Quand la morale du soignant devient l’éthique du soin. Conflits éthiques et normes professionnelles en médecines de la reproduction et palliative

Abstract

The article studies what patients say about the rules underlying medical decision-making in their criticisms of care standards’ morality. It assumes that the ethics of medical decision-making and the actual care itself can be explained by the subjective aspect of the relationship between medicine and care. Two studies are used towards this end: one involving the Cochin Hospital Center for Clinical Ethics (Paris) and dealing with the ethical difficulties faced by medically assisted-procreation services; and the other covering end-of-life experiences and daily activities at a palliative care unit. Analysis shows that medical and care relationships are disrupted by ethics disorders that caregivers’ standards amplify more than they regulate. Patients and relatives often criticize and complain about the institutional violence caused by caregivers’ standards, one where patients’ subjectivity is expressed to the point of resistance. Complaints of malpractice are met, on the other hand, by caregivers’ expressions of professional discomfort, which can go as far as to cause a crisis of integrity or burn-out. Hence the current debate about the ethics of caregiving.

Keywords

• medical relationship
• care value
• professional standard
• morality/ethics at clinical ethics
• institutional violence
• public sector