Introduction

The past several years have been a turbulent time for the French healthcare system. With an institutional environment in the midst of dramatic change, patient care is in a perpetual state of transformation under the effects of factors such as evolving healthcare needs and emergence of new technologies playing an increasingly large role in cost-saving policy.

Collectively, hospital establishments represent assets that are important as much for our healthcare system as for the social role they play. However, they are currently facing significant concerns such as demographic challenges; evolving management tasks, which notably include the hyper-specialization of certain techniques; changing financial regulations with the introduction of fee-for-service practices; quality of services and reception; continuity of the care process; human and organizational management; and obligation to inform, all against a background of budgetary restriction.

This period has been conducive to value conflicts, divergences of opinion and opposing points of view, and even clashes, notably mainly concerning the development of healthcare expenditure control policies, with care opposing cost, providers opposing economists or managers, and the right to individual healthcare opposing the obligation of solidarity and efficiency. In the resulting ethical debates, tensions have appeared between the morals of conviction and the morals of individual and collective responsibility, and between clinical ...

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