Berthiau Denis
Faculty of Law, University of Paris Descartes, Paris, France.
Med Health Care Philos. 2013 Feb;16(1):105-13. doi: 10.1007/s11019-012-9406-8.
In France, bioethics norms have emerged in close interaction with medical practices. The first bioethics laws were adopted in 1994, with provisions for updates in 2004 and most recently, in 2011. As in other countries, bioethics laws indirectly refer to certain fundamental values. The purpose of this paper is threefold. First, I shall briefly describe the construction of the French bioethics laws and the values they are meant to protect. Secondly, I will show that the practice of clinical ethics, as reported in a few studies on ART, living organ donation and PGD, challenge the role attributed to doctors as "gatekeepers" of those fundamental values. Thirdly, I will suggest that the quality of medical practices would improve if the law focused on strengthening the tacit pact between doctors and patients, rather than putting doctors in charge of enforcing societal values. Doctors, for their part, would limit their role to what they can do best: provide sufficient patient support and safe care. Against those who argue that we should dispense with bioethics laws altogether, I hold that the laws are useful in order to limit the development of abusive practices. However, a new legislative approach should be adopted which would a positive presumption in favor of patients' requests.
在法国，生物伦理规范是在与医疗实践的密切互动中形成的。第一部生物伦理法于1994年通过，2004年以及最近在2011年有相关更新条款。与其他国家一样，生物伦理法间接提及某些基本价值观。本文目的有三个方面。首先，我将简要描述法国生物伦理法的构建及其旨在保护的价值观。其次，我将表明，一些关于辅助生殖技术、活体器官捐赠和植入前基因诊断的研究中所报道的临床伦理实践，对赋予医生作为这些基本价值观“守门人”的角色提出了挑战。第三，我将提出，如果法律侧重于加强医生与患者之间的默契契约，而不是让医生负责执行社会价值观，医疗实践质量将会提高。就医生而言，他们应将自己的角色限制在能做到最好的方面：为患者提供充分支持和安全护理。对于那些主张应完全废除生物伦理法的人，我认为这些法律对于限制滥用行为的发展是有用的。然而，应该采用一种新的立法方法，即对患者的请求给予积极推定。
