by NexDev | August 5, 2016 | End of life, Laws, surveys, protagonists
On August 5, 2016, the Official Journal published two decrees and a decision dated August 3 which provide clarification regarding “deep and continuous sedation until death” and on the advance directives, such as those provided for by the February 2, 2016 law on the end of life.
> The first decree n°2016-1066 primarily concerns doctors and health professionals. The French Code of Medical Deontology Code has been modified to include this new form of sedation, with different modalities according to whether or not the patient can express his will. A thorough analysis of its content, and especially the practices to be implemented on its basis, will be needed to assess the actual scope of this text.
In order to put an end to cases which a doctor considers as unreasonable obstinacy, for example, it is specified that the doctor can practice this form of terminal sedation, when the patient can no longer express his will, “even if the patient’s suffering cannot be evaluated given his cerebral condition”. Isn’t it paradoxical to use sedation, whose primary objective is to relieve refractory pain, when we aren’t even sure the individual is suffering?
It will also be necessary to learn to differentiate between two collegial procedures which appear to be only slightly different, according to whether the doctor wishes to curb or discontinue treatment (procedure in article L.1110-5-1) or if he wishes to overlook the advance directives that he esteems are obviously inappropriate or inconsistent with the medical condition (procedure in article L.1111-11).
> The second decree n°2016-1067 concerns the entire French population, since it modernizes the terms of drafting and conserving advance directives that each individual can establish to make his will known in the event where he can no longer express himself. This decree describes the content of the template requested by the End of Life law and the various ways of storing this document.
There are two distinct scenarios, resuming the suggestions made by the French National Authority for Health a few months earlier: one whereby the individual is at the End of Life and realizes that he has a serious and life-threatening condition, and one whereby the individual is not believed to have a serious condition (with a lesser number of sections proposed). Furthermore, a specific section addresses deep and continuous sedation until death. The naming of a person of confidence is also provided for. All of these aspects, as well as other ancillary details are contained in the annex of the Health Minister’s decision for implementing this decree.
> As for the different means of conserving this document, the decree recommends the Shared Medical Record, the computerized tool containing all the medical data for the same individual and which is planned to be available for the entire population by 2017. This choice was suggested in report by the French General Inspection for social Affairs (IGAS)1 last October 2015, and the government decided that this means could be considered as the national register provided for by Article 8 of the end of life law. In addition, the advance directives could be kept, for example, by the family physician, in medical records in the event of a hospitalization, or in the health care records for individuals in nursing homes, in addition to either conserving the document at home or giving it to a chosen individual.
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1 IGAS: « Inspection Générale des Affaires Sociales »: French government audit, evaluation and inspection office for health, social security, social cohesion, employment and labor policies and organizations.
For further information: VITA Decoder n°45 on the End of Life law, February 4, 2016
by NexDev | July 21, 2016 | Medically Assisted Procreation
On Thursday, July 21, the European Court for Human Rights (ECHR) condemned France for having refused registering civil status documents for birth certificates of children born abroad by surrogacy.
This decision concerns the Foulon and Bouvet files, where men employed recourse to surrogate mothers in India.
In two similar cases in 2013, the Cassation Court validated the refusal by the Rennes Court of Appeal, to recognize birth acts established in India,. The Court of Cassation considered that as the birth was the culmination of fraud to the law, since surrogacy is banned in France, the refusal to register foreign civil status acts was justified.
Didier Foulon and Philippe Bouvet then introduced a request before the ECHR in January 2014.
The court judged today that refusing to register constitutes a violation of rights with respect to the private life of children, guaranteed by article 8 of the ECHR. Furthermore, it condemns the State to pay 5,000 € to each child concerned for “moral damage” and 15,000 to each family for legal costs. However, the European magistrates did not uphold the claimant’s demand for violation of respecting the family’s rights.
In November 2015, “to finish with the contentious affairs » whereby France was being held in contempt before the ECHR, the French government, with the Minister of Foreign Affairs serving as an intermediary, proposed 30,000 € compensation to each of the two sponsors of surrogacy; who subsequently refused.
The Foulon Case: a little girl was born in 2009 in a clinic specialized in surrogacy in Mumbai. Her birth certificate indicated that her mother was unemployed, born in 1980, and her father was Didier Foulon. One month after birth, by written document, Didier Foulon declared having given the surrogate mother 100,000 rupees (approximately 1300 €) corresponding to 3 months wages; as well as 60,000 rupees to the clinic.
The sponsoring father wanted France to register the civil status corresponding to the birth certificate established in India. The procurer of the Republic in Nantes was opposed, under the suspicion that having recourse to surrogacy, banned by the Civil Code’s article 16-7, and whereby “all conventions for the procreation or surrogacy for others is invalidated”.
The man then filed at the High Court of Appeal in Nantes who was granted his request. The prosecution subsequently filed an appeal, and the Court in Rennes revoked its decision, cancelling their decision, by specifying that “it’s not only a monetary affair of a contract between a surrogate mother banned by French law, but the purchase of a child, and therefore inherently against the laws of public order. Following that, the Court of Cassation also dismissed the appeal.
The Bouvet Case: two twins born in 2010 in the same clinic in Mumbai. The birth certificate indicated that they were born to a young unemployed Indian girl who was born in 1982, and from Philippe Bouvet, a 45-year-old French-man, in a ‘pact’ relationship with a man where they had already started the formalities in order to obtain custody of the twins. Philippe Boucet first broached the procedures at the French Consulate in India so that his sons would be registered in the French civil status registry. Then he encountered opposition from the procurer of the French Republic in Nantes, but the High Court Tribunal of the city accepted his request, before the court of appeal, and a confirmation of the appeals court’s decision, before being stonewalled by the Court of Cassation in September 2013.
Caroline Roux, International Director at Alliance VITA states :
« Children cannot be given away or sold. By their decision, the European Court for Human Rights contributes to importing into France an ultraliberal market for procreation and renders the country impotent to opposition. In addition, this is in opposition to the Indian States efforts to eradicate this practice which exploits the poverty of women in favor of profiting rich countries.”
Tugdual Derville, General Delegate at Alliance VITA states:
“We are confronted with a typical example of Human Rights biting its own tail. By pushing their conception of “respect of private life”, to extremes, the European magistrates are sanctioning France to pay individuals who have not only conscientiously committed fraud against our foreign laws, but who have also submitted women and children to abuse in its original form.
While there is no formal penalization for the purchase of human beings outside of French borders, this traffic is permitted even if it is not encouraged. Therefore, in the future, we need a courageous majority to contest not only the emotion that the sponsors feel for the children that they have manufactured, and then imported, but to contest the inacceptable abuse intrinsic in surrogacy practices”.
by NexDev | July 21, 2016 | Bioethics
A draft reform for the pharmacists’ code of ethics has generated an unexpected controversy in the past few days on whether a conscience clause is necessary in their ethical code.
This reform is currently being implemented by the National Council for the Order of Pharmacists. The code of ethics, applicable for all pharmacists, lists the general obligations and prohibitions for the profession, as well as specific provisions by profession. The first code of ethics for pharmacists dates from 1953. It was modified in 1995. This set of professional rules and obligations is prepared by the National Council for the Order of Pharmacists in accordance with article L. 4235-1 of the Public Health Code law. It helps maintain the security of professional acts for the patient’s interest, and constitutes a foundation of trust for the public. For the Council’s president, Isabelle Adenot, the ethics code is the “most precious federating heritage, strength when the pharmacist has doubts or uncertainties.” At the end of 2015, the Order of Pharmacists deemed that “faced with changes in the profession and in society, it has become necessary to proceed with modifications” of this text.
In the official process, it is up to the Oder to prepare a reform for the new code of ethics, which would then be validated by the Government then issued under the form of a decree by the Council of State, according the advisory opinion of the Competition Authority. The provisions of this code are then introduced in the Public Health Code (articles R4235-1 + seq).
To write this new draft code, in December 2015,the Order launched an on-line survey to consult approximately 75,000 pharmacists on their list.
This consultation elucidated many requests from pharmacists, including that of instituting a conscious clause. Another working group was created in parallel to consult students, interns, and organizations which represent the pharmacy profession.
The results of this dialogue revealed that 85% of the 3395 pharmacists responding to the survey wished to have a conscience clause instituted for the benefit of the pharmacist. This large majority was seen no matter the age interviewed or the affiliated sector (salaried incumbent or assistant, in metropolitan France or French overseas departments, in distribution, industry, biology or health centers).
Following this consultation and the work carried out by the Order, a “Draft Reform for the new ethics code and other provisions to insert in the public health code” was written. The Council deliberated on July 4, 2016, adopting it entirely with the exception to the article concerning the conscience clause, since they were not able to obtain the needed majority.
The first version for the article on the cause of conscience states: “Without prejudice to patients’ rights to access or continuity of health care, the pharmacist can refuse to carry out a pharmaceutical act liable to endanger human life. He must thus inform the patient, and do everything possible to assure that the patient will be taken care of in a timely manner by another pharmacist. Otherwise, the pharmacist shall be required to perform the pharmaceutical act”.
On July 12, all pharmacists received a letter from the Order inviting them to decide in favor or against this article, via the Order’s extranet website.
This initiative received criticisms very quickly on the social media networks, and a petition addressed to the president of the National Council for the Order titled “We refuse the conscience clause for pharmacists” was launched. This petition emanates from a “Collective group of pharmacists against the conscience clause” created for the event that have no internet site, no spokesman, and the members present themselves are “twitter signers”, the majority of whom are anonymous or use pseudonyms.
On July 19, the Minister for Women’s Rights, Laurence Rossignol, published a press release, in which she expresses astonishment at the consultation launched by the Order of Pharmacists, and asserts in a surprising manner that if “put into effect, it would clearly open the possibility that pharmacists could refuse to deliver emergency contraception (day-after pill), birth-control pills, IUD’s, or even condoms”.
In reply to the minister, the president of the National Council for the Order of Pharmacists recalled the same day that “the debates which took place within the Order regarding this legal article were never focused on contraception but on the end of life, a situation which is often very sensitive to manage by city and hospital pharmacists.”
She specifies that “these non-documented comments by the Minister are appalling at this level of State responsibility and they create a climate of completely detrimental misinformation for patients and for the public”.
For further information:
Press Release from Alliance VITA on July 21st
Our expert notice: Recognized Conscience Clauses in France
by NexDev | July 21, 2016 | Bioethics, Press Releases
Alliance VITA is strongly opposed to the ideological pressure being imposed on pharmacists, who for a large majority wish to introduce a conscience clause in their Code of Ethics. VITA is calling for a calm, reasonable and honest discussion with respect to the freedom of conscience for professionals faced with acts “liable of endangering human life”.
While a survey coordinated by the CSA showed that 85% of pharmacists wish to have a conscience clause in their Code of Ethics, a controversy has been triggered, echoed by the Minister Laurence Rossignol. Contraception issues, morning-after pills, medical abortions, kits for euthanasia or assisted suicide are evoked one by one in a very confusing manner.
The right to conscientious objection has become an unavoidable topic, for at least three reasons:
- Our right to health conceals a major discrepancy which constitutes an injustice: whereas the conscience clause is widely recognized in cases of voluntary interruption of pregnancy – for doctors, mid-wives, even for all the medical auxiliaries who are less directly involved in infringements on human life, for example speech therapists, or physiotherapists – this clause is not yet recognized for pharmacists, who are thereby being discriminated against.
- Some recent changes in the practice of the pharmacist’s profession have exacerbated this injustice: the evolution of techniques and legislation now put them on the front line whenever the delivery of ethically sensitive products is at issue, especially those which provoke “medical voluntary interruption of pregnancy”; such as RU 486 (day-after pill). These voluntary interruptions of pregnancy are performed more and more “at home”, outside of a hospital environment (approximately 40,000 per year*). Only pharmacists are allowed to deliver these abortive products, and one cannot deny that their unique purpose is to “terminate a human life”.
Furthermore, as mentioned by the president of the Order of Pharmacists, this profession legitimately fears being confronted by the issue of lethal products designed for euthanasia or assisted suicide. These fears are legitimate in the rare countries where these practices are legal and where conscientious objection is denied; as well as the ambiguity of the recent end-of-life law on the presiding intent of terminal sedation.
Alliance VITA calls for the respect of freedom of conscience for all health professionals confronted with acts “liable to endanger human life”.
Tugdual Derville, General Delegate for VITA notes:
« The freedom of conscience, as well as the right to the objection of conscience which ensues, are essential principles pertinent to universal human rights. Nothing can obscure them. The recognition of a conscience clause is even more necessary today for pharmacists since their profession has introduced growing personal responsibility for public health and its users. Because of this controversy, the smear campaign orchestrated at the last minute demanding for the government to eliminate the conscience clause which exists for other health professionals is contemptible, all the more so, when the ministers respond with complacency. If the large majority of pharmacists are demanding a conscience clause, it is because they are in direct contact with the social hardships which necessitate dialogue and to be treated humanely. Exercising one’s freedom of conscience is a fundamental requirement in these situations. Pharmacists should not be considered as automatic robotic dispensers. That’s why one needs to let the members of this profession, who are in close contact with the people, reflect without any outside pressure, as to what seems to be most desirable for practicing their invaluable role.”
by NexDev | July 13, 2016 | News
The Supreme Court in India has accused Google, Yahoo and Microsoft research engines of failing to keep out ads promoting sex selection kits since such ads are forbidden in India.
The Supreme Court has requested for the Indian government and the owners of the Internet search engines to find a technical solution to prevent such ads from popping up at any moment, during routine Internet searches. Sex-determination of a child before birth is banned and punishable as a criminal offence in India since 1994. In fact, the Indian government is attempting to fight against the selective abortion of baby girls, which remains at a high rate in this country for cultural reasons. The ratio according to sex at birth reached 112 boys for 100 girls, whereas the worldwide natural sex-ratio at birth averages 105 males for 100 females born. According to the Population Research Institute (PRI), nearly 13 million sex-selective abortions were carried out in India between 2000 and 2014.
Report on female infanticide worldwide
This arraignment from the Indian Supreme Court occurs just as the Asian Centre for Human Rights has published on July 11, 2016 a report on female infanticide worldwide: 117 million girls/women are ‘demographically’ missing in Asia, due to sex selective abortions. This same phenomenon is found in countries which have passed laws similar to those of India: such as China, Nepal, Pakistan or Vietnam. The report indicates “These governmental measures fail to curb this practice due to easy access to ultra-sonography and weak law enforcement.”
In India and all of south Asia, the Dowry system, which makes daughters an economic burden, also contributes to preferring having a son over a daughter. The development of ultrasound technology for sonograms in the 80’s had dramatic affects, associated with abortion laws often widely encompassing, such as those in India. India enacted a law in 1971, amended in 2002, which allows abortion without any pre-existing conditions up to 12 weeks of pregnancy, and up to 20 weeks of pregnancy, in cases where the continuance of the pregnancy would involve a risk to the life of the pregnant woman or of grave injury to her physical or mental health, in rape cases, risks of disability or sterilization failures.
In China, the phenomenon increased substantially with the coercive “one-child” policy. With birth rates showing even more gender imbalance than in India (115 boys for 100 girls), according to the PRI estimates, more than 9 million sex selective abortions were performed between 2000 and 2014. The Chinese National Bureau of Statistics emphasizes that 33.8 million women were missing by 2013.
In addition to abortion, MAP techniques and reproductive tourism are at cause
If the Asiatic countries attempt to fight against this phenomenon, more or less effectively, the report addresses the issue of reproductive tourism as the next cause of female infanticide and going beyond Asian borders.
“In particular, the United States and Thailand have become platforms for such reproductive tourism”. In fact, the report underlines that artificial reproduction techniques and the ability to select embryos will increasingly become a cause of female infanticide. According to the Asian Law Institute, 80% of the pre-implant diagnostics are performed for sex selection in Thailand.
More than the tragedy that this phenomenon represents in terms of loss of human lives and inacceptable discrimination, these practices have particularly severe consequences on the traffic of women and using violence against them, as well as on the future of men who have difficulty finding enough women to found a family.
Among the countries in South Asia, only South Korea has progressively reversed the imbalanced sex ratio. The awareness campaign “Love your daughters” introduced in 1991 had a decisive impact, associated with economic development and appropriate measures such as providing a pension system for elderly individuals, which thus reduces the dependence of aging parents on their sons.
