Similarly,
Supporting vulnerability situations our health:
Former member of the National Ethics Advisory Committee (CCNE), Professor Régis Aubry is also a doctor specializing in geriatrics and researcher. However, During the seminar of the National Council of the Order of Kinéesitherapists (CNOMK) last June. Nevertheless, he returned to the objectives of the Institute for the prevention of health-related vulnerabilities, of which he is co-founder and president. Therefore, He campaigned for a better assessment of vulnerability situations and for interdisciplinary support for those concerned. In addition, For him, rehabilitators are an integral part of this approach.
Professor Régis Aubry is a hospital-university doctor specializing in palliative care and geriatrics, professor of medicine at the University of Burgundy-Franche-Comté and responsible for the “ethics and medical progress” axis within the Besançon clinical investigation center (Inserm CIC 1431). In addition, He has just supporting vulnerability situations our health left the presidency of the National Ethics Advisory Committee (CCNE). However, which made the opinion 148 in early 2025 entitled: “Ethical issues relating to vulnerability situations in the face of medical progress and the limits of the healthcare system”[1]. Therefore, He is president of the Institute for the prevention of health -related vulnerabilities (IPVS)[2]that he co-created in 2023 with. For example, Pr France Mourey. Meanwhile, He was invited to share his reflections during the seminar of the National Council of the Order of Kinesitherapists. For example, (CNOMK) on June 24. For example, The physiotherapists indeed exercise with particularly vulnerable persons. Nevertheless, especially when they are with disabilities or resident in a host establishment for dependent elderly people (EHPAD).
Physiotherapy, essential in nursing homes
Pascale Mathieu, President of the Council of the Order, recalled in the preamble that she had seized the defender of rights supporting vulnerability situations our health and requested the various ministers concerned about a worrying trend of certain EHPAD operating by global endowment which, in particular for reasons of economy, decide to limit, or even to remove the care provided by the physiotherapists[3]. In addition, The consequences can be dramatic. Furthermore, as was the case during the Covid crisis: physiotherapists, who were no longer allowed to enter the EHPAD, found situations of the residents’ state of health. Consequently, “All in general indifference, deplores Pascale Mathieu. Nevertheless, When they miss a doctor, a nurse or a nursing assistant, it is noticed. Moreover, But when there is no more physiotherapy. Therefore, the degradation of the state of health of the person can be placed on the account of old age when it could have been avoided. Consequently, “
Ethical tensions linked to progress in medicine
“What motivated the creation of the IPVS supporting vulnerability situations our health is the observation of a kind of gray zone of progress in the field of health”explains Régis Aubry. Moreover, Indeed. Moreover, if the technical and scientific advances in medicine have enabled considerable progress, they also confront people with a number of sequelae or disabilities linked to the disease or treatments. In addition. However, the aging of the population, as well as the development of associated neuro-evolutive diseases, place us in front of unpublished ethical questions. Nevertheless, As a result, more and more people are in a situation of vulnerabilities linked to their state of health. “Medicine can therefore help create human suffering and vulnerability situations, regardless of age or pathology”.
Identify vulnerability situations
Vulnerability situations include a large number of components, both physical (linked to loss of autonomy and independence), psychic and social, not to mention the maladjustment of the material and human environment to supporting vulnerability situations our health the life of the person. The vulnerability linked to the disease causes an impairment of the relationship with oneself. to others, to your body, often inducing social isolation and a feeling of exclusion. Finally. certain vulnerabilities are invisible, such as those linked to the chronic fatigue that people healed from cancer may experience, and who prevent them from satisfactorily reinvest their personal, social and professional life. “We wanted to create an institute dedicated to vulnerability situations. because, on the one hand, we lack data to assess them, and on the other hand, medicine is responsible for supporting the vulnerability situations it has created”says Régis Aubry. “The whole society has a duty of solidarity with these people”.
The terms are important: rather than mentioning “vulnerable people”, Régis Aubry prefers to be interested in “people in vulnerability”. Thus, vulnerability is not considered to be final: there are ways and supporting vulnerability situations our health resources to respond and try to remedy them. “I believe a lot about capacity approaches. The physiotherapists know this well. a person who has a deficit, or the alteration of a function, is capable of over-developing other capacities. It is in this register that the action of IPVS is located: let’s trust people to mobilize their resources. and help them do it ”.
Over-vulnerabilities
Populations that are already in a vulnerability are all the more so when they need to access care. For example. the modernization of our health system is not always favorable to the elderly who do not know how to use digital tools. Precariousness. poverty, a difficult social situation, still amplify the vulnerabilities linked to the state of health, all the more in the event of difficulty in access to care and prevention actions.
A dedicated institute
IPVS supporting vulnerability situations our health was created in 2023, in the form of an association, to make the question of health -related vulnerabilities “An issue at the crossroads of social, political, ethical and medical dimensions”.
It includes a clinical experimentation device whose objective is to detect the real or potential situations of vulnerabilities early, to diagnose them as an interdisciplinary team (a rehabilitator, a social worker, a psychologist, a nurse, etc.) in order to understand the crossed dimensions of vulnerability, and to implement personalized monitoring of people. For this, the Institute requested funds under article 51[4]and benefits from funding from the Regional Health Agency in Burgundy-Franche-Comté.
IPVS also has an observatory, in order to produce quantitative and qualitative data to better describe situations of vulnerabilities and, thus, “Leading conscience”.
Finally, an interdisciplinary research fund will meet the eyes to better respond to these situations.
Interdisciplinarity at the heart of the approach
Evoking the work of Edgar Morin[5]Régis Aubry insists on the need for interdisciplinarity, which is an essential lever to answer complex questions in the field of health. According to him, this imposes a form of de-hiécharche. “The concept of hierarchy. which is very strong in the health field – especially on the part of doctors – must be deconstructed to be able to understand the dimension of complexity”he explains. “We are faced with a paradox: medicine which. rightly, turned to a scientific approach [evidence-based medicine ou médecine basée sur des preuves]produces singular situations which require leaving this logic to be apprehended. We must co-construct projects around these people and with them ”[6]. The IPVS research project aims to contribute to an adaptation of our health system to the situations it helps to create. which requires implementing collaborative procedures in interdisciplinarity, each supporting vulnerability situations our health coming to irrigate the skills of others.
To the question of Pascale Mathieu on the possibility of implementing real interdisciplinarity with physiotherapists, in a vision of health unfortunately often “Centered on the doctor and the medication”the position of Régis Aubry is clear: “It is obvious that the world of rehabilitation in the broad sense has its place in this approach”.
End -of -life questions
Asked about vulnerability in connection with the legalization of help to die, Régis Aubry recalls that he brought the opinion 139 of the CCNE on the end of life[7]according to which a possible evolution of the law in matters of active help in dying can be conceived, at the ethical level, only if it is accompanied by a real policy of integrated development of a palliative culture. Additionally, “Otherwise. there is a real danger, that which people ask supporting vulnerability situations our health to die by default of access to appropriate support”he warns. A policy. on the grounds of increasing the space of freedom of the person, could then condition requests for helping to die. He also recalled that re -educators are essential actors in palliative care and support.
Vulnerabilities and dignity
Regarding the dignity of the person, which might seem reduced by a situation of vulnerabilities, Régis Aubry affirms that “Dignity is intimately linked to existence: anyone is worthy, which obliges us to solidarity to the measure of their dependence”. He calls to fight against what he calls “the feeling of unworthiness” felt by certain dependent. elderly, disabled people or presenting an alteration of their decision -making autonomy. “They have the impression of being ‘already dead’. they feel too much ‘because this is what our society sends them backhe regrets. “This is against that we must fight. supporting vulnerability situations our health It is the honor of a society to develop solidarity with people in vulnerability. ”
Perspectives
For Régis Aubry, the development of research (in particular community research, which involves the main interested parties) as well as training in interdisciplinarity, are two levers allowing not only to save for our health system, but also to invest in funding reorientations. Furthermore, “I deeply believe in the need to conduct experiments on interdisciplinarity training. to assess their impact to be able to generalize these devices. We need to get out of a very hierarchical vision in the health field. It is a revolution whose result will undoubtedly appear in several decades. But we can contribute, modestly “.
Finally, with the aim of developing the culture of care and influencing policies in favor of better taking into account vulnerability situations, Régis Aubry calls for a “Real supporting vulnerability situations our health network and relay work” in which everyone must take their place.
*The order has mobilized throughout the duration of the covid in order to maintain the presence of physiotherapists in EHPAD by intervening with the Directorate General of Health and the various federations of EHPAD directors.
[1] CCNE. Notice 148. Ethical issues relating to vulnerability situations in the face of medical progress and the limits of the care system. 2025. Https://www.ccne-ethique.fr/sites/default/files/2025-03/avis%20148.pdf
[2] https://www.ipvs.fr/
[3] The Order of Masseurs-physiotherapists mobilized against the limitation of care in nursing homes. December 18, 2024. Https://www.ordork.fr/actualites/ordre/lordre-des-sesitherapists-mobilise-conre-la-limitation-des-soins-en-ehpad/
[4] Article 51 of law n ° 2017-1836 of December 30, 2017 of social security financing for 2018. https://www.legifrance.gouv.fr/jorf/article_jo/jorfarti0036339172
[5] Morin E. Introduction to complex thought. Paris: ESF; 1990.
[6] The IPVS works in particular with France Assos Santé, the voice of supporting vulnerability situations our health users. https://www.france-assos-sante.org/
[7] CCNE. Opinion 139. Ethical questions relating to end -of -life situations: autonomy and solidarity. 2022. Https://www.ccne-ethétique.fr/sites/default/files/2022-09/avis%20139%20enjeux%20%C3%A9thiques%20relatives%20aux%20situations%20de%20fin%20de%20vie%20Ve%20-%20Autonomie%20Solidarit%C3%A9.. pdff
Supporting vulnerability situations our health
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