We have reported previously on the development of palliative care in Lausanne and the Canton of Vaud, where different structures in different places covering different needs have been developed over the last decade [1]. In the University Hospital Lausanne, an 800-bed facility and academic center for the region, a Palliative Care Unit was established in October 1996 with the primary goal of consultation within the University Hospital. In the last 3years, this unit has developed rapidly, to the point where the question of a further step forward towards an integrated regional palliative care program has to be discussed. We will report briefly on current activities and then discuss some of the possibilities for a wider, more comprehensive and better coordinated program for the future and some of the obstacles to its realization.