[Medical ethics, a counter-weight to the logics of the Perruche decree].
FROM A CONTRACTUAL LOGIC TO A PROBABILISTIC APPROACH: Since 1936, reflections on the relationship between the physician and the patient have progressed within the context of a contractual legal concept. Its contents have been based more on jurisprudence than on the physicians' reflections with regard to their practice. Associated with this contractual logic, some confusion exists between a lesion, a medical concept, and a handicap, which is the social consequence of one's status of health. This has been reinforced by the scientific progress made in medicine, which privileges a probabilistic approach based on scientific data, rather than the uncertainty, inscribed in the dialogue and singularity of the encounter. REGARDING THE PERRUCHE DECREE: We analyzed the reports submitted to the court of cessation regarding the Perruche affair, together with the first chapter of the law concerning the rights of the patients and the quality of health system, by studying the extent to which this decision was inscribed or not in the continuity of past legal decisions, and whether the characteristics described above were present. In this decree, the predominating contractual logic is that the notion of handicap is not analyzed, and the scientific and probabilistic conception of medical practice is involved in the debate. THE NECESSITY FOR REFLECTION: Our discussion insists on the necessity of constructing a reflection on the medical presentation; society cannot accept that this be reduced to the strict respect of the elements of the contract, defined by legal decisions. It should be carefully thought out by health professionals, and in collaboration with human science.
François
Irène
I
Laboratoire d'éthique médicale et de droit à la santé, Faculté de médecine Necker-Enfantsmalades, 156, rue de Vaugirard, 75730 Paris. ijl.francois@wanadoo.fr
Moutel
Grégoire
G
Bertrandon
Richard
R
Herve
Christian
C
D006233:Persons with Disabilities / Q000331:legislation & jurisprudence; D004992:Ethics, Medical; D019317:Evidence-Based Medicine / Q000331:legislation & jurisprudence; D005602:France; D006801:Humans; D008128:Logic; D008318:Malpractice / Q000331:legislation & jurisprudence*; D028701:Patient Rights / Q000331:legislation & jurisprudence*; D010817:Physician-Patient Relations; D011787:Quality of Health Care / Q000331:legislation & jurisprudence