Canada v. France: Rethinking Role Of Nurses To Meet Healthcare Needs

To meet its current healthcare needs, France looks to the Canadian provinces of Ontario and Quebec which are giving more autonomy to nurses rather than boost the number of doctors.

Nurses will save France's healthcare system
Nurses will save France's healthcare system
Guy Vallancien*


PARIS — After Ontario, the Canadian province of Quebec has also moved to give specialized nurse practitioners the authority to make autonomous diagnoses and practice certain kinds of therapeutic, even high-risk interventions.

This recognition of nursing's key role and responsibilities is the solution that France must adopt to ensure continuous and smooth healthcare coverage throughout the nation.

Canada"s specialized nurses receive additional training that allows them to do a number of things —​ from diagnosing illnesses, to prescribing medications and performing therapeutic interventions —​ that are normally reserved for doctors alone. The illnesses that such nurses are allowed to treat directly include diabetes, hypertension, asthma and chronic bronchiolitis, among others.

This is a far cry from the baby steps that have been taken in France —​ and tightly restricted always by most healthcare workers unions — to give more autonomy to so-called advanced practice nurses. That's why, without further delay, we need to follow Canada's lead and start offering one- or two-year master's degree programs to train our own specialized nurse practitioners to care for adults, children and seniors, and to work in collaboration with midwives on low-risk pregnancies.

In France, some nurses have taken an additional, year-long course to specialize in prostate care. And in the decade that this option has existed, the results have been wholly positive. Patients don't complain any more than expected when nurses take the lead role in treating them. And it's been good for doctors too, freeing them up to focus on more complex kinds of treatment.

France should focus on training nurses to provide more complex care — Photo: Xu Jinquan/ZUMA

This kind of win-win situation for both nurses and doctors directly calls into question France's plan to increase the total number of doctors by 20%. For one thing, those additional doctors wouldn't arrive on the scene for another 10 years, at the earliest. By then, artificial intelligence and robotics would have already taken up much of the work in various specialties.

In other words, if the 20% plan goes forward, we'll essentially be guaranteeing an abundance of unemployed people without resolving the problem at hand, which are the so-called "medical deserts' in France: areas where there aren't enough qualified people to meet the healthcare needs of residents.

And so here's the other option: Starting next year we begin training several thousand specialized nurse practitioners to go meet those healthcare needs not a decade from now, but in one or two years.

And it's been good for doctors too, freeing them up to focus on more complex kinds of treatment.

There's no time to waste. We need to go further than extending a few discreet privileges to advanced practice nurses and instead embrace real and open professional collaboration between doctors and nurses. The same should go for pharmacists too.

Doctors who oppose this are only shooting themselves in the foot. Canada is already showing us that a rapid transfer of medical responsibilities from doctors to nurses can work. Why wouldn't we at least try to follow the example?

*The author is a member of the National Academy of Medicine and president of the Convention on Health Analysis and Management.

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How Thailand's Lèse-Majesté Law Is Used To Stifle All Protest

Once meant to protect the royal family, the century-old law has become a tool for the military-led government in Bangkok to stamp out all dissent. A new report outlines the abuses.

Pro-Democracy protest at The Criminal Court in Bangkok, Thailand

Laura Valentina Cortés Sierra

"We need to reform the institution of the monarchy in Thailand. It is the root of the problem." Those words, from Thai student activist Juthatip Sirikan, are a clear expression of the growing youth-led movement that is challenging the legitimacy of the government and demanding deep political changes in the Southeast Asian nation. Yet those very same words could also send Sirikan to jail.

Thailand's Criminal Code 'Lèse-Majesté' Article 112 imposes jail terms for defaming, insulting, or threatening the monarchy, with sentences of three to 15 years. This law has been present in Thai politics since 1908, though applied sparingly, only when direct verbal or written attacks against members of the royal family.

But after the May 2014 military coup d'état, Thailand experienced the first wave of lèse-majesté arrests, prosecutions, and detentions of at least 127 individuals arrested in a much wider interpretation of the law.

The recent report 'Second Wave: The Return of Lèse-Majesté in Thailand', documents how the Thai government has "used and abused Article 112 of the Criminal Code to target pro-democracy activists and protesters in relation to their online political expression and participation in peaceful pro-democracy demonstrations."

Criticism of any 'royal project'

The investigation shows 124 individuals, including at least eight minors, have been charged with lèse-majesté between November 2020 and August 2021. Nineteen of them served jail time. The new wave of charges is cited as a response to the rising pro-democracy protests across Thailand over the past year.

Juthatip Sirikan explains that the law is now being applied in such a broad way that people are not allowed to question government budgets and expenditure if they have any relationship with the royal family, which stifles criticism of the most basic government decision-making since there are an estimated 5,000 ongoing "royal" projects. "Article 112 of lèse-majesté could be the key (factor) in Thailand's political problems" the young activist argues.

In 2020 the Move Forward opposition party questioned royal spending paid by government departments, including nearly 3 billion baht (89,874,174 USD) from the Defense Ministry and Thai police for royal security, and 7 billion baht budgeted for royal development projects, as well as 38 planes and helicopters for the monarchy. Previously, on June 16, 2018, it was revealed that Thailand's Crown Property Bureau transferred its entire portfolio to the new King Maha Vajiralongkorn.

photo of graffiti of 112 crossed out on sidewalk

Protestors In Bangkok Call For Political Prisoner Release

Peerapon Boonyakiat/SOPA Images via ZUMA Wire

Freedom of speech at stake

"Article 112 shuts down all freedom of speech in this country", says Sirikan. "Even the political parties fear to touch the subject, so it blocks most things. This country cannot move anywhere if we still have this law."

The student activist herself was charged with lèse-majesté in September 2020, after simply citing a list of public documents that refer to royal family expenditure. Sirikan comes from a family that has faced the consequences of decades of political repression. Her grandfather, Tiang Sirikhan was a journalist and politician who openly protested against Thailand's involvement in World War II. He was accused of being a Communist and abducted in 1952. According to Sirikhan's family, he was killed by the state.

The new report was conducted by The International Federation for Human Rights (FIDH), Thai Lawyer for Human Rights (TLHR), and Internet Law Reform Dialogue (iLaw). It accuses Thai authorities of an increasingly broad interpretation of Article 112, to the point of "absurdity," including charges against people for criticizing the government's COVID-19 vaccine management, wearing crop tops, insulting the previous monarch, or quoting a United Nations statement about Article 112.

Juthatip Sirikan speaks in front of democracy monument.

Shift to social media

While in the past the Article was only used against people who spoke about the royals, it's now being used as an alibi for more general political repression — which has also spurred more open campaigning to abolish it. Sirikan recounts recent cases of police charging people for spreading paint near the picture of the king during a protest, or even just for having a picture of the king as phone wallpaper.

The more than a century-old law is now largely playing out online, where much of today's protest takes place in Thailand. Sirikan says people are willing to go further on social media to expose information such as how the king intervenes in politics and the monarchy's accumulation of wealth, information the mainstream media rarely reports on them.

Not surprisingly, however, social media is heavily monitored and the military is involved in Intelligence operations and cyber attacks against human rights defenders and critics of any kind. In October 2020, Twitter took down 926 accounts, linked to the army and the government, which promoted themselves and attacked political opposition, and this June, Google removed two Maps with pictures, names, and addresses, of more than 400 people who were accused of insulting the Thai monarchy. "They are trying to control the internet as well," Sirikan says. "They are trying to censor every content that they find a threat".

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