It is a charming room nestled under the attic of the Cochin hospital in Paris. To reach it, you have to go through the admissions hall, walk along a corridor, open a door, go up to the first floor, go through another door and climb to the third floor. Here, every Thursday evening, from 6 p.m. to 8 p.m., around thirty people meet as a team. The reason ? Analyze and discuss a concrete medical case raising an ethical question. Welcome to the Clinical Ethics Center (CEC) of the AP-HP (Assistance publique-Hôpitaux de Paris). Exceptionally, the team agreed to open its doors to us.
Created as an extension of the law of March 4, 2002 relating to patients’ rights (known as the “Kouchner law”) by Véronique Fournier, public health doctor and cardiologist, this structure, which she directed until 2020, has the mission to support ethically difficult medical decisions. How to resolve a situation during a conflict? What do you say to a patient who does not want to have surgery or to parents who refuse to have their child transfused? To a healthcare team willing to stop treatments when the family objects – or the opposite? To a disabled person who wants to die? In other words, how can we respond to the demand of some when others contest it?
The concept of clinical ethics was born in the 1970s in the United States. An American doctor, Mark Ziegler, is one of its designers. According to him, “knowing how to debate a question of clinical ethics is as much a part of the rules of good medicine as knowing how to prescribe the right medication”. Requested by caregivers, the family, or even the patient himself, the Center only issues advisory opinions. There is no question of replacing the healthcare team. Its role is to help stakeholders unlock blocking points and broaden thinking in order to identify the best for the patient.
“Primum non nocere”
To do this, the team relies on the four founding principles of biomedical ethics described by philosophers James Childress and Tom Beauchamp in their book The Principles of Medical Ethics (Les Belles Lettres, 2008; published in its original version in 1979), major work of contemporary medical ethics: beneficence (improving the patient’s health), non-maleficence (at a minimum, do no harm – “primum non marriage”said Hippocrates), justice and finally respect for the autonomy of the patient.
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