Lorsque l'autonomie du médecin est remise en cause par l'autonomie du patient : le champ hospitalier de l'éthique clinique aux États-Unis et en France

Abstract

Résumé Nous avons mené une étude exploratoire par entretiens sur la place et les activités des comités hospitaliers d’éthique clinique aux États-Unis et en France. En France, les comités sont rares et sont essentiellement des lieux de discussion et de débat interne. Aux États-Unis, ils sont très répandus et ont un triple rôle institutionnel : intervenir dans des cas difficiles, participer à l’élaboration de lignes directrices, former les professionnels de santé. Après avoir présenté les principaux résultats, nous interprétons cette situation par une approche comparative de certaines caractéristiques de l’histoire du mouvement bioéthique et des règles juridiques encadrant l’exercice de la médecine et de leurs fondements culturels.

Falling on deaf ears: a qualitative study on clinical ethical committees in France

“…Discussion about the place of the patient in the process of dealing with an ethical problem Among the controversies developed in the focus groups, one was relative to the patient's role in ethical committees. CECs were created in a hospital setting with the goal of protecting patients against medical abuse and recognizing patient's rights in the decision making process (Chevrolet 2002, Mino 2002. In parallel to this evolution, nurses and other paramedical professionals claimed their right to participation in medical decision making along with doctors, given their different but essential interactions with patients.…”

“…Not much is known about clinical ethical committees (CEC) in France. A first study about French CECs was published in 1983 (Isambert), followed by a report (Le Mintier-Feuillet 1998) and by a comparison between CECs in France and in the United States (Mino 2002). Some regional or local experiences have been published, such as a survey of development of ethics in health care institutions that can be downloaded from the Espace Ethique Ile de France (Jolivet 2015), a testimony of the Bioethical Committee of Bordeaux (Daubech 2012) as well as research on the Centre of Medical Ethics of the Catholic University of Lille (Boitte et al 2012).…”

“…In 1988 the Advisory Committee for the Protection of Persons in Biomedical Research (Comité Consultatif de Protection des Personnes dans la Recherche Biomédicale or CCPPRB) was created by law (Law relative to the protection of persons in biomedical research) in order to examine research protocols on human subjects. As before 1988 each French university hospital had its own research committee dedicated to research, the creation of the CCPPRBs, and since 2016 the CPP (Comité de Protection des Personnes), led to a modification in the missions of these committees, orienting them more directly toward clinical ethics instead of examining research protocols on human subjects (Mino 2002).…”

“…In order to summarise the French context, we may use the following distinctions, based on Mino's (2002) and Jolivet (2015) observations and on our inquiry. To begin with, research committees (CCPPRB and CPP) remain separated from clinical ethical committees (CECs).…”

A French Perspective on Hospital Ethics Committees

“…The growth of bioethics and ethics committees in France is very different from that in the United States and elsewhere. 1 In our country, ethics committees emerged in the 1980s as the result of two movements, a political movement with the creation of a permanent Comité Consultatif National d'Ethique (CCNE) (National Ethics Committee) and a professional movement, with the development of local ethics committees. The CCNE, created in 1983 by the French President, was given the mission "to express its opinion on moral issues raised by research in the fields of biology, medicine and health, whether these issues concerned individuals, social groups or society as a whole."…”