“Soothing, bringing closer, reconciling” : the three words sum up, for the National Consultative Ethics Committee (CCNE), the path to take to rebuild a relationship of trust between patients and gynecologists-obstetricians. In any case, this is the message that the CCNE intends to convey by making public, on Wednesday March 29, its opinion 142 on the concept of consent during gynecological examinations, a sensitive subject on which the Prime Minister seized it, in July 2022. , Elisabeth Borne. At the time, complaints for rape – and no longer only for sexual violence – against renowned practitioners had shifted the debate from the societal level to the legal level.
At the risk of causing some disappointment, the CCNE has focused on the analysis of the ethical issues relating to the practice of gynecological and/or medical examinations affecting de facto privacy, without taking a position on the legal debate, open to question of a new incrimination in the penal code for medical acts of vaginal or rectal penetration without consent. “We asked ourselves the question of the law, we interviewed lawyers, but this answer is not within our competence.justifies the jurist Karine Lefeuvre, co-rapporteur, with the philosopher Fabrice Gzil, of this opinion. Our domain is and must remain that of ethics. »
The work presented on Wednesday traces a “ridge line”according to Jean-François Delfraissy, President of CCNE, who “Won’t please everyone”, he anticipates. The challenge is plural; it is a question both of recognizing the reality of the violence denounced by patients, and sometimes also by patients, but also of proposing ways to “to avoid that the community of gynecological caregivers is constantly singled out”. A controversy launched in 2014 with the hashtag #payetonuterus on social networks, and which resonates since.
Rolling back “paternalistic” postures
The clearest track – the one at the heart of the referral from the head of government – is based on consent “revisited”. A ” process ” which must be played out in several stages during the consultation and which must be renewed. Not in writing – as can be done in Anglo-Saxon countries – an option ruled out, explains Mme Lefeuvre, in order not to reinforce the“procedural aspect”. “But the idea of tacit consent is undermined, to favor expressly collected consent, as well as the only binary yes/no consent in favor of assent in several stages and in different forms”, adds the co-rapporteur. The opinion indicates that this collection must be preceded by a “accurate, fair and appropriate information”many criticisms finding their origin, according to the doctors, in a “bad initial information” not allowing patients to understand the examination undergone.
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