by Claire Anne Brule | December 9, 2021 | Gender, News
On December 7, the Senate adopted in 1st reading a new bill to ban gender conversion therapy tabled by Laurence Vanceunebrock, from President Macron’s centrist party, LREM (“La République en Marche”). Although the alleged objective is to better protect the victims from such practices, the very introduction of the words “gender identity” into the law can lead to misinterpretations and raise serious issues. This is especially dangerous for minors who have doubts about their sexual identity.
At the beginning of October, the bill was unanimously adopted by the National Assembly. An accelerated procedure allowed the Upper House to vote on December 7th with 305 votes in favor and 28 against. The bill is now poised to be examined by a joint committee.
The bill includes penalties of two years in prison and a fine of 30,000 € for “repeated actions, behaviors or comments aimed at modifying or repressing one’s sexual orientation or gender identity, whether genuine or supposed, and which result in damaging the person’s physical or mental health”. The penalty can go up to three years in prison and a 45,000 € fine if the victim is a minor, vulnerable, or dependent or in cases where the perpetrator is an ascendant. In such instances, the judge may rule parental authority to be completely or partially revoked.
In addition, the bill provides identical penalties for anyone proposing “consultations” or prescribing “treatments to modify or repress genuine or supposed sexual orientation or gender identity”.
The Senators challenged the government’s position by incorporating, to the Assembly’s bill, amendments submitted by the rapporteur Dominique Vérien (Centrist Union). These amendments bring a necessary clarification on the fact that no penal offence is “committed when the remarks are only intended to invite the person to prudence and thoughtful consideration, especially in the case of adolescents who have doubts about their gender identity and may be considering sex change surgery”. This amendment is meant to protect the parents who are concerned about their children and who want to assist and advise them to be very cautious and thoughtful, and who could be in danger of being penalized under this new law.
Several amendments were proposed by the LR group (“Les Républicains”) in the Assembly and the Senate, both in committee and in public session, to remove from the bill the words “gender identity” which are likely to bring confusion. None of these amendments were retained. These amendments insisted on the fact that the notion of ‘gender identity’ is not defined and there is no indication of what it exactly refers to. Therefore, incorporating this concept into law would prevent minors from being helped when they have questions about their sexual identity, except in an exclusively transsexual approach, which would systematically propose medical treatments for sex change. Another LR amendment suggested including sanctions for “prescribing sex change procedures for minors such as puberty blockers, hormonal treatments or surgery.”
During the parliamentary debates, Jacqueline Eustache-Brinio (LR Senator, Val d’Oise region) warned about the danger of the law for minors: “Although it is admitted that minors, especially in adolescence, experience distress and report feeling a mismatch between their birth sex and their perceived sex, they should not be locked into a trans-affirmative approach due to a hasty and premature choice.” The senator denounced the consequences of surgery and hormonal treatments for children. She made it clear that “detransition (reversing a gender transition) is extremely difficult” and that some countries such as Sweden, which had originally approved gender transitions for minors, are now backtracking.
The Senator’s words are confirmed by a collective warning, published in L’Express, on September 20th, by a group of 50 experts, among which are Elisabeth Badinter, Chantal Delsol and Catherine Dolto, from “The Observatory of Ideological Discourses on Children and Adolescents: The Little Mermaid”. All these professionals have voiced their concern about a sharp increase in change sex requests, particularly among teenagers. According to the experts “arguments exclusively based on feelings are presented as indisputable truths, and militant, radical rethorics legitimize requests for a sex change” … “But this is done at the expense of imposing life-long medical treatments on children and adolescents or even of making surgical operations upon them to remove breasts or testicles.” The editorial recalls that “the child is a human being still in the process of being formed, and thus constantly evolving before reaching maturity. »
The Children’s Lawyers Association (“Juristes pour l’enfance “) published a press release on December 2, which underlines the fact that “gender identity refers to the intimate feeling of a person who feels masculine, feminine, neither of the two, sometimes one, sometimes the other. These feelings are subjective and changeable. And an individual’s feelings cannot be used as an argument to punish someone, to the point of criminalizing someone’s mere remarks.” During the parliamentary discussion on the bill, MP Elisabeth Moreno wanted to bring feelings into the definition of gender identity by stating that: “Gender identity is neither more nor less than the identity that one feels deep inside”.
Along with these experts Alliance VITA worries about how the bill will impact the care and support to individuals, especially children and adolescents who might have doubts about their sexual identity, and who would be advised to undergo irreversible treatments. As stated by the rapporteur Dominique Vérien, it is doubtful that such a bill is really needed since the penal code already covers offences relating to intentional violence, moral harassment, illegal practice of medicine and taking advantage of vulnerable persons. Is it urgent to make a new law for only “100 recent cases” according to the 2019 flash parliamentary task force? Moreover, according to the same task force, there are actually no statistics or surveys available on the true extent of this phenomenon in France. According to Alliance VITA there is more urgency in training and raising awareness among parents and educators to offer better support to children and adolescents who feel uncomfortable with their sexual identity.
![[Press Release] –: Alliance VITA Denounces Detrimental French Abortion Bill](https://www.alliancevita.org/wp-content/uploads/2021/12/AdobeStock_75199852.png)
by Claire Anne Brule | December 1, 2021 | Abortion, Press Releases
Alliance VITA denounces the detrimental new French abortion bill, which is totally disconnected from the real-life issues faced by pregnant women. The association calls for suspension of the legislative process until a real analysis of the causes, conditions and consequences of abortion has been carried out.
Due to the constant clamoring for a “right to abortion” throughout the debates, the voices of pregnant women have gone unheard; those who are faced with unexpected pregnancy and who abort reluctantly. It is illusory to think that all women abort of their own free will and after a genuine personal choice. The economic hardship, social pressure, and distress that many women experience is being blatantly ignored by the MPs.
Extending legal abortion deadlines is extremely violent for women because this bill does not provide any solution nor any assistance to women who wish to continue their pregnancy. In addition, abolishing the 48-hour reflection period for minors is a serious infringement on their personal liberty, and also increases the pressure to abort.
Moreover, voting an amendment to allow surgical abortions to be performed by midwives up to 14 weeks of pregnancy is yet another indication of how radical this bill is.
Nonetheless, Alliance VITA acknowledges the MPs who managed to reintroduce the specific freedom of conscience clause for healthcare professionals, thus defending this fundamental right.
“Given the circumstances, Alliance VITA calls for the legislative process to be halted until the causes, conditions and consequences of abortion have been properly assessed. The real priority is to protect pregnant women from all kinds of violence, including against the pressure to abort against their will, and this can only be done by developing a genuine abortion prevention policy,” declares Caroline Roux, Alliance VITA’s Assistant General Delegate.
![[Press Release] – French Abortion Bill Is Completely Out of Touch with Reality](https://www.alliancevita.org/wp-content/uploads/2021/12/Assemblee-nationale.jpg)
by Claire Anne Brule | November 26, 2021 | Press Releases, Abortion
On November 29, French MPs will examine on second reading the draft law to “reinforce the right to abortion” which would extend the legal deadlines from 12 to 14 weeks pregnancy and would abolish the conscience clause for healthcare professionals for performing abortions.
Alliance VITA denounces this bill which is completely out of touch with the lives of pregnant women. The association argues that the legislative process should be suspended until a real analysis of the causes, conditions and consequences of abortion has been made.
In demanding a “right to abortion”, the reality of abortion is ignored. The purpose is to avoid talking about what women are confronted with, to avoid talking about the assistance which could be given to them to avoid abortion.
Successive revisions in the abortion law have progressively removed all provisions to assist women, especially the information on the subsidies and the rights of pregnant women which was delivered to them when consulting for an abortion. Besides, no studies have been made regarding the impact of these changes in the law on women’s lives, even though abortion is an irreversible act where lives are at stake. Yet, when an IFOP survey polled French citizens on their perception of abortion in October 2020, 92% deemed that women experience long-term psychological consequences following abortion, and 73% think that society should provide more assistance to help prevent abortions.
It is illusory to think that all women abort of their own free will following a genuine personal choice.
Furthermore, abortion is a distinctive marker of social inequality and this should challenge public authorities. In 2020, for the first time, abortion statistics were correlated with levels of income by the DREES (Department of Research, Studies, Evaluation and Statistics). The data clearly demonstrated that women with the lowest standards of living had recourse to abortion more often.
In this perspective, it is a terrible injustice to extend legal abortion deadlines without proposing any assistance to allow women to continue a pregnancy.
Caroline Roux, Alliance VITA’s Assistant General Delegate laments: “When confronted with an unplanned pregnancy, we have observed that many women of all ages reluctantly turn to abortion, generally under pressure from their partner, their entourage, or due to fear of losing their job. This latest push to extend abortion deadlines is another sign that the reality and needs of women continue to be ignored. This measure is another a violence to women, especially since this law does not propose any alternatives to abortion nor any specific support. Instead of extending deadlines, it is urgent to protect women from all kinds of violence, including against the pressure to abort against their will, by implementing a genuine abortion prevention policy.”
A happening is organized by Alliance VITA in front of the National Assembly on Monday, November 29 at 6:30 pm
by Claire Anne Brule | November 25, 2021 | Surrogacy, News
The Hague Conference is well known for its work on the International Adoption Convention in 1993. This intergovernmental institution currently brings together 89 member states, including France. Its lawyers mainly deal with issues of private international law. They draw up international conventions which the member states decide to ratify, or not.
In 2015, the Hague Conference created a Group of Experts to establish international parentage laws for children born from surrogacy, a practice which is banned in many countries.
This Group of Experts entitled “Parentage/Surrogacy” includes officials from the Ministries of Justice, lawyers, academics, as well as some associations who contribute as “observers”, such as the UNICEF. The group only met 9 times in 7 years and extremely succinct reports are available on their website.
The ICASM (International Coalition for the Abolition of Surrogate Motherhood) has been denouncing these meetings for years. According to the coalition “working to harmonize national laws on filiation for children born from surrogacy, boils down to legitimizing surrogacy and encouraging it on a world scale”. Since 2020, the ICASM has been denouncing the fact that “The Hague Conference (HCCH) is working hard to regulate surrogacy. This is a real blank cheque to the globalized surrogacy trade, mostly in the poorest countries of the world.” Since 2020, the ICASM has been countering with a “Draft International Convention for the Abolition of Surrogacy”.
The same outcry can be heard from the “CoRP”, (COllective for the Respect of the Person). “You cannot claim to protect a child by endorsing a practice whereby he is bought and sold, treated as an object and cut off from his origins,” asserts its president, Ana-Luana Stoicea-Deram. As co-author of the book The Markets of Motherhood (2021), Odile Jacob aims at the most powerful lobby of American reproductive clinics in The Hague.
The next report from the Group of Experts is expected in 2023.
In 2015, “No Maternity Traffic”, (of which Alliance VITA is a member) listed the serious infringements on women’s and children’s rights caused by surrogacy: “It is more than urgent to set the principle according to which the human body cannot be the subject of legal contracts. Surrogacy, whether it is commercial or not, commodifies women’s bodies and is contrary to the child’s best interests. To tolerate surrogacy means to accept the inherent exploitation of the women and children involved in this practice, while intentionally concealing the fact that what is really at stake is a multi-million dollar market.”
For further information:
Alliance VITA’s Bioethics dossier Stopping “ethical” surrogacy, VITA 2021 https://www.alliancevita.org/bioethique/gestation-pour-autrui/
by Claire Anne Brule | November 18, 2021 | News, End of life
Amyotrophic lateral sclerosis (ALS), better known as Charcot’s disease, is an incurable neurodegenerative disease that progressively leads to muscle paralysis, thus affecting breathing, speech, and swallowing. There is a median lifespan of 36 months, with an annual incidence of 1600 cases. Recently in France, a working group of the National Center for Palliative and End-of-Life Care (“CNSPFV”) evaluated the management of ALS patients at the end-of-life. These patients are particularly affected by the new French law (“Claeys-Leonetti”) enacted on February 2, 2016, which allows deep and continuous sedation until death. The aim of the study was to determine if the new law is adequately meeting these patients’ needs and expectations.
In France, there have been three successive “national plans for rare diseases” (2005-2008; 2011-2016, 2018-2022), which have led to the creation of 19 centers for ALS and other motor neuron diseases. According to the governmental data for the year 2018, (from the Information Systems Medicalization Program), 1031 ALS patients died in hospital, 69% of whom died in medical services, 23% in home hospitalization, 9% in follow-up care and rehabilitation. The average lengths of stay were 12, 74 and 73 days respectively. Of the ALS patients who died in hospital, 8% died in the palliative care units, 8% in beds specifically attributed to palliative care, and 13% in intensive care. Respiratory failure was the leading cause of death. At the end of life, hospitalization is often warranted when the clinical situation is too severe for at-home care or when relatives become too exhausted to provide at-home care.
hed a report which questions the low percentage of deaths in palliative care, especially when compared to intensive care. The increased rates of tracheostomy have also been examined, since they rose from 3% in 2008 to 8% in 2016 for this patient group. Historically performed in emergency situations of unexpected asphyxia, the numbers were expected to be lower, in view of the development of non-invasive ventilation (NIV) techniques.
These figures regarding the mortality statistics have triggered off essential questions to better understand the phases in SLA patients’ healthcare. For example, were the patients who died in medical wards transferred from other medical units, or from home; and if so, did they receive at-home hospitalization care prior to being hospitalized? Should we assume that there are variations according to healthcare sites or according to the patient’s age? Further research studies are needed to answer these questions.
The answers collected by the working group reveal that, regardless of the variety of healthcare pathways, the complexity of the end-of-life is a common denominator in all three case scenarios, marked by respiratory decompensation which required hospitalization in the month prior to death. Home healthcare reinforced by a coordinated medical and paramedical network seems to be the preferred option, although depending on the circumstances, this cannot always be implemented.
End-of-life and ALS patients: the paradox of more medicalization
As a nurse in one of the specialized ALS centers and a member of the CNSPFV working group, Camille Brodziak declares: “ALS is unique in that the closer one approaches the end-of-life, the more medicalized healthcare becomes. From a psychological point of view, this is paradoxical, not only for the healthcare workers but also for the patients. There is nothing to be done and palliative care is already considered, and yet a lot of medical equipment is installed.”
An IFOP survey published in the spring of 2020,and made on behalf of the French research association for ALS (“ARSLA” ) show that the patients interviewed are very lucid in the face of inevitable death. But they also worry about the conditions of the end of their life and they have little opportunity to discuss it with healthcare professionals, especially with those who would be taking care of them in the terminal phase.
The ambiguities in the Claeys-Leonetti Law
The discussions within the working group revealed two opposing viewpoints:
- on the one hand, some caregivers believe that deep and continuous sedation until death is the final clinical procedure, only to be implemented whenever all other therapeutic options have failed;
- on the other hand, some patients, relatives, doctors, and caregivers consider deep and continuous sedation until death as a right to be invoked whenever their decision is made to stop treatment.
The dilemma resides in identifying who is the legitimate decision maker for deciding whether deep and continuous sedation should be started? The law is somewhat ambiguous on this point since it states that under certain conditions the patient may have access to deep and continuous sedation, although this must be founded on a medical decision.
Nowadays, an increasing number of ALS patients are frequently requesting deep and continuous sedation until the death. The reason for this is invariably existential suffering, although the legitimacy of these requests has been questioned. Some attribute this request to society’s approbation for performance whereby those who are dependent, have disabilities, or who trail behind in any way are excluded. Couldn’t this be the cause of existential suffering for the sick person? Others purport that SLA patients don’t suffer from others’ opinion of them but are fully cognizant of what lies ahead. They no longer desire to live under these conditions, nor suffer the final degradations imposed on them by the disease progresses.
Deep and continuous sedation is part of a process which inevitably leads to death, and where medical accountability is strongly implicated. A form of ritualization is being initiated which is difficult for caregivers to live with. Dr. Richard, a physician in the Palliative Care Unit, declares: “When the request is accepted and scheduled, the patient often plans a last meal with his family to bid them farewell; he arranges the events and relations before his sedation. These types of rituals to prepare for death resemble how euthanasia is carried out in Belgium, the Netherlands, or other countries where it has been decriminalized. This inevitability of death certainly disturbs palliative care teams. One imagines that once the oxygen mask is removed, the patient’s breathing will stop right away. However, it is not uncommon for the patient to start breathing on his own again, raising a difficult dilemma for relatives on how to cope during this lapse of time. How should the patient and his loved ones be cared for while awaiting the expected death which has knowingly been induced by deep and continuous sedation and which cuts off all communication?”
The palliative care practitioners in the working group emphasized the difficulty, not only for loved ones, but also for their teams and themselves, of these questions which reveal a paradox. They are faced with the certainty of death since sedation will be maintained until death, but also the uncertainty of the time of the death, because the idea is neither to retain nor to accelerate the departure.
Another ambiguity induced by the Claeys-Leonetti law is that of the temporality of the end of life.
The law allowing deep and continuous sedation until death does not specifically define short-term prognosis. The doctors of the working group have considered this end-of-life temporality as being very short, corresponding to the HAS recommendations, which were updated in 2020, whereby short-term is defined as lasting a few hours to a few days. This means that deep and continuous sedation until death can only be implemented as an end-of-life provision for individuals who are debilitated, physiologically weak and who have a short-term vital prognosis.
Caring is informing, anticipating, and coordinating
The “CNSPFV” working group has noted an organizational inadequacy between the specific end-of-life needs for ALS patients and the medico-economic criteria. This has led to malfunctions in healthcare. Besides, obtaining end-of-life support at home may be limited by inequalities in available care networks and/or by the intense burden on relatives/caregivers. On top of this shoud be considered the difficulty of access to palliative care units for ALS patients. In conclusion the “CNSPFV” declares “The ideal scenario is to remain informed to anticipate the evolution of the disease. Neurology and palliative care services should be coordinated to progressively take care of the patient at all stages of his disease”. Regarding the implementation of deep and continuous sedation until death, it should respect the legal provisions for each situation: “The primary objective is to relieve the patient’s suffering without intentionally accelerating his death”. Consequently, units need to be developed for ALS patients at the end of life “where a high standard of care is guaranteed by the procedures and practices implemented”.
