Laïcité in hospitals
Authors: Sebastien Tassy, Ladislas Polski, Julie Banet, Guillaume Gorincour
Journal: The Lancet (2004)

The French Parliament has just passed a law banning any conspicuous religious symbols in public schools. It has also planned to push through another law on secularism, known as laïcité, in public hospitals.1Hassoux D Les députés, lête dans le voile à l'Assemblée nationale.Libération. Feb 4, 2004; (http://www.liberation.com/page.php?Article=176147 (accessed Mar 26, 2004))Google ScholarAlthough the government's ban in schools has met with much criticism, we believe that respect of laïcité in public hospitals is of paramount importance. The concept of laïcité appears in the first amendment of the French constitution.2Présidence de la République 1958 Constitution of the French State.http://www.elysee.fr/ang/instit/text3_.htmDate: Oct 4, 1958Google Scholar It is the essential element of a “republican” way of living-together, inherited from the 1789 Revolution. Laïcité implies a distinction between the universal public domain and a private domain in which every citizen is free to follow his own spiritual path.3Pena-ruiz H What is La¨cité? Gallimard, Paris2003Google ScholarIn hospitals, public and private spaces are mixed, so the institution has to reserve private domains within the hospital environment. There are three requirements for fulfilment of laïcite in hospitals. First, the institution must show strict neutrality concerning any visible religious symbols. There should be no risk that patients, weakened by their condition, are upset by religious symbols. Consequently crucifixes and cribs at Christmas time are banned, and staff members must not wear any visible religious symbols such as Islamic veils, kippas, or large cross pendants. Second, a private domain must be maintained for patients so that they can fully and freely partake in their own spiritual way of living. Thus, the institution must be able to accommodate different forms of worship, dietary restrictions, and funeral rites. Third, the respect of patients' spiritual choice should neither hamper the work of the medical staff, nor permit showy worship in public spaces. For example, hospitals should not accept a patient's demand to choose the sex of their attending doctor or nurse, nor permit prayers in hospital corridors.4Commission de reflexion sur l'application du principe de laïcite dans la Republique Rapport au President de la Republique. Présidence de la République, Paris2003http://lesrapports.ladocumentationfrancaise.fr/BRP/034000725/0000.pdfGoogle ScholarThese three requirements can be summarised into two mainstream ideas: institutional respect of the patient's right to neutrality in public spaces and to freedom in private ones, and patients' respect of the public hospital's secular model by acceptance of its working rules.This choice of living together without distinction is in keeping with solidarity and universal access to hospital care without condition (eg, financial).5Présidence de la République La charte du patient hospitalisé. Paris:Présidence de la République.http://www.american-hospital.org/praticiens/francais/pdf/charteDate: 1995Google Scholar France has chosen this option of universal access instead of a more cost-efficient one. However, it is subject to practical constraints, such as limited funds and staff availability (hospitals should not show any racial or religious discrimination, even positive).Laïcité is not anti-religious whatsoever. On the contrary, it makes possible a way of living together for the different spiritual denominations. Since laïcité is an essential component of the ethics of responsibility within the hospital, it must be protected with conviction if threatened. The French Parliament has just passed a law banning any conspicuous religious symbols in public schools. It has also planned to push through another law on secularism, known as laïcité, in public hospitals.1Hassoux D Les députés, lête dans le voile à l'Assemblée nationale.Libération. Feb 4, 2004; (http://www.liberation.com/page.php?Article=176147 (accessed Mar 26, 2004))Google Scholar Although the government's ban in schools has met with much criticism, we believe that respect of laïcité in public hospitals is of paramount importance. The concept of laïcité appears in the first amendment of the French constitution.2Présidence de la République 1958 Constitution of the French State.http://www.elysee.fr/ang/instit/text3_.htmDate: Oct 4, 1958Google Scholar It is the essential element of a “republican” way of living-together, inherited from the 1789 Revolution. Laïcité implies a distinction between the universal public domain and a private domain in which every citizen is free to follow his own spiritual path.3Pena-ruiz H What is La¨cité? Gallimard, Paris2003Google Scholar In hospitals, public and private spaces are mixed, so the institution has to reserve private domains within the hospital environment. There are three requirements for fulfilment of laïcite in hospitals. First, the institution must show strict neutrality concerning any visible religious symbols. There should be no risk that patients, weakened by their condition, are upset by religious symbols. Consequently crucifixes and cribs at Christmas time are banned, and staff members must not wear any visible religious symbols such as Islamic veils, kippas, or large cross pendants. Second, a private domain must be maintained for patients so that they can fully and freely partake in their own spiritual way of living. Thus, the institution must be able to accommodate different forms of worship, dietary restrictions, and funeral rites. Third, the respect of patients' spiritual choice should neither hamper the work of the medical staff, nor permit showy worship in public spaces. For example, hospitals should not accept a patient's demand to choose the sex of their attending doctor or nurse, nor permit prayers in hospital corridors.4Commission de reflexion sur l'application du principe de laïcite dans la Republique Rapport au President de la Republique. Présidence de la République, Paris2003http://lesrapports.ladocumentationfrancaise.fr/BRP/034000725/0000.pdfGoogle Scholar These three requirements can be summarised into two mainstream ideas: institutional respect of the patient's right to neutrality in public spaces and to freedom in private ones, and patients' respect of the public hospital's secular model by acceptance of its working rules. This choice of living together without distinction is in keeping with solidarity and universal access to hospital care without condition (eg, financial).5Présidence de la République La charte du patient hospitalisé. Paris:Présidence de la République.http://www.american-hospital.org/praticiens/francais/pdf/charteDate: 1995Google Scholar France has chosen this option of universal access instead of a more cost-efficient one. However, it is subject to practical constraints, such as limited funds and staff availability (hospitals should not show any racial or religious discrimination, even positive). Laïcité is not anti-religious whatsoever. On the contrary, it makes possible a way of living together for the different spiritual denominations. Since laïcité is an essential component of the ethics of responsibility within the hospital, it must be protected with conviction if threatened.