Accepted Paper:

How to implement a 'moral biopolitics': a French experience of clinical ethics practice ?  

Author:

Marie Gaille-Nikodimov (CNRS)

Paper short abstract:

For four years, an experimental structure has been developing into a clinical ethics activity within one of Paris's public hospitals, the Cochin. This structure, the Centre for Clinical Ethics, has been set up in order to answer requests for ethical advice, whether coming from medical teams, patients or their proxies.

Paper long abstract:

For four years, an experimental structure has been developing an activity of « clinical ethics » within one of the public hospitals of Paris, the hospital Cochin. This structure, the Center for clinical ethics, is implemented in order to answer queries for an ethical advice, whether coming from medical teams, patients or their proxies. These queries arise when a medical decision must be taken while raising a particular ethical problem that cannot be solved through a refinement of the medical analysis. The Center for clinical ethics only deals with the queries when each participant to the decision (physicians, patients, proxies) agree with the principles of explaining their moral point of view and hearing the various moral options at stake within the decision.

Created in the wake of the law on patients' rights (2002), the Center for clinical ethics is conceived as a way to contribute to the implementation of this law and more generally speaking to the development of the "démocratie sanitaire". The "démocratie sanitaire", though promoted first by leftwing political parties, has become today a consensual way to conceive the French health public policy and is very much supported by citizens themselves, whether individually or through various associations.

We are interested in the way the Center for clinical ethics has been conceived by its creator and present director as a tool of this French biopolitics. Two elements are decisive in this perspective. On the one hand, the "staffs" during which the queries are discussed, taking place every two weeks, are an essential place to observe how the Center for clinical ethics intend to achieve these goals. On the other hand, one is not to neglect the educational program created by the Center to give the adequate competences to the people participating in these "staffs" and develop a team spirit. One thing that is particularly interesting for our study is how these members have assimilated and accepted a methodology to deal with ethical problems first elaborated abroad, in the United States, and how this methodology has been converted to implement a biopolitics within the French health system and its social and cultural context.

In this paper, we intend to develop an ethnographic approach and we'll comment the specific position occupied for two hears and a half in order to get the necessary material to the description and analysis of this "moral biopolitics" (an "insider" position).

Panel W082
Anthropology of biopolitics and moral choices