Ethics and Vulnerable Charters

The Ethics is a set of ethical rules of operation of a medical or paramedical profession. The charter concerns the ethical rules governing the functioning of a health establishment or a service or social or medico-social institution.

The ethics of care or caring [ ref.  Wish] is not limited to ethics and the respect of a charter, it concerns concrete application in everyday professional practice. In care, ethics is central to the professional practice of doctors and nurses. This ethical dimension is open to other professions of social support , the social work of the therapy and nursing .

This ethical approach concerns all vulnerable groups, regardless of the nature of the vulnerability:

  • chronic disease
  • Disability
  • Old age and dependence
  • Social marginality



Ethics refers to:

  • The deontological ethics that is to say, moral philosophy and the moral law .

That is, it dictates what is right or wrong. Professional ethics are therefore the set of rules that define the moral obligations of this profession. We talk about code of ethics, charter, principles … Vocabulary that refers to the foundations and values ​​of an organization, an institution, or an individual. Http://

  • A code of ethics is the set of moral rules that determine the ethical obligations of a profession. This code applies to all professionals in this field

In terms of accompanying care only doctors, midwives, dental surgeons have a code of ethics published in the Code de la Santé. Physicians are governed by the Ordre des médecins The Code serves as a reference for the jurisdictional bodies of the Order and guides physicians in their daily practice in the service of patients. The other health professions or support or therapeutic support have developed rules of ethics, internal to their professional organization 1 . However, they do not have the authority of a code of ethics published in the OJ by the government in a law annexed to the codes of health or social action and families. However, certain professional rules may be regulated by the ministry, such as the paramedical professions united in the High Council of Paramedical Professions. 2 For example, the professional acts of psychomotricians are the subject of this publication In addition they must declare their professional activity to the departmental delegations of the Regional Health Agency (ex DDASS) 3

The creation of the nursing order 4 on the model of the order of physicians in 2008 is controversial 5 This order has two objectives to have a code of ethics and weigh in the political debate on health as an organization professional.


The Charters are legal acts which determine the rules of an institution of care or social accompaniment. They are subject to compulsory regulation and display in all the institutions concerned so as to respect the rights of the users and patients of these establishments. They impose themselves on all professionals and address all the users and their families.

Compliance with the rules laid down in the Charter may be subject to administrative supervision, criminal prosecution and revocation for hospital or territorial civil servants, dismissal for gross negligence for The employees of the private health or medico-social, in case of serious breach.

The Charter of Rights and Freedoms of the Elderly Dependent was negotiated between the Ministry of Employment and Solidarity and the National Foundation of Gerontology.

Like ethics, the charter is of the order of the Kantian moral law .


Beyond the rules, Ethics is a reflection on the application of these standards to the concrete situations encountered by the personnel of the services and establishments that accompany the users of the equipment in which they exercise. The ethical approach becomes central in the care and support to the point that this approach is one of the stakes of the evaluation and the accreditation of the establishments and services. The National Agency for Accreditation and Evaluation in Health and the National Agency for the Evaluation and Quality of Anesm Social and Medical and Social Institutions and Services are fully involved in the agreement of healthcare facilities and medical and social facilities .

Anesm has produced various documents concerning ethical questioning

  • Ethical questioning in social and medico-social institutions and services 6
  • Welfare: definition and benchmarks for implementation 7

For Anesm, goodness is a collective approach to identify the best possible support for the user, while respecting his / her choices and adapting to the needs of the client. To implement it, Anesm focuses on:

the user co-author of his / her path , this is what comes under the contract of residence and the elaboration of the individual path (individual care or therapeutic project, educational project or individual accompaniment), information To the user and to his / her relatives of the compliance to the care and the therapeutic education, the empowerment and the right of the users.

the quality of the link between professionals and users , this is what belongs to professional acts (nursing examples, nursing help), the code of ethics and professional orders, professional acts defined by regulation, charters in institutions . But also social counseling and customer relations services or hospital users.

the enrichment of structures and support through all relevant internal and external contributions ; this concerns research, the care network and partnership, but also the internal and external audit of the quality and Evaluation of service to users.

support for professionals in their approach to wellness . This is part of initial and continuing training, the role of management, the internal rules applied to professionals, the expression processes: transmissions and syntheses, speech groups and supervision, but also the expression of social dialogue (union)

Inpatient charter

The charter of the hospitalized patient constitutes an update of the charter of the hospitalized patient of 1995, necessitated by the evolution of the legislative texts, in particular the laws of 4 March 2002 on the rights of patients and the quality of the health system, 6 August 2004 on bioethics, 9 August 2004 on public health policy and 22 April 2005 on the rights of the sick and the end of life.

Declaration of the Rights of Persons with Disabilities, Convention and Charters

The United Nations has produced two texts that establish ethical rules in favor of persons with disabilities, both of which are based on the Universal Declaration of Human Rights

  • A declaration, which is resolution 3447 adopted by the General Assembly of the United Nations on 9 December 1975 8
  • A Convention on the Rights of Persons with Disabilities , which is an international treaty signed by 149 countries in 2007, France signed the Convention in 2007 ratified on 18 February 2010 9

The practical implementation of the 22 principles of the Convention by the Member States is the subject of Agenda 22 defined as a set of “good conduct” rules implemented by States and local authorities

The UNAPEI passed a motion in the Brest Congress May 20, 1989, CHARTER DIGNITY OF PEOPLE WITH DISABILITIES MENTAL 10 this text is a declaration of ethical intent and a CODE OF ETHICS AND ETHICS OF MEMBER ASSOCIATIONS UNAPEI in 2002 11

Charter of Human Rights and Freedoms allowed

Order of 8 September 2003  [ archive ] , Article L. 311-4 of the Code of Social Action and Families.

This charter applies to persons admitted to social and medico-social establishments. Its purpose is to prevent any risk of ill-treatment.

The user or his legal representative is given a welcome booklet to which are appended:

A) A charter of the rights and freedoms of the person accepted, specific to the nature of the institution. For example, for the EHPAD , the Charter of Rights and Freedoms of the Dependent Elder is included in the welcome booklet

B) The Operating Rules of the Institution

C) A residence contract or an individual care document is drawn up with the participation of the user or his legal representative. This contract or document defines the objectives and the nature of the support or accompaniment in compliance with the ethical and ethical principles, the recommendations of good professional practices and the project of establishment. It details the list and the nature of the services offered as well as their estimated cost.

The charter of the rights and freedoms of the person granted constitutes a regulatory basis which ensures respect for the following fundamental principles and rights 12 :

  • Principle of non-discrimination
  • Right to appropriate care or support
  • Right to information
  • The principle of free choice, informed consent and the participation of the individual
  • Right to renunciation
  • Right to respect for family ties
  • Right to protection
  • Right to autonomy
  • Principle of prevention and support
  • Right to exercise the civil rights attributed to the person
  • Right to religious practice
  • Respect for the dignity of the person and his privacy

Vulnerable persons in a state of precariousness or exclusion

There are no specific charters for these audiences but academic research reports address the difficulties of intervening with these people in two forms:

  • Taking care of the specific health problems of these groups. Persons in a state of precariousness or exclusion  [ archive ] . In the years 1990/2000 the policy of risk reduction in an unchanged legal framework of the fight against drug addiction (law of 1970) is the right to the care of the drug users.

The ethics of health care practices in prisons  [ archive ] is also part of this aspect.

  • Social intervention with marginalized youth or adults.

This intervention is marked by the political debate on poverty, security and social relegation . Also historically practices that today we designate as abusive, see as practices of eugenics , or euthanasia mass took place in the xix th and xx th centuries (see history of social work France ). Today the placement of the children of the poorest families gives rise to a debate on the appropriateness of this intervention. How far should we defend the best interests of the child 13 ? This makes it difficult to reach the consensus necessary for an ethical approach to the management of these audiences.

The report of the IGAS 2005 Monitoring, control and evaluation of social work and social intervention also addresses social intervention with marginalized youth of the limits of this work and the ethical dimension that this intervention 14

Charter of Rights and Freedoms of the Dependent Elderly

This charter applies to all private and publicly-funded public or private retirement homes, also LTCUs ( long-term care units ) to SSIADs for approved or declared home support services.

Abridged Charter text  [ archive ]

  • Art 1 Lifestyle
Any elderly person who becomes disabled or dependent is free to exercise his or her choices in everyday life and to determine his / her way of life.
  • Art 2 Living environment
Any elderly person with a disability or dependency must be able to choose a place of life – personal or collective home – adapted to his or her needs and expectations.
  • Art 3 Social and cultural life
Any elderly person with a disability or dependency retains the freedom to communicate, move and participate in society.
  • Art 4 presence and role of loved ones
The maintenance of family relations, friendly and social networks is essential for the elderly person with a disability or dependency.
  • Art 5 Heritage and Income
Any elderly person with a disability or dependency must be able to maintain control over his or her assets and income.
  • Art 6 Valorisation of the Activity
Any elderly person with a disability or dependency must be encouraged to keep on doing business.
  • Art 7 Freedom of expression and freedom of conscience
Everyone must be able to take part in the associative or political activities and the religious and philosophical activities of his choice.
  • Art 8 Preservation of Autonomy

Prevention of disability and addiction is a necessity for the aging person.

  • Art 9 Access to care and compensation for handicaps
Any elderly person with a disability or dependency must have access to advice, skills and care that are useful to him or her.

Art 10 Qualification of the speakers

Care and aids to compensate for the handicaps required by chronically ill persons must be provided by trained staff in sufficient numbers, both at home and in institutions.

Art 11 Respect for the end of life

Care, assistance and support must be provided to the elderly at the end of life and to the family.

Art 12 Research a priority and a duty

Multidisciplinary research on aging, age-related disability and disability is a priority. It is also a duty.

Art 13 Exercise of Rights and Legal Protection of the Vulnerable Person

Every person in a vulnerable situation must have his or her property and person protected.

Art 14 Information

Information is the best way to combat exclusion.

Protected Major: Charter of Rights and Freedom

The law of March 2007 reformed the legislation on the rights of protected persons, both major and minor, and provides for the possibility of organizing the mandate for future protection, thus preparing the protective measures that one wishes for oneself, Even in later dependence. This law specifies the obligations of non-professional representatives and guardians, obligations which impose respect for a freedom of choice for the protected person even when he is under tutelage without civil rights. The guardian must both protect the property and property but also to the extent of guardianship the person himself while respecting his choices. Professional lawyers have the tools to supervise their new profession, including a charter internal to their profession 15 This charter is a synthesis of the main principles of the law of 2007.


  • Http://  [ archive ] Anesm’s comprehensive documentary base on ethics

Moral philosophy of many documents

  • Kant E. Ethics lessons . Classical philosophy. Paris: Librairie Générale Française, 1997. Collection: Livre de poche.
  • Levinas E. Ethics and Infinity . 2 e edition. Paris: Librairie Générale Française, 1982 (2008). Collection: Livre de Poche. 120 p.
  • Ricoeur P. Self as another . Reproduction. Paris: Seuil, 1997 (1990). Collection: Points Tests

Elderly, end of life

  • Yves Gineste Jerome Pellissier, Humanitude, Understanding old age, taking care of old men 2 e edition, Paris, Armand Colin, March 2007, 319 p. ( OCLC 195743593 )
  • La Marne P. End-of-life ethics: therapeutic eagerness, euthanasia, palliative care . Paris: Ellipses, 1998.

Social Work

  • Brigitte Bouquet, Ethics and Social Work , Dunod, June 2004.
  • Pierre Verdier, Jean-Pierre Rosenczveig, Professional secrecy in social work , Dunod editions, July 2011.
  • Coline Cardi, “Social Control for Women: Between Prison, Justice and Social Work”, in Deviance et société , vol.  31, n o 1, Medicine and Hygiene, 2007.


  • Exclusion, marginality, culture and handicaps Attempts to explain and understand the mechanisms of social rejection Claude Hamonet$FILE/Hamonet.pdf  [ archive ]
  • Handicap, ethics in clinical practice Collective Study (Paperback). Released in 09/2008 éditions éres
  • Handicap, ethics, institution , Jean-François Gomez Study ( Paperback ). Released in 01/2005 Publisher Dunod

Medicine and Nursing

  • Care of comfort and well-being, relational care, palliative care and end of life, teaching unit Laurence Pitard, Elisabeth Peruzza, Frédérique Lacour School / Academic | Paperback | Masson | October 2010
  • Palliative and psychomotor care Gaucher-Hamoudi School / University | Paperback | Heures De France | February 2007
  • Ethics in Care, From Theory to Practice Case Studies Odile Paycheng, Stéphane Szerman. Released in 11/2001 Out of print, éditions Heures de France.
  • The Ethics of Odile Paycheng Study (Paperback). Published in 10/2006 by editions Heures de France


  1. ↑  [ archive ] ANAS code of ethics for social workers
  2. ↑  [ archive ]
  3. [PDF]  [ archive ] professional acts of psychomotricians
  4. ↑  [ archive ]
  5. ↑  [ archive ]
  6. ↑  [ archive ]
  7. ↑  [ archive ]
  8. ↑  [ archive ]
  9. ↑  [ archive ]
  10. ↑  [ archive ]
  11. ↑  [ archive ]
  12. ↑ Olivier Poinsot, The right of the people welcomed or accompanied, the users in the social and medico-social action  [ archive ] , coll. General titles, LEH Edition 2016, 410 pp., ( ISBN  978-2-84874-647-0 )
  13. ↑ Regis dry. “The placement of children: help or coercion for their parents? “. Fourth World Review, No. 217 – A Human Work Year 2011  [ archive ]
  14. ↑  [ archive ]
  15. ↑  [ archive ]