Nursing Homes in France: Both the Elderly and their Caregivers are Suffering

Over the past several months in France, overwhelming evidence has been accumulating on the living and working conditions in the “EHPAD’s” (nursing home establishments for aged and dependent individuals): lack of resources, an exhausted nursing staff, patients’ suffering.  
On January 30, 2018, in an unprecedented general strike, several tens of thousands of people rallied throughout France to denounce these living conditions. The strike mobilized both staff and managers of public and private nursing homes, all employee trade unions, patient associations and their families.
The EHPAD’s are chronically understaffed, and can no longer provide for the patients’ well-being (safety and dignity), because they are more numerous, and older, and need more care.  In French nursing homes, the rate of caregivers per resident is 0.57, which is low compared to Northern European countries where this rate is one to one.
In addition, institutions are struggling to recruit caregivers. According to the National Health Insurance, the rate of work-related accidents and occupational illnesses are increasing (+ 2% in one year and + 45% over 10 years), especially a rise in lumbago or lower back pain. The average percentage rate is 9.4%, compared to 6% for construction workers. According to the parliamentary report submitted in September 2017, the absenteeism rate of “an average of 10%” is also troublesome and causes additional exhaustion for the working caregivers.
According to the French Directorate of Research, Analysis, Evaluation and Statistics (“DREES”). there were 728,000 elderly people attending or living in nursing homes in 2015. The parliamentary report specifies that the current population has evolved in recent years: “People entering nursing homes are over 85 on average, and the average stay is 2 ½ years […]. They present multiple pathologies, complications from chronic diseases, and some suffer from behavioral disorders…”
Launched more than ten years ago, the Solidarity Plan for the Elderly (2007-2012) was intended to make improvements in the quality of life in retirement homes, explore means of sustainable financing for those who lack self-sufficiency, and control costs for staying in an EHPAD … Even if more resources have been allocated for EHPAD’s in recent years, the means implemented are still inadequate. How can France better address this challenge of an aging population?
In addition, a pricing reform is being implemented in accordance with the December 28, 2015 law for adapting to aging, which provides for progressively aligning the allocations for public and private nursing homes from the year 2017 onward, until 2023. This very unpopular reform could represent a cut-back of 200 million Euros over 7 years to public nursing homes and could force staff reductions in many nursing homes, declares the French Hospital Federation (“FHF”). Nevertheless, the Health and Solidarity Minister, Agnès Buzyn, confirmed that the reform would continue. She announced that 100 million Euros would be provided by National Health Insurance budget to be allocated to the EPHAD’s and an additional 50 million Euros would be reserved for EPHAD’s facing difficulties (January 25, 2018 announcement).
With the increase in life expectancy, and consequently the aging of the population, the problems associated with an advanced age deserve a more in-depth analysis, as well as implementing sustainable long-term solutions. Caring for the elderly who are no longer self-sufficient is a major issue, one that not only concerns public authorities, but also families and society as a whole.

Vincent Lambert: French State Council Rules to Continue Collegial Procedure

A new legal phase ended on January 31, 2018, in the doleful case of Vincent Lambert. The State Council rejected the parents’ appeal requesting urgent suspension of the fourth collegial procedure initiated last September by Dr. Sanchez, which could lead to care being stopped, and therefore lead to their son’s death.
Vincent Lambert has been at the University Hospital in Reims since 2008, in a pauci-relational state following a serious car accident. Since that date, three collegiate procedures for possibly stopping due care have taken place at the hospital. Following Dr. Kariger’s departure, the first two procedures are no longer relevant, and the third was suspended until further notice by Dr. Simon, who also left the department (see the reference note on all the legal proceedings concerning Vincent Lambert).
The parents considered that the fourth collegiate procedure was legitimate. They filed an appeal with the Administrative Court in Chalons-en-Champagne, where their case was rejected. They then appealed (via an emergency procedure) with the State Council to have the collegial procedure suspended and cancelled.
The French State Council judges ruled in accordance with the rapporteur’s arguments, whereby the referred procedure did not conform to the situation, since the collegial procedure is only a preparatory step intended to clarify the situation for the doctor in charge of making the decision. Only the final decision can be appealed using an emergency procedure.
Following this judgment, the collegial procedure initiated by Dr. Sanchez is likely to continue in the coming weeks. Whatever the nature of the resulting decision, it will undoubtedly be legally contested since Vincent Lambert’s family remains deeply divided on what should be done for his welfare.

The phases of the French Bioethics Law Revision

The process includes 3 major phases, with some partially overlapping dates on the timetable. The first two correspond to the French “National Consultations on Bioethics” as specified by the July 7, 2011 law.
1) The phase for public debates
2) The phase for the national organizations’ reports
3) The phase for drafting the law

I – The phase for public debates: January to April-May 2018

During this phase the population will be consulted: citizens, associations, scholarly groups, various local organizations, etc.

A) National website

In early 2018, the website should be launched to allow every public citizen an opportunity to express his opinions and suggestions.

B) Consultations organized by the Regional Ethical Review Boards

They are organized in each of the 13 main French regions, and coordinated by the National Consultative Ethics Committee.
They usually consist of:
– conferences/debates on one or two themes chosen by the Regional Ethical Review Boards, and are to include at least one lecture addressed to youth/students. The events will be covered by the local press.
– Online questionnaires to be completed by any citizen so desiring.

C) Contributions from specialized organizations

– Ethical committees from the major research organizations (“CNRS: National Centre for Scientific Research, and “INSERM”: National Institute of Health and Medical Research] – Faculties and Academies (Sciences, Medicine…) and specialized scholarly groups,
– National Health Conference (a think-tank on basic rights for users) and “CRSA”: Regional Conferences on Health and Autonomy,
– Etc…
Each ethical board or specialized organization will submit its results to the National Consultative Ethics Committee.
There will also be one or more randomly selected citizen panel(s), although the organization and role of the panel has not yet been specified.

II – The phase for the national organizations’ reports: 2nd quarter of 2018

A) Specialized groups

Besides the scientific, ethical and public contributions, evaluation reports of the 2011 Bioethics law will be submitted, which have been elaborated by:

  • The Parliamentary Office for Scientific and Technological Choices (“OPESCT” (,
  • The Biomedicine Agency, (“ABM”)
  • The State Council (responsible for studying ethical and legal issues, as requested by the Government). They will also carry out various consultations.

In addition to these reports, elements will be submitted concerning international comparisons and reflections, carried out by European and international ethical groups, (Council of Europe, European Group on Ethics, etc…).

B) The National Consultative Ethics Committee

This Committee will also conduct auditions to gather opinions especially from concerned parties, scholarly groups and associations.
They will then summarize all these contributions in a summary report, which will be sent to the Parliamentary Office for Scientific and Technological Choices, which includes members of the National Assembly and the Senate, presumably by the end of spring 2018.
A national event is planned to finalize these National Bioethical Conferences on July 7, 2018, the 7th year anniversary date for the law passed in 2011.

III. The phase for drafting the law: 2nd semester of 2018 and 1st semester of 2019

A) The Government Bill

The bill to be drafted requires inter-ministerial coordination, and will begin in parallel with the National Bioethics Conferences.
They will progressively take into account all the local and national contributions, in order to prepare the draft law in coordination with the National Consultations on Bioethics. The stated goal is to finalize the bill by summer 2018, for submission to Parliament in the fall (Source: Health Minister Circular, November 29, 2017).

B) Parliamentary Debate and Voting the Law

To prepare for the parliamentary proceedings, presumably after the bill is tabled, the Parliamentary Office for Scientific and Technological Choices, will evaluate the summary report by the National Consultative Ethics Committee “by highlighting the scientific elements essential to a good understanding of the issues at stake in the proposed reform” (Article L1412-1-1 of the Public Health Code, from the 2011 bioethics law).
Parliamentary procedure generally requires several readings to be held in both assemblies. Thus, according to the government’s provisional calendar, the law is due to be adopted during the first half of 2019.

ART and Surrogacy Debate: Tugdual Derville on Sud Radio

On January 23, 2018, Tugdual Derville was invited as a guest speaker on France’s “Sud Radio” station, by Philippe David, to debate opposite Martine Segalen, ethnologist and sociologist, and Pascal Neveu, psychoanalyst, for the “Speak Out” broadcast, to discuss Artificial Reproductive Technology (ART) and surrogacy just as the  French National Consultations on Bioethics  have just opened.
Quotes Extracted from the Broadcast; Tugdual Derville:
[Regarding the survey published in La Croix on January 3, 2018, on “The French and Bioethics”]: French people are generous, and compassionate. When asked if they are in favor of a certain right, they answer yes. When the same individuals are asked whether a child born by ART is entitled to have a father and a mother (Opinionway survey in September 2017), 72% also answered Yes. They are lost because they don’t have any grass root experience on these subjects.
[ART] is an extremely deeply-felt claim, related to a strong desire for a child; to the point that one’s consciousness is paralyzed. Our society prides itself on having laws for women and children that protect the weak from the strong.
Alliance Vita has just launched a petition to the French President, to demand that children be protected against the huge, globalized or state-controlled reproductive market. France must continue to resist against the commodification of the human body; I do not sell my blood, my kidney, even my gametes, in contrast to what happens abroad (for example with the growth of oocyte sales in Spain, faced with increasing poverty, although it is a heavy surgical operation, which can put women at risk).
Being aware of the [in utero] exchanges and communication that take place for 9 months between a mother and her child, how can she not be affected by her pregnancy [and her baby]? How can she tell her own children: this one, we’re going to give it away? We don’t give away a baby; a baby is not an object; he is a person to be unconditionally welcomed. Surrogacy can never by altruistic; it is being pressured and forced by conditioning.
Our civil society supports families in difficulty, single-parent families, and orphans: we must recognize their suffering and help them. But it is another thing to deliberately create from scratch the suffering of this separation, to eliminate half of someone’s biological heritage, thus creating very complicated legal imbroglios. The result is a reproductive process which is broken up between donors, genitors, educational parents … such a number of  parents.
Regarding ART, I took out this poster published by Act Up: “I want sperm, not a guy.” As a man, I don’t feel respected by this type of poster; we cannot reduce men or fatherhood to spermatozoids which could be handed out (…) This is how the ART claims for women is presented today; instead of welcoming paternity, especially when our society is already suffering enormously from being cut-off from fathers, we are deliberately conceiving children cut off from their fathers.
Some prohibitions cannot have exceptions to the rule; otherwise the rule is ruined.
The desire to have a child, to transmit and extend one’s own life, is one of humanity’s most beautiful and strong desires. These desires should be heard and respected. Nevertheless, the law exists to regulate the desires of the strongest in order to protect the weak. This is where the question arises. Is it legitimate for a child to be deprived of a father or a mother, in response to one’s personal desire? Not in our opinion, since parity in reproduction is a principle of human ecology. Genetically, we all come from a father and a mother; it is one of the fundamentals of our identity as men and women.
If we decide to bypass this rule, (and this is going further than the requests from homosexuals), if we determine that we can have a baby just by asking for sperm, how will the nation organize this? By establishing sperm banks? By calling for “civic masturbation” for men to give women their sperm? And what about the result? A national marketplace, as predicted by Orwell. The nation would control the sperm banks, and instead of making babies under the duvet, as most needed, a national reproductive market would be created! We at least need to respect the parity between men and women for reproduction. This is the red line which must not be crossed, otherwise reproduction will be a big market; this is a very high risk for humanity.
There are special values in France as the country of the Human Rights that recognizes human dignity. France knows how to fight against prostitution. This is what we are asking President Macron: to guarantee that the child is at the heart of his political policy. In the United States, there is a second-hand market for adopted children; if the parents are not pleased with their adopted child, they can post it on the internet to “pass along” the child … This is absolutely incredible! In France, it’s different.
Surrogacy creates a pre-planned rupture which is unfair and unscrupulous, no matter the conditions or the presumed legal frame. A child needs maternity to be unified, and not have motherhood split between several women. It is a serious attack on a child to separate him from his mother at birth. He wants to suck his mother’s breast; he needs the smell of his mother: what about breastfeeding, skin to skin (sometimes practiced with sponsors)? Motherhood is a continuum; a child is born in an ecosystem with very strong communicative interactions. This separation is incredibly aggressive. This is absolutely unfair for the child.
Be careful, because even love can hold someone hostage; we can love a child very much, take care of him very well, but if that child doesn’t have the right to protest against injustice, then he is being discriminated against and subjected to oppression. I am anxious to hear of the voice of these children, who have been deliberately deprived of their father or mother, when they are teenagers.

[Press Release] Euthanasia: Alliance VITA Protests Attempts to Force Laws Through

[Press Release] Euthanasia: Alliance VITA Protests Attempts to Force Laws Through

While the current priority is to evaluate how the 2016 end-of-life law is being implemented, Alliance VITA protests the sudden pressure by some MP’s who are trying to impose the legalization of euthanasia in France. Today a proposal by Caroline Fiat (“Insubordinate France” political party) was examined by the National Assembly, but rejected by the Committee on Social Affairs. Nevertheless on February 1st, it will be debated in a public session.

The Claeys-Leonetti law dated February 2, 2016 is only starting to be recognized and implemented, since the application decrees are only dated from August 2017.

Several official initiatives are ongoing or planned in the short term future, to evaluate whether taking charge of the end-of-life situation is improving in France. The government has launched a survey via the “General Inspection for Social Affairs” (IGAS); Parliament is planning a study group and hearings in the upcoming weeks; the EESC also took up the subject; and medical assessments on the practice of “deep and continuous sedation until death” are in progress via the National Center for Palliative and End-of-Life Care (CNSPFV) and the French Society for Accompaniment and Palliative Care (SFAP).

After barely finishing 3 years of profound and in-depth debate on these end-of-life issues between 2012 and 2016, Alliance VITA views this ideological offensive as threatening to occult the genuine end-of-life issues at hand.

Improving support for people at the end of their lives is the main priority, whether they are in hospitals, nursing homes or at home, especially through pain management, palliative care and intergenerational solidarity. Indeed, in the few foreign countries which have legalized euthanasia, the serious “ethical slippage” observed is a warning for using our utmost caution.

On Monday January 29th, Alliance VITA will be heard by the EESC. VITA remains attentively alert that the National Bioethics Consultations do not serve as a pretext to question the prohibition to kill, which remains the basis for trust between patients and caregivers.

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Alliance VITA  was founded in 1993, when the first bioethics laws were at issue, and has been active for 25 years, to heighten awareness that biotechnology should be used to protect the weak, and in respect of human beings’ dignity, especially at certain vulnerable phases of life (embryonic stage, birth, disease, disability, old age or end-of-life).

Its help-lines and listening service SOS End-of-Life, created in 2004, offers support to people with complex dependency needs, those at the end-of-life, their caregivers, their relatives, as well as bereaved individuals.