and infusion pumps.

The "deep-seated" or underlying causes reveal a systemic strain within the healthcare environment:

• Patient-Related Factors (79%): The sheer complexity of the patient’s state and the intricate web of treatments required often created a margin for error that overwhelmed existing protocols.
• Task-Related Factors (70%): Issues regarding the availability, outdated nature, or non-application of clinical protocols were frequently cited.
• Professional Factors (66%): A lack of specialized experience or training among staff members was identified as a major contributor.
• Environmental Factors (58%): Overwhelming workloads, insufficient staffing levels, and inadequate equipment maintenance created a breeding ground for errors.

Strategic Recommendations for Reform

The HAS has outlined a roadmap for healthcare facilities to mitigate these risks. A primary recommendation is the total "securitization" of high-risk medications, particularly morphine and other strong analgesics. The report advocates for a mandatory "double-check" system for all dosage calculations and the programming of administration devices. Furthermore, the authority calls for the standardization of preparation methods to eliminate the guesswork that often leads to errors.

However, the HAS is careful to state that these errors should not be blamed solely on the competence of individual staff members. "These are high-risk products, inherently difficult to handle," noted Legris. Instead, the burden lies on institutions to improve storage, standardized prescription pathways, and the organizational culture surrounding medication management.

A second, equally critical recommendation is the formalization of regular clinical re-evaluations. In many cases, the patient’s condition evolved rapidly, but the medical management remained static, leading to inappropriate dosing or ineffective palliative support. The HAS suggests that in end-of-life care, re-evaluation cycles must be significantly shortened to ensure that care remains responsive to the patient’s immediate physiological changes.

Broader Implications for the Healthcare Sector

The implications of this report extend beyond individual clinical practices. The HAS is currently exploring ways to integrate these safety requirements into the broader framework of hospital certification and medico-social evaluations. While the integration of these specific criteria remains a subject of ongoing debate, the report provides a clear mandate: the status quo in end-of-life care is failing to meet basic safety benchmarks.

This report, when read in conjunction with the separate HAS publication on adverse events in Nursing Homes (Ehpad), suggests a systemic crisis in the management of the elderly and the terminally ill. The 20 percent increase in reported EIGS in 2025 serves as a warning sign for the entire French healthcare sector. The surge in reporting is a double-edged sword—while it indicates a more transparent culture of reporting among staff, it also reveals a terrifying reality regarding the frequency of preventable harm.

As France continues to navigate the sensitive ethical and legal discussions surrounding end-of-life care, this report provides the necessary empirical evidence to shift the focus toward clinical safety. It demonstrates that the right to a dignified end of life is not merely an ethical ideal but a technical and operational challenge that requires robust, well-staffed, and highly disciplined healthcare systems. The path forward, according to the HAS, lies in the marriage of advanced clinical oversight and a genuine commitment to addressing the systemic fatigue that currently defines the environment of care for those in their final days.