The ethical aim in health care. Teaching ethico-practical conflicts.
La visée éthique en santé : l’enseignement des conflits éthico-pratiques.
Résumé
Most ethical think tanks will at some point face ethico-practical conflicts that will make them feel that they go around in circles, making them hesitate and preventing them from moving forward. This is notably the case when judicial and organizational notions and the respect of good practice no longer suffice. The experience of the Group of Ethical Reflection in Voironnais, described in this article, lead the members of the group to question the meaning of these conflicts. Such clinical situations for which no practical reply or concrete solution can be given have been considered a medical scandal. There is however one issue that has been completely omitted from the discussion of these clinical situations, namely the figure of evil—evil that must be eradicated but that has instead been transformed into a functional defect to be remedied simply by means of improving management.
However an ethical question only arises because evil exists. And it is this evil that must be questioned, the human enigma by which there are only two bad solutions to a problem, two solutions that neutralize each other, forcing us to make difficult choices between bad and worse, between grey and grey. From this insight arose the two principal aims of the ethical think tank: (i) Putting into words the actual experience of professional health care workers, allowing to take distance and displace the center of gravity. (ii) Preventing evil, fighting evil but without completely eradicating it from the institution. For evil is the price to pay for human liberty.
This ethical think tank gave rise to a kind of communal phronesis—a collective form of prudence which becomes a factor in a triangulation that allows appealing to law, to moral norms when necessary, but also to the non-sense of life.