From U Paris Descartes: "clinical ethics...challenge the role attributed to doctors as "gatekeepers" of those fundamental values"

http://www.ncbi.nlm.nih.gov/pubmed/22484728

Med Health Care Philos. 2012 Apr 7. [Epub ahead of print]

Law, bioethics and practice in France: forging a new legislative pact.

Berthiau D.

Source

Faculty of Law, University of Paris Descartes, Paris, France, denis.berthiau@sfr.fr.

Abstract

In France, bioethics norms have emerged in close interaction with medical practices. The first bioethics laws were adopted in 1994, with provisions for updates in 2004 and most recently, in 2011. As in other countries, bioethics laws indirectly refer to certain fundamental values. The purpose of this paper is threefold. First, I shall briefly describe the construction of the French bioethics laws and the values they are meant to protect. Secondly, I will show that the practice of clinical ethics, as reported in a few studies on ART, living organ donation and PGD, challenge the role attributed to doctors as "gatekeepers" of those fundamental values. Thirdly, I will suggest that the quality of medical practices would improve if the law focused on strengthening the tacit pact between doctors and patients, rather than putting doctors in charge of enforcing societal values. Doctors, for their part, would limit their role to what they can do best: provide sufficient patient support and safe care. Against those who argue that we should dispense with bioethics laws altogether, I hold that the laws are useful in order to limit the development of abusive practices. However, a new legislative approach should be adopted which would a positive presumption in favor of patients' requests.