The Conseil d’État today issued a reprimand under the French Public Health Code to two ophthalmologists for discriminatory refusal of care. It pointed out that the law, which had been strengthened several times since 2002, prohibited any discrimination based on a patient's administrative or social situation in access to preventive care or medical treatment.
The medical code of ethics has for a long time required doctors to treat everyone with the same conscientiousness, regardless of their social status. Doctors must also ensure continuity of care and may only refuse treatment in very limited cases, excluding emergencies.
In this respect, the legislature has paid special attention to cases of refusal of care demonstrably based on the administrative or social situation of individuals, particularly those benefiting from complementary healthcare insurance (C2S) or state medical aid (AME). Over the years, Parliament has passed several laws against such refusals to provide care.
For example, the law of 4 March 2002 prohibited discrimination in access to preventive care or medical treatment (1). This prohibition was further strengthened by the law of 21 July 2009, which specifically made refusal of care on the grounds that the patient is a beneficiary of the C2S or the AME illegal (2). The legislature also created a system for processing complaints. Finally, the law of 26 January 2016 (3) reinforced the role of professional bodies in monitoring discriminatory practices, and the law of 24 June 2016 (4) extended the list of prohibited forms of discrimination in criminal law by introducing a reference to the economic situation of the victim.
The Conseil d’État drew conclusions from these provisions.
Appeals against decisions of the Chambre Disciplinaire Nationale de l’Ordre des Médecins [French disciplinary chamber of the order of physicians] were brought before it by a person receiving AME healthcare assistance. This individual had accompanied their daughter, a minor, to two ophthalmology consultations, which were not carried out normally. Considering that they were the victim of discriminatory refusal of care, they unsuccessfully submitted a complaint, to the disciplinary body of the order of physicians.
The Conseil d’État ruled, pursuant to the provisions of the French Public Health Code, that the two ophthalmologists in question had committed discriminatory refusal of care, constituting a breach of their ethical obligations (articles L. 1110-3 and R. 4127-7). The practitioners could not make the medical examination of the applicant's child conditional on the advance payment of costs, as required by the first ophthalmologist, while the applicant was legally exempt from such payment, nor could they refuse to conduct the examination on the grounds that they did not have the necessary treatment forms to cover the cost of the consultation, as required by the second ophthalmologist.
On these grounds, the Conseil d’État overturned the decisions of the Chambre Disciplinaire Nationale de l’Ordre des Médecins, which had found no breach of ethics. However, it only imposed a reprimand on these two practitioners, as it was not established that the discriminatory practice in question was systematic or habitual.
(1) Law of 4 March 2002 on patients' rights and the quality of the healthcare system
(2) Law of 21 July 2009 on hospital reform relating to patients, healthcare and territories
(3) Law of 26 January 2016 on the modernisation of our healthcare system
(4) Law of 24 June 2016 aimed at combating discrimination on the grounds of social vulnerability