Respect of dignity in Hospitals Anne-Marie Duguet MD, Ph.D Maître de Conférences des Universités Université Paul Sabatier Toulouse ( FRANCE) INSERM Unité 558 IV Conference of the International Society for Clinical Bioethics Franco Japanese Third Seminar on Bioethics Aix en Provence 14 and September 15, 2007

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 2 A- Deontological basis

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 3 The dignity in the medical deontology The various codes of deontology of health professionals establish the fundamental duty to respect the dignity of the person, as well as respect for life.

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 4 Art 2 Physicians’ code of Deontology The doctor, at the service of the individual and Public health carries out its tasks in respect for human life, for the individual and his dignity. Respect due to the person does not stop after the death(R Public health code).

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 5 Art 7 Physicians’ code of Deontology The physician must listen, examine, advise or treat with the same conscience all persons, regardless of their origin, their habits and their family situation, their membership or non-membership of an ethnic group, a nation or religion, their disability or their health, their reputations or the feelings that he or she may experience for them. In all circumstances, he or she must give any assistance (R Public Health Code).

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 6 Art 7 Physicians’ code of Deontology The physician should never depart from a correct and attentive attitude to the person reviewed (R Public Health Code)

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 7 Art 10 Physicians’ code of Deontology A doctor examining or giving care to a person deprived of liberty can not, directly or indirectly, even by his mere presence, facilitate or support an attempt to the physical or mental integrity of this person or to her or his dignity. (R Public Health Code)

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 8 Art 38 Physicians’ code of Deontology The doctor must accompany the dying until its final moments, by providing care and appropriate measures to the quality of a life that ends, safeguarding the dignity of the patient and comfort the entourage. He is not allowed to cause death deliberately. (R Public Health Code).

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 9 B - The dignity in the relationship of care at the hospital: Professional practice, legislation and recommendations

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 10 The dignity in the relationship of care at the hospital For the patient able to express his or her will For the subject incapable of making decisions and choices concerning his or her health

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 11 Dignity in the end of life The pain The Leonetti Act on the end of life April 23, 2005 Advanced Directives art L CSP “Personne de confiance” (Person of trust) Approaching the end of life and death in reanimation 8 September 2005 ( )

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 12 Treating after death with dignity Treating after death and post-mortem practices in burial chambers ”Espace éthique AP-HP” Special Issue No. 3

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 13 Quality of care and dignity: The repositories of ANAES / HAS for accreditation of health establishments The web site of the HAS: Patient’s rights and patient information references Organization of care for the patient references

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 14 C. Violations of dignity: Patients’ experiences

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 15 Investigation in the emergency department of the Toulouse University Hospital Study of 188 letters of complaint received in 5 years in adults emergency departments. 12 were complaints related to human rights and dignity

Respect of dignity in hospitals Anne-Marie Duguet MD PhD Maître de conférences des Universités INSERM U 558 Université Paul Sabatier Toulouse France 16 Investigation in the emergency department of the Toulouse University Hospital Among the answers given by the hospital’s administration to these 18 letters complaining for violation of dignity, only one presented the regrets of the care team. In the other cases, the staff has justified his behaviour by the circumstances or the conditions of hospitalization.