Search

The main theme of this article is the conditions leading up to, during, and following a policy passed in France in 1998. The policy allowed residency to "any foreigner habitually resident in France and suffering from a serious medical condition requiring medical treatment, and for whom deportation would result in exceptionally serious consequences, provided that he or she would be unable to receive appropriate treatment in the country to which he or she is returned" The author likens the poicy to "compassion protocol" or palliative care. The law should only apply in extreme circumstances and is based on an emotional response to pain/suffering. 

This policy had good intentions, but led to a number of resulting issues, such as disparity in care due to ambiguity in the law. For the enforcers of the law, there was much interpretation which allowed for individuals to exercise "humanitarian reason" and decide what conditions were a "serious medical condition" and what was not. This politicized medical care for foreigners/immigrants, as medical proffessionals no longer diagnosed based on symptoms, but socioeconomic status as well. 

No bibliography found. 

The author, Didier Fassin, is an anthropologist and sociologist at the Institute for Advanced Study. He is a professor of Political Science and orginially a physician in internal medicine. He researches public health and "medical anthropology" looking at AIDs epidemiology, mortality disparities, and global at large. He is hailed as the developer of "moral anthropology, which looks at moral judgement's effect on everyday life and international relations. He conducted research in Senegal, Ecuador, and France, focusing on power and inequality issues. He was also the CP for MSF from 1999-2003. 

Emergency response isn't directly addressed as much as ongoing access to care. 

The author relied on a combination of resarch and personal experience to support his arguments. First hand experience during the time the policy was in effect also contributed to his knowledge on the subject.

"... pathology, which previously aroused suspicion, has therefore become a source of social recognition"

"The issuing of a diagnosis and prognosis- an every-day act for the clinician, in principle involving no difficulties other than technical ones- became a problem of conscience that seemed like to invovle ideological of ethical issues" 

"The logic of state sovereignty in the control of immigration clearly prevailed over the universality of the priciple of the right to life. The compassion protocol had met its limit" 

The author cites a number of cases in which the law proved difficult to enforce. One example is seen when looking at the difference in residency application acceptance rates between different locales/prefects. The much larger and metropolitan areas would accept down to 47% of the applications, indicating a possibly fair division of candidates reviewed. Other more rural areas would accept over 90% of the applications, showing almost no distiguishment between ailments. The question becomes whether this is reflective on the doctors' judgements of "serious ailment" given location, the political beliefs of the prefect, or simply the lack of caring whether someone emmigrates or not. Another example of the flaws in this law is highlighted by a personal anecdote from a patient. The patient was given a diagnosis when originially coming to France on a personal visa. They were told their condition was quite serious and would require ongoing care. However, when the doctor who diagnosed him was asked to sign for evaluation for the residency permit, the doctor changed his diagnosis to something much less serious. The political thought behind the poicy came into play and interrupted the normal proceedings, tearing doctors between their obligations to the law (and only allow exceptional cases) and to medicine (and err on the side of caution).  

The author also highlights the development of this law and its effects in three stages. Pre-1990: Serious illness was a factor in residency completely at the discretion of local government. Immigrants were seen as workers and they served that purpose only. If a worker was sick, they were of no use to society. 1990-1998: Illness was more often factored into the decision making process, but those allowed to stay received no paid employment or social wellfare benefits. Post 1998: Written into law, ill immigrants were allowed to stay with the opportunity for pay and legal status in France. 

The author references this article in a number of his other works.