[Theoretical risk management and legitimacy of the precautionary principle in medicine. Look back at HIV contamination through blood transfusion in France, twenty years ago].
The precautionary principle first appeared in France during the health crisis following the contamination of patients with HIV via blood transfusion. This study analyses whether the risk associated with blood transfusion was taken into account early enough considering the context of scientific uncertainty between 1982 and 1985. The aim was to evaluate whether a precautionary principle was applied and whether it was relevant. First, we investigated the context of scientific uncertainty and controversies prevailing between 1982 and 1985. Then we analysed the attitude and decisions of the French authorities in this situation to determine whether a principle of precaution was applied. Finally, we explored the reasons at the origin of the delay in controlling the risk. Despite the scientific uncertainties associated with the potential risk of HIV contamination by transfusion in 1983, we found that a list of recommendations aiming to reduce this risk was published in June of that year. In the prevailing climate of uncertainty, these measures could be seen as precautionary. However, the recommended measures were not widely applied. Cultural, structural and economic factors hindered their implementation. Our analysis provides insight into the use of precautionary principle in the domain of blood transfusion and, more generally, medicine. It also sheds light on the expectations that health professionals should have of this principle. The aim of the precautionary principle is to manage rather than to reduce scientific uncertainty. The principle is not a futile search for zero risk. Rather, it is a principle for action allowing precautionary measures to be taken. However, we show that these measures must appear legitimate to be applied. This legitimacy requires an adapted decision-making process, involving all those concerned in the management of collective risks.
Moutel
G
G
Département d'éthique médicale et de médecine légale et institut international de recherche en éthique biomédicale (IIREB), faculté de médecine des Saints-Pères Paris-V, 45, rue des Saints-Pères 75006 Paris, France. moutel@necker.fr
Hergon
E
E
Duchange
N
N
Bellier
L
L
Rouger
P
P
Hervé
C
C
D000163:Acquired Immunodeficiency Syndrome / Q000209:etiology; D001803:Blood Transfusion / Q000592:standards; D003469:Culture; D003657:Decision Making; D005602:France; D019983:Guideline Adherence; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D008954:Models, Biological; D011639:Public Opinion; D012106:Research; D012306:Risk; D012308:Risk Management / Q000639:trends*; D065227:Transfusion Reaction