by NexDev | October 13, 2017 | End of life, News
On October 11, 2017, French Council of State rejected Dr. Nicolas Bonnemaison’s appeal against the decision of the Order of Physicians to maintain the revocation of his license to practice medicine. In April 2014 he was removed from the Order after being accused of being involved in the death of 7 patients in the Bayonne hospital between 2010 and 2011.
This is the final ruling for the professional proceedings initiated by the Order of Physicians. Previously, criminal procedures were carried out in the judicial court system, with two trials held in assizes (the first in Pau, in June 2014, whereby Dr. Bonnemaison was acquitted, and the second in Angers in October 2015, where he received a 2-year suspended sentence).
The professional procedure began in January 2013, when he was removed from the Order of Physicians on a regional level. Bonnemaison then appealed but the Disciplinary Chamber of the Order confirmed the April 2014 decision forbidding him to practice medicine, which became effective on July 1, 2014. Then an appeal was filed with the Council of State, which is the highest ruling authority for cassation cases when the ruling concerns a professional order. In December 2014, the appeal was dismissed by the Council of State judges.
At the end of 2015, following his acquittal for 6 of the 7 suspected deaths at second criminal trial in Angers, Dr. Bonnemaison requested to be reinstated to practice medicine throughout France. In June 2016, this request was rejected, with the Order stating that “Acting on his own initiative, Dr. Bonnemaison deliberately caused the death of at least 2 of his patients.” For the Order of Physicians, revoking his license “does not appear to be excessively severe, regardless of whatever humanity grounds he invoked to justify these acts”.
A new appeal was filed to contest the latter decision; however the Council of State has again upheld the prior ruling.
Following the public rapporteur’s recommendations issued on September 13, the Council of State’s judges initially ruled that the Disciplinary Chamber of the Order had “not committed any legal error” since it is not bound by the Anger’s Assize Court ruling of partial acquittal.
Afterwards, the penalty was verified to be proportional with the accusations. They ruled that since the Health Code law “forbids deliberately causing death” the gravity of Bonnemaison’s acts justified his dismissal.
Nevertheless, the eventuality of a new professional procedure is not yet completely ruled out. As pointed out by the Disciplinary Chamber in its June 2016 decision, at the end of the initial 3-year time limit set by the law, Bonnemaison may request for the sanction to be lifted, meaning July 1, 2017.
For a few months in 2017, Dr. Bonnemaison was re-employed by the Bayonne Hospital, on a fixed-term contract and without patient contact, to perform clinical research on medical protocols, such as oncology.
by NexDev | October 13, 2017 | Difficult pregnancy
On October 11, 2017, the first results of the French national perinatal survey 2016 were published. The report shows an increase in delaying child bearing until later in life, and an increase in the number of premature babies.
Periodically, these surveys are carried out by “Inserm” * and “DREES” **, with the latest one dating from 2010. They provide detailed information on pregnancy and childbirth. The March 2016 data includes reports of 14,142 births, from both metropolitan France and its overseas departments and territories.
In metropolitan France, certain risk factors have increased:
Besides the preoccupying fact that obesity is on the rise, the cumulative report emphasizes that “As noted for the past several decades, child bearing is being increasingly postponed until later in life, even though it is also well-documented that this greatly raises the risks for both mother and child.” For example the number of women in the ≥ 35 year-old group who postpone having a child has increased from 19% in 2010, up to 21% in 2016. Likewise, the statistics of infants born either with low weight and/or prematurely has risen from 1995 to a level of 6% in 2016: “Insofar as other countries have either reported a steadfast low or declining rates, these current French results raise issues for discussion.” Those who chose exclusively to breastfeed declined to 52% compared to 60% in 2010.
Job situations for both women and their partners have deteriorated: with 28% of households benefitting from various subsidies allotted during pregnancy such as those for unemployment or low income.
The investigation shows how certain public health guidelines are being are applied. For an uncomplicated pregnancy, no more than 3 sonograms are usually recommended. But in 2016, 75% of women had more than 3, and 36% had 6 sonograms. Following changes in screening procedures for Trisomy 21, also known as Down syndrome, the numbers of trophoblast biopsies stabilized, and the number of amniocentesis performed fell from 8.7% in 2010 to 3.6% in 2016. As usual in these reports, the screening procedures target Trisomy 21, thus a sign of ongoing apprehensions as far as this disorder is concerned.
Since the risk factors are higher in the French overseas regions and territories, the data for perinatal health is more preoccupying. Compared to the French mainland, there are numerous women in “dire straits”, or poorer living conditions.
Hospitalizations for complications experienced during pregnancy are more commonplace, often because of irregular clinical follow-up. In mainland France only 5% of women live alone, whereas in these overseas territories 25% of pregnant women do not have a partner. In the mainland, the 18-19 year-olds account for 2% of pregnancies, compared to 6%. A higher rate of premature births has been demonstrated as well.
Private maternity clinics are still on the decline (517 in France and 20 in the metropolis), in favor of larger maternity wards, which are thought to provide greater health and safety by increasing offering readily-available services from obstetricians, anesthetists and pediatricians. Comforting women during delivery appears to be more individualized, and including improved pain treatment.
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*Inserm: National Health and Medical Research Institute
**DREES: Directorate for Research, Studies, Evaluation and Statistics
by NexDev | October 6, 2017 | News
No one can remain indifferent following the incident of Anne Bert’s highly publicized euthanasia. Anyone suffering from severe disabling pathologies deserves to be heard, comforted, and supported. While being sympathetic to Anne Bert’s suffering, it does not entitle her to be a spokesperson for other patients, their relatives and all those professionals and volunteers who take care of them.
The French public was caught unaware by the mass media’s no-holds-barred coverage of Bert’s personal suffering, even announcing that her book’s release would follow her planned suicide in Belgium. Without judging the person, in hind-sight we must try to understand the fatal consequence of her act. In view of all the publicity, was she still acting under her own free will? Could she desist without incurring consequences from those who used Anne Bert’s situation to further their cause, without mentioning her publisher’s disappointment?
This suicide’s impact on patients, families, and caregivers needs to be addressed. To speak of having the “courage to die” in such a situation, is completely obliterating the courage it takes to live. It is desperately critical when vulnerable people hear that it’s better for them to choose death, rather than life, to choose euthanasia over palliative care and research. Every individual needs to be taken into account and supported during the difficult loss of autonomy. If the media only give voice to a person who does not accept dependence, no one will hear the edifying testimonials of those who assume their difficulties…, thus demonstrating how society excludes those who are vulnerable.
Some speak of having to seek exile in Belgium. What is shocking however, are not the differences in terms of death, but those in terms of life: accompanying, supporting, and giving people access to palliative care. Are we going to do our best to relieve physical pain and moral, social and spiritual suffering when facing the natural end of life and implement the necessary resources? Or are we going to take the easy path by “extinguishing” people?
Forbidding killing is society’s red line which must not be crossed. At stake is the challenge of refusing both therapeutic eagerness and euthanasia. France has made this decision in favor of humanity. Acting otherwise would risk hindering medical research’s huge efforts to combat illness- especially the one this woman suffered from- and to fight against pain.
The treatment of most vulnerable individuals in society reveals much about our humanity. It is inacceptable to judge people according to their supposed usefulness. The way we look at them often influences the way they see themselves.
If society deems that euthanasia is required for anyone who is seriously ill, we will become dehumanized. This latest media coverage should incite a leap of conscience, without ceding to the influence of those who are taking advantage of the situation, trying to force the government to relent in favor of euthanasia and assisted suicide. ”
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Listen to Tugdual Derville and the complete debate on Assisted Suicide recorded by Sud Radio on September 12, 2017.
by NexDev | October 6, 2017 | Bioethics
On October 5th, French Health Minister, Agnès Buzyn, met with Jean-François Delfraissy, the new chairman of the ‘CCNE’ (National Consultative Ethics Committee) to reflect on the timetable for revising the bioethics law planned for 2018.
The current version of the bioethics law was voted on July 7, 2011.
It was voted that the law could be revised after 7 years.
Last September 13th, Mr. Delfraissy unveiled the major steps ahead concerning the law’s revision. The General Assembly is scheduled for the first half of 2018, followed by a bill in the autumn, in order to adopt a new legislative text by the beginning of 2019. From January 2018 onwards, major regional public debates are planned throughout France, organized by the local ethical departments of the Regional Health Agencies. A “citizen’s panel” may also be held to discuss the issues. Mr. Delfraissy intends to convene jurists and scientists, as well as representatives from various religions and associations. More specific details are expected following the meeting between the Health Minister and the Ethics Committee chairman.
Some worry that the debate will focus on extending the law to allow “medically assisted procreation” for female couples and single women. But many additional issues were not addressed in 2011, such as human genetic modifications with the CRISPR-Case9 technique, the use of “Big Data” for medicine or for artificial intelligence, and in a more general manner, transhumanism.
by NexDev | October 5, 2017 | Old age and Dependency
On September 28, 2017, the association “Little Brothers of the Poor” has just published an unprecedented study entitled « Over 60: Isolated and Lonely in France in 2017” The opinion survey was carried out last June by the CSA Institute (Consumer Science and Analytics). Over 1,800 individuals were interviewed either by telephone or in person, including those in nursing homes, hospitals or prisons.
Founded in 1946, the Little Brothers of the Poor is committed to relieving isolation and loneliness. Over 12,000 elderly French people are visited at least weekly by the association’s 11,500 volunteers.
This survey established three conclusions:
- 300,000 French who are over 60 have « no social life »: meaning they almost never, or only rarely visit with others – whether it be members of family or associations, or in social or neighborhood circles. Moreover, just because the elderly in nursing homes are surrounded by attentive caregivers, this does not exclude them from experiencing feelings of loneliness. Poverty exacerbates the risk of being isolated, as well as living in the countryside or far from a large city.
- “Digital exclusion” or unconnected to Internet: By age group, 31% of those over 60 have never used Internet, increasing to 47% for those over 75 years old, and reaching 68% for those over 85. The various reasons include the lack of connection, or training, but also the means to subscribe. Thus, today when Internet is used for an increasing number of formalities (administrative or otherwise), the elderly have a complete disadvantage. Nevertheless, since smart phones and tablets are easier to use than computers, some communicate with friends and family, with audio and video options, in spite of geographical distances.
- Age 85: new threshold for old age. Starting at this age, the elderly are noticeably less autonomous. They have fewer contacts, they go out less often, but nevertheless it is also the period where their children visit them more frequently: at least once a week for 62% of those parents who are 80 and over.
This study also observed that a large majority of those surveyed prefer to remain in their own homes (only 3% preferred nursing homes with medical care). One notable fact was that 88% of those over 60 declare they are happy, (compared to 82% of those over 18 years old.) The associative network plays an important role in maintaining contact with others. One in 3 individuals participated in associative activities on a weekly basis, which gave some an opportunity to establish genuine bonds of friendship.
