Grandstand. Calls for a democratic refoundation are multiplying on the occasion of the coming presidential election. So true is it that the signals of democratic fatigue are patent, question analysts and elected officials, and lead to sometimes explosive anger. Of course, we can count on participatory approaches to be a valuable adjunct to representative democracy. Certainly, but not without conditions.
First, we clearly lack a forum and models for public health debate. A citizen consultation on vaccination against Covid-19 has just taken place. No one talked about it. Poorly posed subject, rhythm incompatible with the health emergency, superimposition of instances on the same subject? Without a doubt.
Still, this first regulation of public debate flopped. To the point of wondering whether, in the field of health, the organization of this public debate should not be entrusted to independent authorities, as shown by the recent approach of the National Advisory Council on Ethics on the occasion of the last revision of the bioethics law. Also to the point of questioning the constitution of specifications specific to the public debate on health.
With each crisis its debate
Because, for forty years, we have not stopped inventing models of debate for each health crisis, while public debate is a tool to help make strategic choices, the rules of which must be set by applicable specifications whatever whatever the subject. Maybe more than one model is needed? It is from these clarifications that the expectation of democratic strengthening in health can take place, as invited by the High Authority for Health in its 2018 prospective analysis report.
Then, at the other end of the democratic chain, we need to build participatory health on a daily basis. With patients and users. Because there is no point in deciding better overall if it is to do badly in practice, as we have just seen with the revelations contained in The Gravediggersby Victor Castanet (Fayard).
From this point of view, the promise of the Kouchner law to 2002 which makes the connection between the quality of the health system and the rights of patients is its title, demands to be relaunched. Without necessarily mobilizing the legislative tool which could run the risk of freezing the evolution of practices rather than allowing them.
If legal efforts should be retained, it is to delegate to health institutions of expertise the definition of good participatory practices in health. There are remarkable initiatives in intervention research or in community health which require to be referenced, and updated regularly, on a solid basis in order to be multiplied wherever possible: in multi-professional health centres, in health centers , in care or social and medico-social support establishments, in the health actions of associations or private operators.
You have 34.65% of this article left to read. The following is for subscribers only.