Resistance as a Relational and Ethical Practice in Social Movements

Social mobilization encompasses collective actions that challenge dominant power structures and strive for systemic change. In organizational studies, social movements are recognized for promoting participatory democracy, equality, and autonomy (De Bakker, Den Hond, King, & Weber, Reference De Bakker, Den Hond, King and Weber2013; Parker, Cheney, Fournier, & Land, Reference Parker, Cheney, Fournier and Land2014; Reedy, King, & Coupland, Reference Reedy, King and Coupland2016). By rejecting traditional organizational norms such as hierarchical structures and profit-driven models, these movements create inclusive spaces where marginalized voices can be heard (Reedy et al., Reference Reedy, King and Coupland2016). At the heart of these social movements lies resistance, which Critical Management Studies (CMS) scholars conceptualize as an inherently ethical act that confronts oppressive practices and dominant moral frameworks (Weiskopf & Willmott, Reference Weiskopf and Willmott2013), offering a pathway toward emancipation (Foster & Wiebe, Reference Foster and Wiebe2010). The mainstream approach to organizational ethics, however, frequently focuses on compliance-driven codes of conduct (McMurray, Pullen, & Rhodes, Reference McMurray, Pullen and Rhodes2011; Courpasson & Marti, Reference Courpasson and Marti2019), which, by regulating behavior, often perpetuate the exploitation and oppression of subordinated groups (Rhodes, Pullen, & Clegg, Reference Rhodes, Pullen and Clegg2010; Pullen & Rhodes, Reference Pullen and Rhodes2014, Reference Pullen and Rhodes2015; Younes, Courpasson, & Jacob, Reference Younes, Courpasson and Jacob2020. In response, CMS scholars advocate for viewing ethics and politics as inherently interconnected (Parker, Reference Parker2003).

This approach conceptualizes ethics as an embedded praxis that arises from the everyday experiences of individuals within organizations (McMurray et al., Reference McMurray, Pullen and Rhodes2011; Courpasson & Marti, Reference Courpasson and Marti2019; Younes et al., Reference Younes, Courpasson and Jacob2020), turning ethics into political action (Alakavuklar & Alamgir, Reference Alakavuklar and Alamgir2018) and the ethical subject into a political agent (McMurray et al., Reference McMurray, Pullen and Rhodes2011: 541). By placing resistance at the core of ethical theorizing, this perspective emphasizes an alternative and radical dimension of ethical practices that challenge dominant norms (Alakavuklar & Alamgir, Reference Alakavuklar and Alamgir2018; Rhodes & Wray-Bliss, Reference Rhodes and Wray-Bliss2012). Resistance is framed as inherently ethical, with its relational nature highlighting the interconnectedness of individuals and their collective struggles (Alakavuklar & Alamgir, Reference Alakavuklar and Alamgir2018; Aldossari & Calvard, Reference Aldossari and Calvard2022; McMurray et al., Reference McMurray, Pullen and Rhodes2011; Pullen & Rhodes, Reference Pullen and Rhodes2014, Reference Pullen and Rhodes2015). Central to this relational understanding is the emphasis on love and care—not only for oneself but also for others—as essential drivers of political action and resistance (Alakavuklar & Alamgir, Reference Alakavuklar and Alamgir2018; Courpasson & Marti, Reference Courpasson and Marti2019; McMurray et al., Reference McMurray, Pullen and Rhodes2011; Vachhani & Pullen, Reference Vachhani and Pullen2018). Resistance within social movements, therefore, becomes a relational and ethical practice, offering a transformative approach to dismantling dominant power structures.

Feminist Perspectives on the Ethics of Resistance in Social Movements

Feminist scholars within CMS have refined the interconnectedness between ethics and resistance by emphasizing embodied vulnerability as central to relationality (Fotaki & Harding, Reference Fotaki and Harding2017; Johansson & Wickström, Reference Johansson and Wickström2023; Mandalaki & Fotaki, Reference Mandalaki and Fotaki2020; Pullen & Rhodes, Reference Pullen and Rhodes2022; Vachhani, Reference Vachhani2020). These studies recognize embodied vulnerability as an inherent aspect of the human condition, framing it as a political category (Fotaki, Reference Fotaki2023) and a foundation for fostering affective relations, compassion, and care (Fotaki, Reference Fotaki2017; Fotaki & Harding, Reference Fotaki and Harding2017; Pullen & Rhodes, Reference Pullen and Rhodes2022). By conceptualizing ethics as an embodied process, feminist scholarship offers a powerful lens for envisioning alternatives to oppressive organizational practices (Mandalaki & Fotaki, Reference Mandalaki and Fotaki2020). This perspective is particularly important for understanding resistance within social movements, as feminist scholarship enhances its analysis by focusing on the embodied and affective dimensions that underpin such resistance (Bell et al., Reference Bell, Meriläinen, Taylor and Tienari2019; Fotaki & Pullen, Reference Fotaki and Pullen2024; Smolović-Jones et al., Reference Smolović-Jones, Johansson, Pullen and Giritli-Nygren2024). For instance, women’s embodied resistance within anti-extractivist movements demonstrates how public and private spaces are redefined, with their physical presence and emotional engagement serving to foster solidarity (Daskalaki & Fotaki, Reference Daskalaki and Fotaki2024; Fotaki & Daskalaki, Reference Fotaki and Daskalaki2020). Projects like the Everyday Sexism Project illustrate how the archived and shared narratives of sexism foster affective solidarities, transforming individual grievances of sexual violence into collective resistance (Vachhani & Pullen, Reference Vachhani and Pullen2018). Similarly, disclosure-based movements (Kenny, Reference Kenny2024) and digital campaigns such as #MeToo and #BeenRapedNeverReported (Vachhani, Reference Vachhani2024) amplify personal experiences and foster connections that challenge systemic gender violence. These examples illustrate how feminist perspectives deepen our understanding of social mobilization as an embodied and relational process that bridges personal experiences with broader structures of power and resistance. By focusing on social movements often led by women (Smolović-Jones et al., Reference Smolović-Jones, Johansson, Pullen and Giritli-Nygren2024), feminist scholarship provides critical insights into the interconnected roles of gender and care in shaping collective action (Fotaki & Pullen, Reference Fotaki and Pullen2024).

Yet, while feminists have long placed care at the center of their philosophy and activism (Fotaki, Reference Fotaki2021, Reference Fotaki2023), scholars advance that its radical political potential remains underexplored in organizational and management studies (Branicki, Reference Branicki2020; Fotaki & Harding, Reference Fotaki and Harding2017; Johansson & Wickström, Reference Johansson and Wickström2023; Pullen & Rhodes, Reference Pullen and Rhodes2022). Although care is gendered and often associated with femininity, it is fundamentally both a human need and a capability (Fotaki & Pullen, Reference Fotaki and Pullen2024). This recognition provides a critical foundation for exploring how feminist perspectives can illuminate the transformative potential of social movements centered on care. Building on this body of work and to further advance research on feminist perspectives and social movements, our focus will turn to a social movement led by hospital workers, whose work is rooted in an ethics of care.

Embodied Political Mobilization and the Role of Public Infrastructures

Following previous feminist organizational ethics scholars (Fotaki, Reference Fotaki2017; Kenny, Reference Kenny2018; Mandalaki, Reference Mandalaki2022; Mandalaki & Fotaki, Reference Mandalaki and Fotaki2020; Pullen & Rhodes, Reference Pullen and Rhodes2022; Vachhani, Reference Vachhani2024) who have used Butler’s insights to rethink organizations (Tyler, Reference Tyler2018, we turn towards Butler’s (Reference Butler2015, Reference Butler2022a) work on embodied political mobilization. Butler (Reference Butler2015,) posits that it is only when individuals come together in public spaces with a common purpose that they can assemble and forge alliances to act, resist, and make demands to challenge current norms. Butler (Reference Butler2015) emphasizes the significance of physical presence in assemblies as a means of fostering the political performativity of mobilization through the tangible togetherness of bodies. This performativity underscores the embodiment of collective intent, where the physical gathering of individuals in public spaces becomes a visible and powerful expression of resistance. Importantly, Butler (Reference Butler, Butler, Gambetti and Sabsay2016) extends this notion to media platforms (see also Vachhani, Reference Vachhani2024) which, she argues, facilitate modes of solidarity by creating new spatio-temporal dimensions of the public sphere. These dimensions encompass not only those who are visibly present within the public domain but also those excluded from the visual frame due to “coercion, fear, or necessity” (Butler, Reference Butler, Butler, Gambetti and Sabsay2016: 14). Media platforms do, however, carry a certain number of limitations such as replicating offline power imbalances, excluding intersectional voices, and contributing to compassion fatigue, which can undermine the long-term reach of digital activism (Vachhani, Reference Vachhani2024). Nonetheless, Butler’s framework highlights how both physical and digital spaces enable collective resistance which can take multiple forms, including publicly displaying the vulnerability of assembled bodies (Butler, Reference Butler2015), thereby affirming one’s condition as human beings with feelings, needs, reflexivity, and desires (Butler, Reference Butler2004). In Butler’s words, resistance is thus plural and embodied.

The hospital workers in our dataset mobilize in both public and digital spaces, using the political symbolism of death and love to challenge the neoliberal approach to care that has contributed to the deterioration of public hospital services. Death is political (Le Theule et al., Reference Le Theule, Lambert and Morales2020, Reference Le Theule, Lambert and Morales2023) insofar as the inherent vulnerability of bodies, rooted in the shared inevitability of death, emphasizes their interconnectedness (Butler, Reference Butler2004, Reference Butler2015). Butler (Reference Butler2022a) contends that while death is universal and inevitable, it is crucial to ensure that every individual has the right to a livable life prior to death. This requires providing access to infrastructural support (Butler, Reference Butler, Butler, Gambetti and Sabsay2016), such as healthcare, as a fundamental condition for achieving a livable life. In our study, behind the hospital workers’ mobilization lies their concerns about the right of all bodies, including theirs, to be sustained by the public healthcare system regardless of financial cost. Their mobilization emphasizes death as a shared embodied vulnerability experienced by both patients and hospital workers, directly challenging public policies with a collective demand to preserve public healthcare as a vital infrastructure for all lives. This resonates with Lynch’s (Reference Lynch2022) critique of the current neoliberal order, which undermines adequate social policy and care services. Similarly, Fotaki (Reference Fotaki2017: 187) stresses the “utter failure of consumerist patient choice policy to define caring relationships in terms of an individualised market-type exchange rather than a socially conditioned and dynamic process.” One possible answer to such failure is to bring to the front the ideal of compassion as the foundation of care and to resist such market-business ethos through love and relationality (Fotaki, Reference Fotaki2017).

In our study, the hospital workers use death and love as powerful tools in their embodied political mobilization to counter the gradual demise of the French public hospital system. As “relationally engaged caring citizens” who challenge systemic neglect and exercise caring values (Lynch, Reference Lynch2022) in their mobilization, the hospital workers’ acts of resistance bring to the forefront a form of ethics that we call an ethics of publicness, that we will define later in the article.

Research Setting and Background

Welfare states are facing huge financial pressures and have been in crisis over the past forty years (Blanc & Al-Amoudi, Reference Blanc and Al-Amoudi2013). France is no exception. The French healthcare model operates on a state-run social insurance system (Blanc & Al-Amoudi, Reference Blanc and Al-Amoudi2013). Initially, its mission was to provide medical care for every member of society, including the most vulnerable, regardless of cost. However, this mission has undergone many reforms to reduce expenditure on public health insurance.

In 1996, the French government decided to reduce health insurance expenditures by implementing annual financial targets called “national objectives for health insurance spending” (Objectif National de Dépenses d’Assurance Maladie). On December 18, 2003, the most significant reform was introduced: activity-based payment (Tarification A l’Activité or “T2A”) replaces the previous financing model. While formerly, the budget was renewed every year without being linked to the activity actually performed, T2A uses a case-mix coding system to determine payment rates for activities, inspired by the Prospective Payment System in the United States. This change was intended to provide transparency in healthcare funding by aligning payment with the actual services provided. Other budgetary allocations include psychiatry, rehabilitation care, research funds, and teaching, research, reference, and innovation missions. However, the largest proportion of the budget is allocated to care delivery activities financed by T2A. In addition to this financial reform, the Hospital, Patients, Health, and Territories Act of July 22, 2009, instituted a new mode of governance by creating “clinical poles,” decentralized medical units that are accountable for their financial performance.

France’s healthcare reforms have been widely criticized by the country’s hospital workers, and local and temporary strikes have taken place over the years. Particularly widespread action took place in 2019, with more than 250 hospitals on strike at its peak. This nationwide action was driven by two main collectives (not unions) of hospital workers. The Collectif Inter-Urgences (CIU, Inter-Emergency Department Collective) formed in March 2019 and is made up of all categories of emergency health responders including doctors, nurses, and nursing assistants, as well as emergency medical technicians and other first responders across the country. It was established in response to the growing number of violent attacks on emergency department staff. The emergency departments of many hospitals had held local protests after an assault, and the CIU was created to join forces and coordinate to challenge the status quo. Another collective, the Collectif Inter-Hôpitaux (CIH, Inter-Hospital Collective), emerged a few months later in September 2019. The CIH is a group of workers from all departments of French public hospitals, including doctors, surgeons, nurses, auxiliary nurses, orderlies, and administrative staff. These two collectives are officially registered as associations and hold general meetings that are videotaped and shared on Facebook Live. They exist to protest the lack of funding that is exposing hospital workers to increased risks of violence, burn-out, and infectious disease, and to oppose chronic staff shortages, which are preventing hospital workers from taking their full vacation time, among other things. The two collectives are calling for more hospital beds, better pay, and job creation. In addition to these demands, the CIU is campaigning for safer emergency departments.

Although these collectives hold many strikes and demonstrations, they still have a duty of continuity of care and a duty of patient confidentiality under French law. This restricts their public expression and actions, to an extent. For example, during strikes, hospital staff may defer nonurgent appointments and procedures but cannot stop work completely, and some will wear an armband bearing the word assigné (“requisitioned”) when they do have to work. Also, both collectives deliberately restrict their use of public space to ensure their actions remain nonviolent. For these reasons, the CIU and the CIH use social networks extensively and creatively.

Data Collection

The data collection began in November 2019, when one of the authors, whose daughter was hospitalized, received a three-page leaflet produced by the CIH about the worrying working conditions in pediatrics departments. In vivid detail, the leaflet described how children were being transferred 200 km away from home, long wait times for vital surgeries, and exhausted hospital workers pushing past their physical limits to make up for a lack of resources. The author promptly went to read an online petition mentioned in the leaflet and visited the Facebook pages of the two collectives cited. She found numerous posts about hospital workers’ exhaustion and unacceptable working conditions, dying public hospital services, increasing violence towards healthcare workers, and details of the collectives’ demands. This online content quickly became a data source (Vachhani & Pullen, Reference Vachhani and Pullen2018), reflecting how hospital workers try to engage with citizens to challenge the individualistic, market-based ethos taking hold in French healthcare (Fotaki, Reference Fotaki2017).

The posts analyzed contained photos of actions and demonstrations, personal accounts, media commentaries, short videos created by healthcare workers, and cartoons drawn by journalists, hospital staff, or other followers. The CIH and CIU also used their Facebook pages to organize actions inside and outside public hospitals. For example, they would create a Facebook event for a planned action and ask followers to click “Interested” and replicate the action in their own hospitals, and then send documentation of their action to the account administrators, the organizing committees of the collectives. Sometimes, the collectives used their Facebook pages to share bottom-up actions, such as videos of actions taken by hospital workers independently or photographs of shocking situations.

Since November 2019, we have conducted document analysis, collecting textual, visual, and video data from these two Facebook pages. Data from March 2019 to November 2019 were gathered retrospectively. After November 2019, the first author read the content of the two collectives’ Facebook pages daily, watched their videos repeatedly, and reviewed the comments. She also visited the pages when key events occurred (McCarthy & Glozer, Reference McCarthy and Glozer2021) to gauge the atmosphere and read hospital workers’ reactions. Such events include protests or other activist actions; media stories about assaults, strikes, hospital closures; yearly outbreaks of influenza, bronchiolitis, and gastroenteritis; government statements or speeches about the public hospital network; and budget announcements. Table 1 quantifies our data collection.

Table 1:

Data Collection

This data gave the first author an idea of the burning issues and dissident voices. It also allowed her to witness the ongoing construction of these communities around their shared concerns (Barros, Reference Barros2018) and to experience her own ties to these communities. Some posts made her cry or laugh, others made her angry. In such instances, she would write reflective notes or share her feelings and the posts that elicited them with her coauthors. Our data collection process also involved reviewing secondary data, including other forms of online activism from healthcare workers (e.g., YouTube videos, opinion pieces, blogs) and print media articles.

This document analysis covers March 2019 to May 2023. Data collection ended in May 2023, when posting frequency dwindled and these collectives gradually dropped off. During this period, there were one to several dozen posts per day per page, as well as a large volume of comments, as the CIU and CIH eventually amassed more than 60,000 and 30,000 followers respectively. By March 2020, our computers experienced difficulties loading older posts due to data volume. We thus began copying posts and links to them, for the purposes of tracking comments, into a PowerPoint file. We repeated this process every month, selecting the posts that resonated most vividly with us (Vachhani & Pullen, Reference Vachhani and Pullen2018) and focusing on embodied, moving, and relational content. Since then, Facebook has added a filter function that has facilitated our ability to revisit posts, review comments, reanalyze post dynamics, and concentrate on content drawing on death and love, in line with the purpose of our article.

Data Analysis

We first pursued our data analysis inductively, taking an interpretive approach. One striking aspect emerged from the data: namely, the engagement of bodies in both online and offline activism from these collectives. This included images of hospital workers’ precarious bodies, embodied representations of public hospitals, physical presences at protests, and abundant depictions of dead bodies. The two collectives also used a variety of public and digital spaces in their online and offline actions, protesting in the streets but also on hospital walls, in break rooms, on the internet, and in the media. Death was an omnipresent theme in their communications, either explicitly or implicitly through symbols such as coffins or minutes of silence. As we reviewed this Facebook content, we occasionally felt the healthcare workers’ despair, rage, and suffering viscerally. In our analysis, this is precisely how their actions were intended: by eliciting an emotional response to engage citizens’ ethical responsibility for the public hospital system and hospital workers’ precarious bodies. Hospital workers also explicitly expressed their Love for the public hospital system and engaged citizens to declare their Love for public hospitals. The first analytical categories—bodies, death, love, public and digital spaces, emotions—thus emerged inductively.

Through our initial analysis, it became clear that images produced by hospital workers—whether videos, cartoons, or photos—played a significant role in constructing narratives to try to connect with citizens (Bell, Reference Bell2012). These visuals embodied their protests, showcased the diversity of public spaces occupied, featured symbols of death and love, and added emotional intensity (e.g., by adding gentle music to a video). They also allowed us to “capture embodied aspects of participants’ organizing” (Fotaki & Daskalaki, Reference Fotaki and Daskalaki2020: 1271). Throughout our inductive process, we repeatedly examined the photos and video clips, focusing on how bodies were organized: their poses, gestures, movements or lack thereof, and mutual support. We also examined the accompanying symbols and materials, such as coffins, Grim Reapers, ravens, flowers, syringes, but also hearts. We paid particular attention to the positioning of bodies relative to symbols of the public hospital: bodies alternately sank with it, supported it, or grieved it. For instance, when hospital workers knelt in front of a public hospital coffin, we interpreted this as the public hospital embodied and the workers to be mourning its loss. Embedded or captioned text accompanying the visuals, as well as comments on them, helped us refine our understanding (Bell & Taylor, Reference Bell and Taylor2015). For example, for pictures of hospital workers carrying the public hospital’s coffin on their shoulders, the text helped us understand that the mock funeral procession was heading to Bercy—the metonymy for the French Ministry of Finance—pointing to politicians’ responsibility. Visuals helped us better understand the story hospital workers sought to convey (Bell & Taylor, Reference Bell and Taylor2015), revealing not only bodily vulnerability and relationality, but also the radical potential of embodied mobilization.

As feminist scholars, our analytical process was informed by feminist epistemologies that embrace researcher subjectivity (Fotaki & Daskalaki, Reference Fotaki and Daskalaki2020; Vachhani & Pullen, Reference Vachhani and Pullen2018; Skeggs, Reference Skeggs2001) and advance that we understand the world through our bodies (Thanem & Knights, Reference Thanem and Knights2019). As such, we did not use reflexivity to “neutralize” our position in the field. Rather, we saw our personal ties to public hospitals, our empathy for hospital workers, and our embodied vulnerabilities, as means of better understanding the roles of bodies, public spaces, love, and death in social relations. For example, in repeatedly examining the data, we experienced anxiety and empathy for public hospitals, hospital workers, and neglected patients. In embracing feminist “emotional reflexivity” (Gray, Reference Gray2008), we recognized that hospital workers were using death as an electroshock in visual and textual data to forge supportive connections. Data analysis also led to discussions about our personal experiences with public hospitals. The dimension of constant support, gratitude, solidarity, and love as bonds that ensure a life worth living emerged from one author’s memory of a nurse’s support during a medically necessary pregnancy termination. One author’s recollection of her daughter’s hospital stay at nine months old, which included delayed medications and meals, helped underscore our interdependency with hospital workers. Overall, our experiences with the public hospital service made us realize our universal dependency on the public hospital service. Yet, our unobtrusive approach via social media imparted some limitations, including restricting our embodied and relational experience of this social movement.

We then sought a theoretical framework to illuminate our findings. Judith Butler’s thoughts on “What is a livable life” (Reference Butler2022a, Reference Butler2022b) and Notes toward a performative theory of assembly (Reference Butler2015) proved particularly insightful, as explained in the theoretical section. Using an open coding system, we aligned several significant themes with Butler’s concepts, which helped refine our analytical categories. For example, we observed hospital workers publicizing the public infrastructure’s death by staging public and collective rituals of mourning. Such actions were intended to alert the public to our universal dependency on the public infrastructure for a life worth living and to point to our ethical responsibility towards saving the public infrastructure immediately. We labeled this analytical category as death to publicize the common purpose: saving public infrastructure. Two other categories emerged from this analytical process: death to publicize the precariousness of life: calling for a livable life and love to publicize the values that make a life worth living. We further elaborate on these categories in the findings section. Based on this analytical process, we propose an “ethics of publicness.”

Making Hospitals’ Death Visible to Publicize the Common Purpose: Saving the Public Infrastructure

In what follows, hospital workers mobilize the symbolic death of hospitals to underscore the consequences of cost-cutting reforms, driven by profit-oriented logic and decades of resource scarcity. Through public assemblies, protests, and online campaigns, they draw attention to the life-saving role of public hospitals and the urgent need to preserve and protect them. One powerful way hospital workers use death to signal the pressing need to save public hospitals is through mourning rituals performed as part of their embodied political mobilization. For example, on October 29, 2019, they staged a funeral for the public hospital system—a performance captured in Figure 1, shared on the CIH Facebook page:

Figure 1:

Funeral Procession for the Public Hospital System (CIH, October 29, 2019)

Note. Courtesy of CIH.

The words on the coffin read: “HOSPITAL” and “IN CRITICAL CONDITION.” The image published to Facebook was captioned “EN ROUTE TO BERCY!! Give us back the power to heal!! The Hospital must not sink! Let’s save it!” To add emotional intensity, this “funeral procession” was accompanied by Chopin’s Funeral March and flowers were placed around the coffin. It personified the public hospital as a body whose death should be mourned. Hospital workers served as pall bearers, carrying the coffin to its final resting place, Bercy—the metonym for the French Ministry of Finance.

Here, death allows hospital workers to convey the purpose of taking collective action to the public—saving this infrastructure that in turn saves lives, before it is beyond remedy. “Let’s save our hospitals together” (#EnsembleSauvonsLHopital) is a popular mantra and hashtag found across these collectives’ actions, protests, and Facebook posts. As they argue in many of their posts, the public hospital service will die if people do not act to save it: “Our healthcare system is collapsing before our very eyes. If we don’t do something now, it will soon be too late” (CIH, January 12, 2020). While death has the potential to change our perspective of time by confronting us with our own finitude, here death is used as an electroshock to create a sense of urgency and to spur people to act. Another coffin reads, “let’s not have eternal regrets” (CIH, November 1, 2021), calling citizens to support this vital infrastructure. This “funeral procession” also intends to define the common enemy. Upon arriving at Bercy, a protestor shouted the following through a megaphone: “Minister Le Maire [the French Minister of Finance], … We are here today to lay a public hospital in a state of dire emergency at your feet. Its future is in your hands. It’s up to you to decide whether to resuscitate it or to look on as it runs out of air” (CIH, October 29, 2019). Death is here mobilized to hold political leaders accountable for their inaction and to ask them to reverse course.

The common purpose thus defined, hospital workers then tried to physically rally citizens around this common purpose. For example, they regularly held a minute of silence in public to mourn public hospitals (Figure 2).

Figure 2:

Mourning a Hospital (CIU, October 29, 2019)

Note. Courtesy of CIH.

These events became a ritual in 2022. Held every Friday at 2:00 p.m., they were staged at roughly forty hospitals by hundreds of hospital workers and citizens. Participants knelt and prayed for the dead, sometimes surrounded by flowers. Some signs read “in memory of my beloved hospital.” In many of these minutes of silence, hospital workers also held each other’s or citizens’ hands, laid their head on each other’s or citizens’ shoulders. Death is then used to underscore embodied relationality as a central mechanism of survival when life-sustaining infrastructure is threatened. More generally, these minutes of silence bring hospital workers and citizens together “from across the whole country” in common emotions of suffering and despair towards the loss of the public infrastructure. In turn, eliciting these shared feelings bind the “mourners” together around a common purpose: avoiding this unbearable death.

In addition to the embodied political mobilizations occurring in the streets, numerous pictures, cartoons, and stories are shared on the Facebook pages of the two collectives to depict the public hospital system as dying. The photomontage in Figure 3, a caricature of Théodore Géricault’s iconic painting The Raft of the Medusa, vividly conveys this message.

Figure 3:

The Public Hospital System Sinking (CIH, November 28, 2019)

Note. Photomontage by palliative care team members at Paul Brousse Hospital, Paris.

The caricature was accompanied by the following paragraph, written by Sarah B, a social worker:

This reappropriation of The Raft of the Medusa is interesting, as the original painting offers an ethical and political critique of the French government’s role in this tragic shipwreck.Footnote ¹ In their restaging of this masterpiece, hospital workers portray the public hospital system as sinking due to cost killing, taking its staff down with it. In the accompanying text, the public hospital is personified, and metaphors of storms and shipwrecks are used to dramatically protest the unethical consequences of “rationalized” healthcare on hospital workers and vulnerable patients. This tragic reproduction highlights how the death of public hospitals jeopardizes the lives of all human beings, especially the most vulnerable—the “people who find themselves shipwrecked by life”—and asks, “if I sink … who will take care of you?” At the same time, this caricature underscores that what remains of the system depends on the dedication of the staff, at such great personal cost that many feel forced to leave: “even the biggest-hearted sailors will abandon ship, because they’ll need to, to survive.” Calling attention to these ethical issues more broadly helps hospital workers stress that our connectedness consists not only of the ties between patients and hospital workers, but is also situated in an infrastructure. It also illustrates that hospital workers believe that there is still hope of a final rescue, provided citizens and politicians take heed of these warnings and rally in support of the cause.

The examples in this section show that hospital workers use the finiteness of death to outline our dependence on public hospitals and to publicize their common purpose of immediately saving them. Death is also used to bind hospital workers, politicians and citizens around this common purpose. In the following section, we show how hospital workers make death visible to outline how their working conditions put them at risk.

Making Workers’ Death Visible to Publicize the Precariousness of Public Workers Conditions

The findings in this section show how hospital workers use death as a symbol to highlight the precariousness of their working conditions. In so doing, they intend to trigger compassion both among politicians and the public, in the hope of collectively restoring the right to work in dignified conditions.

To make this demand visible, hospital workers took to the streets to denounce their desperate working conditions. In some of these public assemblies, healthcare workers used the striking image of syringes held to their heads (Figure 4).

Figure 4:

Workers Hold Syringes to Their Heads in a Public Die-In Action (CIU, May 19, 2019)

Note. Courtesy of CIH.

Another concerted action took place all over France on the same day, in which hospital workers performed a public die-in and invited passersby to join them. Each participant held a huge syringe to their head, then fell to the ground in a symbolic death, while shouting, “because understaffing kills, because austerity kills, because cutting government funding for hospital workers and healthcare provision kills, because reducing hospital beds kills” (CIU, May 19, 2019). The syringe—typically an instrument of healing—was transformed into a weapon, underscoring the toll that systemic neglect and chronic underresourcing take on medical staff. By simulating their own demise, the workers delivered a powerful message: without urgent reform, healthcare workers will continue to suffer. But this die-in, along with the accompanying text, also outlined the strong ties that bind all human beings: if hospital workers’ working conditions are rendered difficult, then everyone’s life is threatened. Further, by encouraging citizens to embody hospital workers’ precariousness, this die-in urges the public to stop looking away and to embrace the ethical responsibilities they have towards hospital workers—to care for those who are sacrificing their lives to care for and save ours.

In other actions, the two collectives staged their own asphyxiation as a metaphor for the suffocating nature of their desperate working conditions (Figure 5).

Figure 5:

Workers on Strike Stage Their Asphyxiation (CIU, September 10, 2019)

Note. Courtesy of CIH.

This way, workers outline that they are pushing themselves past their limits to sustain what is left of the public hospital system. The digital spaces help them further argue that “we are working ourselves to death here, and some of us are dying from our work” (CIU, February 20, 2021). On the two Facebook pages, they relay statistics showing that suicides rates for healthcare workers are twice that of the general population (CIH, May 17, 2021). As Ines underscores, “our work can kill us. Most healthcare workers have had suicidal thoughts, and that’s horrible, because some actually go on to do it” (CIU, July 18, 2019). Outlining that their bodies are overly subjected to death allows hospital workers to stress that, far from being immortal heroes whose superpowers can be endlessly exploited—as media, politicians, and citizens often assume—they share the universal embodied vulnerability of being human, especially when they lack essential resources (time, staff, funds).

Other posts contain stirring narratives describing “hospital workers’ deadly working conditions” (CIH, February 12, 2020) as in the following, which was posted on a nurse’s personal Facebook page and reshared by CIU:

In these posts, the descriptions of what they call their “deadly working conditions” help hospital workers highlight the ethical issues ensuing from the neoliberalization of care: hospital workers’ bodies are deprived of certain rights (“we work eight hours a day … we’re only paid for seven and a half hours”); their physiological needs are unmet (“we skip meals and even taking a bathroom break can sometimes be a challenge”); their reality is excluded from governmental and media discourse (“nurses, nursing assistants, and nursery attendants … have no reason to complain or hold demonstrations”). More generally, such moving narratives outline the precariousness of their working conditions and intend to develop compassion for hospital workers among the public.

To deepen public empathy, hospital workers further emphasize that their deteriorating working conditions have serious consequences for patient care: “always having to do more and more with less and less is killing patients!” In an article by two doctors published in Libération on January 26, 2022, shared widely by the CIH, hospital workers more generally state:

The piece helps hospital workers reclaim a public voice after years of silence, letting them loudly declare—in a widely read newspaper with substantial social media reach—what happens inside the walls of public hospitals. While the ethical issues described could be considered uncomfortable truths, breaking the silence emerges as an act of ethical responsibility. More precisely, in this opinion piece, these two hospital workers connect to citizens by detailing how their deadly working conditions force hospital workers to ignore patients’ suffering. The lack of beds, the shortage of staff, and insufficient basic resources expose patients. This underscores the interdependence between citizens and hospital workers, calling forth compassion for those who care. Concomitantly, hospital workers call for an ethics where anyone, including them, is cared for in a relational and embodied way—with “a reassuring hand or a soothing voice”—to ensure that “every life is worth living, whatever the cost” (CIU, March 14, 2021).

These findings show that hospital workers use the symbolism of death to give voice to the deterioration of their working conditions. In doing so, they call for an ethics rooted in care and compassion—one aligned with feminist ethics of care, which emphasizes relational interdependence, attentiveness to vulnerability, and the moral imperative of sustaining one another. In the following section, we show how hospital workers make love for the French public hospital visible, as a call to defend and revive the core values of public service.

Making Love Visible: A Call to Rescue Public Service Values That Make a Life Worth Living

In what follows, we show how hospital workers use political mobilization to invite citizens to reflect on their love for the public hospital system, to resist its perceived demise. By encouraging citizens to publicly express their attachment to the hospital in the face of its decline, caregivers help reaffirm the fundamental values that make a life worth living.

One powerful way hospital workers engage citizens in this process is by publicly demonstrating—in the streets—their own deep commitment to the French public hospital system.

The photograph in Figure 6 captures a public demonstration in which healthcare workers and citizens march together, holding banners and signs that read “I love my hospital.” The scene conveys a collective expression of support for the public hospital system, likely in response to perceived threats such as budget cuts, worsening working conditions, or the erosion of healthcare services. By publicly displaying affection for the hospital, participants transform personal appreciation into a visible and political act—reaffirming that the hospital is not merely a service provider, but a cherished institution rooted in fundamental social values. Through this collective mobilization, emotions such as love, concern, and solidarity are shared and made visible, highlighting that healthcare is not only a technical or economic matter, but a deeply ethical and collective one. Marching side by side, caregivers and citizens forge a sense of unity, reinforcing the idea that the hospital is a shared space of love. This form of protest affirms that healthcare institutions are vital to the fabric of society, and that defending them is both a professional demand and a civic responsibility.

Figure 6:

Public Mobilization “Declare One’s Love for Public Hospitals” (February 14, 2021)

Note. Courtesy of CIH.

Complementing these expressions of love and collective care, other public protests highlight the breakdown of trust between healthcare workers and policymakers.

The image in Figure 7 features heart-shaped balloons alongside signs that read, “Divorce request from your healthcare policy.” The “divorce request” metaphor suggests that the original commitment to a strong public healthcare system has been broken by harmful policies. It frames the crisis as a technical and financial issue as well as a relational one. The romantic symbolism of rupture between healthcare workers and policymakers further turns the expression of love itself into a powerful political statement.

Figure 7:

A Public Mobilization on the Theme of Love (CIU, February 14, 2020)

Note. Courtesy of CIH.

What is particularly striking in this set of actions is how hospital workers also create space for citizens to express themselves—not only outside in the streets, but also within hospital walls and on Facebook. More specifically, they invite people to write messages of love for their dying public hospitals on heart-shaped post-it notes, which are then displayed on the hospital walls (see Figure 8).

Figure 8:

Post-it Notes Left by Citizens on Hospital Walls (CIH Salon de Provence, February 14, 2020)

Note. Courtesy of CIH Salon de Provence.

On top left: “Hospital, I love you because you’re public.”

On top right: “Thank you. We stand with you. What would become of us without public hospitals?”

On bottom left: “I love my public hospital and suffer to see it slowly dying.”

On bottom right: “We mustn’t let our heart stop.”

In these short notes, the threat of death pushes citizens to reflect on what it would mean to live without this infrastructure. Writing about the death throes of public hospitals leads citizens to consider our interconnectedness (“our heart”), the real risk of losing it, and our exposure to others through these attachments (“What would become of us without public hospitals?”). What is notable is not necessarily the novelty of the ideas these actions prompt—indeed, they mirror the arguments advanced by hospital workers—but how hospital workers give voice to the public. They speak with, rather than for patients, pushing them to embody and reflect on their shared embodied vulnerability and interdependencies. Also, the reflexive questions that arise in response to the finitude of death leave a literal mark on the walls. A mark that remains there for everyone to see. A mark that urges everyone to assume responsibility for the death of public hospitals (“we mustn’t let our heart stop”), calling on more and more citizens to adopt this ethical responsibility throughout their lives.

In another action, the CIH asked people to write love letters to their dying public hospitals for Valentine’s Day. They hoped to stimulate reflection on challenging neoliberal values and what makes a life worth living. The letter below is one example:

In these actions, writing to the dying public hospital system prompts the writers to reflect on the role public hospitals play, have played, or will play in their own life, their loved ones’ death, or their own death. More precisely, in the example provided above, the writer—through imagining the death of the infrastructure—engages in a reflexive process about the values that will be lost in this demise: compassionate care, universal care, and decent care. This reflexivity in turn prompts a commitment to fight to preserve lifelong care for “anyone and everyone, regardless of how much they earn,” if we want to experience emotions that lie in every critical and relational event of life—be they happy or unhappy—to the fullest, unaffected by any polluting concerns such as money. The reflexivity triggered by writing about the death throes of the infrastructure also gives rise to gratitude, solidarity, endless support, and love, as the fundamental values that have made the author’s life worth living. In the sharing of these declarations of love for dying public hospitals on hospital walls and the collectives’ Facebook pages, citizens’ reflections and messages are amplified. They become a public expression of how and why public hospitals are essential for everyone and allow hospital workers to promote the ties citizens cherish and are ready to fight for, for a life worth living.

Through these findings, we show that writing about the death throes of public hospitals prompts ordinary citizens to engage in a reflexive process. This reflexive process outlines the neoliberal values that need to be challenged to keep living to the full the relational moments that make a life worth living. It further publicly promotes solidarity, constant support, and love as foundations of a fair society.