France
Summary (ref 1)
In France treatment is restricted to legally regulated personnel. Osteopaths are regulated.
Professionals and non-professionals
Legally regulated personnel
According to the Code of Public Health only authorised medical professionals (physicians, dentists, midwives) and recognised paramedics professionals (working under recommendation of a physician) are allowed to carry out medical acts, and the practise of medicine without a legal qualification is an offence. In addition the Code of Professional Ethics of 1995 plays an important role in safeguarding the patients, especially by stating the rights and duties of practising physicians. In 2002 osteopaths were regulated (ref 2).
The Order of 1945 has two kinds of regulations for physicians; the first set of rules determines the requirements for the license to practise medicine, the second one provides that the practise of medicine would unfold under the authority of the National Order of Physicians, which is itself under the supervision of the Council of State. The Council of State and the Order of Physicians are designated as disciplinary authorities.
In general the French Academy of Medicine has not recognised the validity of alternative medicine. The Code of Ethics states that physicians may not propose cures to their patients, which are insufficiently proved, and that physician have to use scientifically proven methods. When authorised health personnel practise CAM, they may be prosecuted according to the Code of Professional Ethics. This may lead to disciplinary sanctions; however, the authorities are becoming more tolerant towards the practise of CAM by authorised health personnel. In the later years the practise of chiropractics, osteopathy and acupuncture are by the medical orders considered as "responsible professional conduct".
Supervising regulated personnel
According to the law, the professional medical orders (like the National Order of Physicians) supervise health services and health care personnel and ensure fulfilment of laws and regulations. Therefore, they have a public mission although they are private institutions. They have to elaborate general rules of practise, particularly the Professional Code of Ethics. The Orders also have to ensure the enforcement of professional rules through administrative controls. The Order can withdraw the registration in the Order (and thereby the license to treat) of health personnel if the law is violated. If the violation is serious, the Order may also ask the police to investigate the matter. The professions, which are not organised in Orders, are under the surveillance of public authority, which have the same functions and play the same role as the existing professionals Orders.
Not anybody may treat
The practise of medicine without a legal qualification is an offence. There are no specific legal regulations of CAM in the country. The Code of Public Health includes rules regarding the illegal "practise of medicine". Performing a medical act reserved to authorised personnel is an offence. Three categories are specified as "practise of medicine"; making a diagnosis, prescribing a treatment, and performing some medical acts. In addition to the medical acts usually reserved for physicians, the following list is strictly restricted to physicians:
- all manipulations of joints, enclosing slipped disc, osteopathy, vertebra therapy and chiropractics;
- prosthetic massage;
- gynaecologic massage;
- specific physiotherapeutic acts;
- methods for removal of hair, expect for methods using tweezers and wax;
- abrasion of teguments
- handling of a machine determining the ocular refraction;
- tonal audiometry.
French law has been very repressive with regard to the illegal practise of medicine and intrusion of medical professions. Any non-allopathic provider in the field of medicine providing any of the acts defined as "practise of medicines" may risk lawsuit, but the current trend is rather to impose lighter sentences on these issues. Providing CAM is not illegal when referred to as a counselling service not intruding on health service and the practise of medicine.
Reimbursement
The social security system, as well as some private insurance companies, reimburses a number of complementary treatments (mostly acupuncture sessions and homeopathic prescriptions) provided by physicians.
The social security system designates physicians using complementary medicines as "doctors with a particular type of practise" (MEP). A MEP indicates a physician’s orientation, without any guarantee of the quality of care.
References
1. Reference for the chapter where nothing else is noted: Maddalena S. The legal status of complementary medicines in Europe. Berne: Universitè de Neuchâtel, Stæmpfli Publisher Ltd. 1999.
2. Social and Health Directory, Norway. Report about Osteopathy, Naprapathy and Manuel therapy. Oslo: 2005.
