In health economics, value has usually been understood within the framework of the production and consumption of healthcare. Two tools of measurement, efficiency and equity, have been used to make decisions on healthcare resources. However, the healthcare system is also not a market like others, and applying the criteria of efficiency and equity to the field of health calls for significant adaptation. In addition, even when epistemologically informed and technically equipped, care is also attention and an engagement toward the person for whom the care is directed. Current models fail to take into consideration the individual, qualitative nature of individual patient experience, but also the wider environment affecting the patient’s health outcomes. Therefore tensions continue to exist between value as understood in a health economics perspective and the relational values promoted in proposals of person-centered care. Healthcare values are plural and explain what one commits to in terms of actions and relationships with others. Taking into account this plurality reminds us both of the ethical dimension of care but also how it is made possible through financing. Person-centered care therefore calls for new models of evaluation, ones which will understand the values of care for the person in their personal and professional contexts.
Propos : Dans le cadre du traitement du cancer, la médecine conventionnelle est confrontée à un débat d'école pour définir ce qui fait la vérité de la maladie. Elle est prise entre la maladie objectivée par la technologie médicale, la souffrance du patient et les représentations culturelles de la maladie représentée comme une figure du mal.Points forts : Soucieuse d'efficacité thérapeutique, la médecine privilégie une modélisation biochimique du cancer. En évacuant sa dimension culturelle, elle se prive de ce qui peut aider à assumer le versant thérapique (thérapeu-tique ?) de celui-ci. Il y a une efficacité de l'imaginaire de la maladie. Il permet au sujet malade de passer de la sujétion à la subjectivation de cet événement qui configure douloureusement son existence. Plus largement, le traitement du cancer fait émerger une nouvelle symbolique du mal dans une société sécularisée.Conclusion : Il y a une dimension active d'un imaginaire de la maladie et d'une symbolique du mal. Au-delà des fantasmes, cela doit permettre de développer une interprétation élargie, enrichie et intégrée du soi malade. La symbolique du mal n'est pas un parasite contre lequel la médecine doit lutter. Elle révèle la dimension existentielle de l'imaginaire du mal au coeur de l'explication médicale.Abstract: Objectives: In cancer treatment, conventional medicine faces an ideological debate about what constitutes the true nature of the disease. Should it focus on the objective view offered by medical technology, the suffering of the patient or the cultural dimensions of a disease shaped by its representations as an evil entity?Main points: With therapeutic effectiveness as a goal, medicine favours a biochemical perspective, dispensing with the cultural dimensions that can nonetheless play a role in treatment acceptance. We would like to demonstrate that the imagery of this disease created by the individual and society allows cancer patients to advance from dependence to subjectivation of the disease that is so profoundly transforming their lives. More broadly, cancer treatment is fostering the development of a new symbolism of evil in a secularised society.Future prospects: We brought to light the active role played by the imagery of cancer and the symbolism of evil. Although we must view the effects of phantasms with care, they can clearly lead to the development of a wider, richer and assimilated interpretation of the suffering self. The symbolism of evil is not a parasite against which medicine must struggle, but rather a revealer of the heuristics of the imagery of evil at the core of medical explication.
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