Putting ethics back at the heart of the healthcare system is what the National Ethics Advisory Council (CCNE) is proposing in an opinion published on Monday 7 November and focusing mainly on the tense situation of public hospitals which are “the most salient symptom” of the crisis that the French health system is going through. “The Covid-19 health crisis has highlighted and accelerated a deeper, earlier crisis in our system”underlines Régis Aubry, head of the palliative care service of the CHU of Besançon and rapporteur of the opinion.
While numerous reports have noted dysfunctions in the French health system, this opinion will not fail to challenge caregivers and stakeholders in the health component of the National Council for Refoundation (CNR) launched on October 3 and whose conclusions are awaited. in January 2023. After a tense summer in the hospital which prompted the government to organize a “flash mission” to find emergency solutions, the heads of the pediatric intensive care units sounded the alarm, at the autumn, on the deteriorated care conditions for children.
In this long report, the members of CCNE – doctors, researchers and scientists selected for their competence in ethical issues – draw up an uncompromising assessment of the ills of public hospitals, “too polarized on the health dimension to the detriment of public health and a global approach to people”implementing a management “dysfunctional” based on activity-based pricing – the famous “T2A” – and overvaluing technical acts to the detriment of the time devoted to patients. “The time of caregivers intersects less and less with that of the sick”write the authors.
A system that is too hierarchical and built around the figure of the doctor who does not value the knowledge of other caregivers, in particular nurses and midwives. More generally, the CCNE describes a partitioned system between hospital and city medicine, private and public, health and medico-social… And therefore unsuited to changing health needs.
“Ethical Suffering”
“The valorization of technical acts has eliminated acts that consist of listening and spending time with patients. This is why today we end up with the desertion of health professionals.insists Régis Aubry, mobilizing the notion of “ethical suffering” developed by the Canadian professor Lyse Langlois during her hearing by the CCNE. A suffering encountered by many caregivers, who face “an increasingly obvious discrepancy between their practices, perceived as dehumanized, and the ethical values of care”.
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